The ASC industry is at a watershed moment as hospitals and health systems mature their ASC operations, and private equity groups increasingly eye ASC acquisitions for their low-cost, high profit potential.
Twenty-five ASC leaders and physicians joined Becker’s to discuss their thoughts on mergers and acquisitions in the ASC space over the next five years.
The leaders featured below are speaking at Becker’s 31st Annual: The Business and Operations of ASCs, Oct. 16-18, 2025, at the Swissotel in Chicago.
If you would like to join the event as a speaker, please contact Francesca Mathewes at fmathewes@beckershealthcare.com
As part of an ongoing series, Becker’s is connecting with healthcare leaders who will speak at the event to get their insight on thought-provoking questions within the industry.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How do you think mergers and acquisitions will shape the ASC space over the next five years?
Nicholas Aubin. Co-founder and CEO of Commons Clinic (Los Angeles): Over the next five years, I think there are going to be two prevailing M&A strategies in the ASC space: The consolidators like SCA, USPI and multi-market hospital systems are going to continue to pursue large-scale strategic acquisitions to further expand their footprint. Part-and-parcel to this strategy will be the current wave of venture and private equity-backed ASC platforms that are going to be looking for a home and liquidity. This is really the big get — bigger strategy.
The other side of this coin will be recapitalizations and turnarounds. Despite the rapid growth of facilities, there remains a long tail of broken physician syndicates and underperforming surgery centers that will be attractive to physician groups, physician practice management roll-up strategies, and others that bring strong physician alignment and new capabilities (i.e., service lines) to bear.
Across both strategies, I believe everyone will be looking to level up the stickiness/performance of their physician partners, as well as the complexity of care delivered in those sites to drive value for health plans and earnings for partners.
Alejandro Badia, MD. Hand Surgeon at Badia Hand to Shoulder Center (Miami): I believe the pendulum is beginning to swing back for clinician-owned ASCs. We have seen large, national surgery center companies accumulate centers like we are heads of cattle. Many are starting to sell off some of those centers. Yes, there are some centralized processes that can be managed more cost-effectively but at what price? We cannot negate that healthcare is also a business, but a very different type. Ultimately it is surgeons, anesthesiologists, nurses and technicians that care for the patients in often their most vulnerable moments, and herein lies the key to success. Caring and direct engagement which cannot be done from a boardroom, no matter how pure the intentions are. The unpredictable variable lies within the insurance companies who fund most of that care and it is my belief — perhaps naïve — that they will realize that much of surgery can be done in a specialized, cost effective but independent environment.
Adam Bruggeman, MD. Spine Surgeon at Texas Spine Care (San Antonio): Independent ASCs face the same financial reality that physicians face: an increasingly consolidated payer market is forcing independent facilities to consolidate themselves in order to keep up. Until insurance companies create financial stability through fair and sustainable payments to independent physicians and independent facilities, I anticipate consolidation will continue. Given that site neutrality is also unlikely to raise payment to ASCs (and instead only bring down HOPD rates), government actions will further the race to consolidation.
Janet Carlson. Vice President of ASCs at Commonwealth Pain and Spine (Louisville, Ky.): A major shift is occurring in how surgeons (the producers) are viewed in M&A deals. Rather than being viewed as passive participants, physicians are now seen as essential stakeholders. Successful partnerships increasingly depend on:
Physician buy-in: This is essential for alignment of surgeon investment along with guaranteed optimized ASC block times.
Leadership roles for clinicians: This is an opportunity for the ASC industry to recognize the need for surgeon leadership to drive excellent outpatient surgical outcomes.
Equity-sharing models: That align incentives for the desire to capture more of the outpatient market and perform surgeries and procedures in the correct site of service.
It does seem like these deals have slowed from the pace prior to [COVID-19], I believe there is much more rigor to the diligence process for M&A specific to the ASC space. There is still steady consolidation occurring in the ambulatory space and an increased shift toward value-based care and cost-efficiency. The continual migration of higher acuity cases to the ambulatory setting will make ASCs a premium target for M&A transactions in the next five years.
Edward Dixon. Sterile Processing Manager of Surgery Center Mountain View (Calif.): Over the next five years, mergers and acquisitions are poised to significantly reshape the ASC space — marking a clear shift from fragmented, independent operations toward large-scale, integrated systems.
The days of small, standalone ASCs springing up on every corner are dwindling. Instead, we’re witnessing a powerful trend: hospitals and health systems are increasingly forming partnerships with — or outright acquiring — ASCs to expand their outpatient footprint. This move isn’t just strategic; it’s essential in an environment where rising operational costs, complex reimbursement structures, and growing technological demands are squeezing smaller players out of the market.
Large systems benefit from economies of scale, particularly when it comes to supply chain leverage. A health system that manages dozens of ASCs can negotiate more favorable contracts with suppliers, optimize staffing models, and implement system-wide best practices — advantages a single-site or entity ASC simply can’t match. As a result, being part of a larger organization is no longer just an option; it’s becoming a necessity for long-term viability.
Azizza Dorsey. COO of Advanced Pain Medical Group (West Hills, Calif.): On the physician-owned side, the competition with nearby health networks is huge in [Southern California]. There is no way to compete with them because their reimbursement is so high, volume of supply usage is high, so they actually pay less per item, and their volume of patients is high as they are connected to a funnel for patients to just show up without any true effort or marketing.
Physicians who have been in private practice their entire career have to decide to retire early or for the first time ever be an employee to a system and follow their rules. Mergers are their saving grace, give up 51% ownership and still maintain a level of autonomy without so much of the financial burden sitting on you. The question is who they merge with. Looking for an insurance reimbursement set at 4x’s Medicare with Medicare volume? That would be a health system or large hospital network. But, the bigger up-and-coming player is private equity. These large financial savings teams are prepared to buy out 51% with straight cash! Very enticing. But what do they bring to the table? They cannot affect change in your rates. They do not understand your world. They will only care about the bottom line and will push anyone to the side who is not helping them achieve that.
As far as acquisitions, let the numbers speak, facts not feelings. Owning more isn’t always better and expanding too quickly without a true infrastructure is risky. A common thing I see in physician practices is a lack of a written strategic plan and formalized budgeting process. Start there, then think about acquiring things. For physician practices that are looking to be acquired, I rarely see this go the way they want. Their entire staff is transitioned over a period, they have no control over who works there, and they come to “work” and then leave. Physicians closer to retirement, this may work and sound like a better option.
Corporation-owned companies have a bit of a different take. While physician-owned practices have a very personal and sentimental value that must be cautiously addressed, corporations have a much easier time deciding how this will or will not work for them solely based on the numbers. These are more likely to pique the interest of private equity teams and are more expensive to buy than a physician-owned practice or surgery center. They tend to be better monitored with budgets and plans, usually have a leadership team with certain and explicit skillsets.
These corporations have a better chance of being bought by a large player like Optum, Kaiser, Tenet, etc., but they will lose their company identity. There is only a buyout world for them with a complete restructure and design. Acquisition and a takeover! In five years, the ones that are highly successful will try to compete with the big healthcare players and the ones that are lower than 25% profit margin with $20 million or less in revenue will highly consider an offer as the market is becoming harder, not easier.
The minimum wage is increasing to $25 per hour which means everyone wants a raise. [Radiology] techs cost $60 to $70 per hour and scrub techs with skills the same. Add in an operating room circulating nurse and a [pre-operative, past-anesthesia care unit] team, to run the surgery center one day is costing thousands! [Two thousand dollars] for anesthesia for eight hours and you are doing pain procedures on 35 patients with insurance to try to salvage the day. At a few hundred dollars per injection, the corporation needs the doctor to see more patients.
But the doctor has no sentiment like the private practice. So then you pay them a lot more or entice them with a bonus structure, all reducing your profit. So what do you do? Start talking about a major acquisition. Take that money and maybe the corporation starts a PE fund of their own and buys something else. You never know!
Bruce Feldman. Administrator of Bronx Ambulatory Surgery Center (New York City): There is no doubt that we will see continuing consolidation in the ASC industry. As we continue to see a shift in surgical volume from the hospital setting to the ASC setting in conjunction with higher acuity level cases, large healthcare systems are either acquiring existing ASCs or developing ones of their own. There has also been a lot of acquisition of ASCs by venture capital firms as well as by companies such as USPI, SCA, Compass Surgical Partners, AmSurg, amongst others. Many independent de novo ASCs owned exclusively by physicians are strategically partnering themselves with hospitals in order to obtain better reimbursement rates from third party payors and gain access to their group purchasing organizations for better pricing on supplies and equipment.
Megan Friedman, DO. Anesthesiologist and Director of Pacific Coast Anesthesia Consultants (Los Angeles): Consolidation is the dominant trend in the ASC space today, largely driven by rising labor costs, supply chain disruptions and mounting pressure on reimbursement. For many centers, partnering with health systems or national platforms appears to be a practical response to financial and operational complexity.
But over time, the limitations of many large-scale models have become increasingly clear. Cost savings are typically achieved through staffing cuts, rigid protocols, and centralized control — often at the expense of quality and operational flexibility. In anesthesiology specifically, we have seen national groups take over contracts, reduce coverage to bare minimums, and struggle to recruit or retain experienced clinicians. When that model inevitably breaks down, facilities are forced to pay inflated rates or bring in emergency coverage just to keep rooms open — wiping out any supposed savings and destabilizing care.
Independent, physician-led anesthesia groups offer a different path. They are not driven by investor returns or corporate mandates. We are focused on reliability, adaptability and aligning with the long-term goals of each ASC and hospital partner. That flexibility and accountability becomes especially important when surgical schedules are full and every room matters.
Anesthesia departments also bring a unique operational perspective that has been underutilized until recently. While surgeons typically focus on their own service lines, anesthesiologists work across all specialties and are embedded in day-to-day operations. Involving anesthesia leadership in planning — whether for case flow, staffing models or efficiency strategies — often reveals systemwide improvements that might otherwise be missed. This collaboration is no longer optional in today’s climate.
Consolidation is not going away — but as the ASC space matures, there will be a growing distinction between thoughtful integration and margin-driven rollups. The most successful models will be those that invest in clinical infrastructure, maintain local agility and value true partnership — especially with anesthesia departments.
Over the next five years, we will likely continue to see consolidation — but with a more strategic focus. Transactions will become increasingly selective, aimed at creating synergy, expanding service lines, and integrating care across the continuum. ASCs that demonstrate strong clinical outcomes, operational efficiency and physician alignment will be best positioned — whether they choose to remain independent or enter into a partnership.
Andrey Ibragimo, MSN, RN. Director of Ingalls Ambulatory Surgery Center at UChicago Medicine: We’re going to see a sharp increase in ASC mergers and acquisitions over the next five years. Health systems and academic medical centers have fully awakened to the value ASCs bring — lower cost, better access, and aligned incentives with payers. That realization is translating into aggressive growth strategies: acquiring independent centers, building de novo sites, and forming joint ventures with physicians.
Payers are shifting more procedures outpatient. CMS continues to greenlight higher-acuity cases in ASCs. And state regulations are loosening, making expansion easier. All of this creates pressure on independent ASCs to either scale, partner or sell.
The most successful systems will be the ones that combine M&A activity with a clear strategy: strong data infrastructure, aligned payer contracts, and a focus on growing service lines like ortho, spine, and cardiac.
M&A won’t just change ownership — it will reshape how outpatient care is delivered. The organizations that think long-term, value physician leadership, and move with purpose will set the pace for the future of surgical care.
Narasimhan “Sim” Jagannathan, MD. Professor at the University of Arizona College of Medicine in Phoenix, Division Chief of Anesthesiology at Phoenix Children’s Hospital: Over the next five years, mergers and acquisitions will continue to reshape the ASC landscape, with anesthesia groups under growing pressure to scale or affiliate. As health systems and private equity firms acquire ASCs, they will favor anesthesia partners who can demonstrate consistency, efficiency, and alignment with broader operational goals. This may lead to fewer but larger anesthesia groups, with centralized management and standardized protocols. While this can drive efficiency, it risks diminishing provider flexibility and engagement. Groups that can offer tailored, high-quality care while navigating this consolidation trend will be best positioned to thrive.
Leslie Jebson. Administrator of the Orthopedics and Sports Medicine Network at Prisma Health (Greenville, S.C.): Nonprofit Catholic-giant Ascension Health’s pending acquisition of ambulatory surgery management services company AmSurg for about $3.9 billion has national implications.
Aside from this, I anticipate more regional integration – hospital systems acquiring or partnering in new regional ventures. One cannot rule out another potential national deal as well.
Andrew Lovewell. CEO of Columbia (Mo.) Orthopaedic Group: The next five years we will continue to see a lot of activity in the ASC space. Tech-centric or tech-forward ASCs will have an upper hand on those that do not embrace technology, as the data will be essential for payer strategy. Many ASCs will also explore consolidation and strategic partnerships. Private physician groups must evaluate their ASC strategy, and I see many of them turning to [joint venture] relationships with private equity and health systems/hospital partners. The appropriate deal structure will be essential as physicians want to have control and clinical autonomy while getting appropriate payer contracts. I also think that we will see more employers push for ASC utilization through various programs. With the cost of care on the rise, many self-funded health plans are exploring ambulatory strategies.
Justin Marburger. Director of Surgical Services of Plastic and Cosmetic Surgery Center of South Texas (San Antonio): The balance between efficiency and quality care is delicate. While the benefits of merging business together are surely there when it comes to financial outcomes, I am more than likely one of few who believe it outweighs itself in the long run. Having started from the bottom up, I still have the little-guy mentality that can see the threads begin to frey in the seams. When larger companies take over smaller centers, it is almost always with a financial eye. While that in itself is the “bigger picture” so to say, it often leads to a detriment in patient care and the overall emotional well being of the employee. When healthcare becomes increasingly consolidated under large conglomerates, several challenges can arise:
- Reduced competition: With fewer independent providers, prices can rise, and innovation may slow down.
- Limited patient choice: Patients may have fewer options for care providers, leading to potential mismatches in specialized treatment needs.
- Profit over patient care: Large corporations may prioritize cost-cutting and efficiency over personalized, high-quality care.
- Potential for monopolies: A few big players controlling vast portions of healthcare can dictate pricing and policies, making access less equitable. (Particularly what we are now seeing with anesthesia)
- Impact on healthcare workers: Independent practices often allow for autonomy and flexibility, while conglomerates might enforce rigid protocols, leading to burnout and dissatisfaction among doctors and nurses.
Brett Maxfield, CRNA. Director of Anesthesia and Surgical Services at Teton Valley Health Care (Driggs, Idaho): Acquisitions and mergers will definitely change the landscape of the ASC world going forward. Based on several encounters I have personally had, I think many hospitals and hospital systems are realizing that they may have made an error during the pandemic era decision-making, and are now realizing that letting some of the lower performing specialties leave the hospital didn’t hurt their bottom line from a revenue generation standpoint, but it did hurt their bottom line in terms of loss of staff and especially loss of anesthesia providers. I think you’ll see several hospital systems actively pursuing opportunities within the ASC market to try to bring some of that revenue and cost savings back in house over the next few years.
Neil Mangus. Senior Director of Business at Orlando (Fla.) Health: Over the next five years, I anticipate mergers and acquisitions will shape the ASC landscape more than de novo development, particularly in saturated markets like Central Florida. For Orlando Health, M&A presents a strategic opportunity to expand ASC capacity, enhance service offerings, and deepen community impact without the time and capital intensity of ground-up builds.
To succeed, healthcare systems must look beyond financials and assess cultural fit, physician alignment, and integration potential. As payers continue to shift procedures to lower-cost outpatient settings, strategic ASC partnerships — particularly with independent surgeons — will be essential to maintaining referral pipelines and optimizing case mix. In this evolving environment, M&A is not just a growth lever, but a mission-aligned strategy to reclaim and elevate the role of ASCs in delivering high-value, community-based surgical care.
Stan Plavin, MD. President and Owner of Ambulatory Anesthesia Partners (Atlanta): I do see that there will likely be some accelerated consolidation but the ASC market is still highly fragmented, with many still independently owned and operated. There continues to be interest by private equity firms, healthy systems and large ASC operators to pursue acquisitions to expand reach and their footprint.
Another key to transformation will be the expansion of specialization and high-acuity procedures. … This is relevant on a number of levels due to the reimbursement metrics and also access to these types of settings. There is large growth in the Vascular and Cardiology ASC space.
The regulatory climate may facilitate expansion which can help shape mergers and acquisitions. Several states are looking to relax their [certificate-of-need] laws which have traditionally restricted the development of new medical facilities. Private equity investment surge has also found its way to drive further M&A business in the ASC space. There is a continued focus of operational efficiencies and value based care which provides an attractive opportunity for those ASCs that have their ducks in a row. Value based care can take on many shapes and forms and thus will be a driver in the M&A space. Technology and integration will also provide more data-driven decision making and with the enhancements of EHR, AI and predictive analytics now taking shape — providers will be more in tune and focused on where to enhance their deliverables. I also feel that the thresholds and barriers to providing safe and appropriate care are being stripped away daily by providers and technologies allowing this to occur and improving the overall patient care outcomes and experiences.
Johnny Russell, MD. Director of Area Operations at Sutter Health (Sacramento, Calif.): Mergers and acquisitions will strengthen ambulatory surgery centers over the next five years as they strive to achieve distinction in specific service lines. For instance, an established orthopedic center with proven best practices can partner with newly onboarded centers within an existing organization. This collaboration will accelerate the integration of orthopedic specialization into the new center or support its development of a high-performing service line, ultimately positioning it as a center of excellence.
By doing this, patients who research care and where to receive it will see this as an opportunity to get their care at the best facility. This will drive more patients to a center and bring in increased revenue.
Tammy Smittle, RN. Group CEO of Stonegate Surgery Center and Northwest Hills Surgical Hospital (Austin, Texas): Mergers and acquisitions are poised to shape the ASC space significantly over the next few years. Large healthcare systems, private equity firms, and payer-provided organizations are aggressively acquiring ASCs. This trend is likely to accelerate due to economies of scale for supply chain and payer reimbursements; staffing efficiencies by sharing teammates with sister facilities in a city, like we do in Austin, Texas; and technology adoption for EHRs and patient engagement platforms.
This does threaten independent facilities by creating increased pressure for these ASCs to either align with larger entities or risk falling behind on payer contracts and compliance issues.
Patty Shoults, BSN, RN. Corporate Director of Ambulatory Surgery at AdventHealth (Altamonte Springs, Fla.): As hospital systems mature in their ASC strategy, we can expect acquisitions and mergers to continue at a steady pace. The introduction of new AI platforms will likely disrupt the market by offering services that were once exclusive to larger management companies. This evolution will empower independent ASCs and small to medium-sized management companies to become more organized and leverage these innovative AI services.
I believe the key to long-term success will be balancing scale and efficiency with quality care and personalized service.
However, one question that remains unanswered is how ASCs will afford to implement EMRs and more complex electronic platforms. The government does not appear to be offering financial assistance for EMRs in the ASC space anytime soon. This technology is indeed expensive and may be out of reach for smaller centers.
Other factors impacting the market include aging physicians, a shortage of anesthesia providers, and increased reporting requirements. Despite these challenges, the future looks bright for ASCs.
Vijay Sudheendra, MD. President of Narrangansett Bay Anesthesia (Providence, R.I.):
Large ASC leaders will either acquire or merge to become industry leaders, broadening their specialty offerings (cardiovascular, orthopedic, bariatric, vascular, etc.). CMS’ expansion of ASC procedures further augments this.
- Technology: Large ASCs offer Robotics and advanced AI imaging, which will further advance specialty offerings (CV, spine, etc.).
- Partnerships with hospitals: Hospitals that partner with large ASCs might benefit from efficiency, cost savings, volume and quality.
- Payers and hospitals will continue to drive ASC M&A over the next few years. Strategic acquisitions of high-performing ASCs in a select geographical area might solidify their position in the industry and transform how outpatient care is delivered.
Maria Todd, PdD. Director of Business Development at Red Rocks Surgery Center (Golden, Colo.): We’re entering a cycle where scale will be rewarded—but only when it’s paired with operational excellence and strategic contracting. While private equity continues to show interest in ASC rollups, many of these deals are no longer about explosive growth. Instead, they’re pivoting toward infrastructure optimization, market access and payer leverage. The goal is no longer just aggregation. Instead, it’s integration. The days of indiscriminate rollups are waning. Sophisticated acquirers are targeting high-performing ASCs with favorable payer mixes, robotic capabilities, and direct employer contracting potential. Those without clear differentiation may be overlooked or undervalued. M&A will increasingly be used as a tactic to gain contracting clout with commercial payers. But it’s getting harder to sign national contracts. Most want a presence in at least 20 states. It will be tempting to integrate into health system or MSO portfolios, but where reimbursement rates are often averaged down or discounted via silent PPO clauses that were underestimated or overlooked on analysis.
With ongoing CMS and employer pressure to shift volume out of hospitals, ASCs are poised to benefit, but only if they maintain cost transparency, bundle pricing options, and data to prove value. Acquirers view these elements as non-negotiable in their due diligence criteria.
The most attractive acquisition targets will be those with smart infrastructure, including but not limited to: digital intake, automated billing, accurate case costing (price integrity) and real-time OR efficiency tracking and block time optimization. Post-acquisition success will hinge on how quickly the ASC can integrate and optimize across the new parent’s platform.
M&A activity will drive the formation of regional ASC supergroups and specialty hubs. These networks may appeal to self-funded employers and direct contracting partners looking for redirection and savings from ASO agreements.
M&A will not simply grow the ASC footprint. Instead, it will determine who thrives and who gets absorbed. For physician owners and ASC administrators, do the entrepreneurial and innovative things the big brands cannot or will not execute. Get your house in order: clean your data, price with logic, integrity and transparency, contract language analysis that checks for supply chain surprises and tariff risks, margin control, and payer mix. Analyze your business and build persona types that will resonate with what makes your ASC different from others. Discipline will increase your value, whether your future includes a sale or not.
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