St. Louis-based Ascension is reportedly positioning itself for a major expansion into the ASC space, taking cues from Dallas-based Tenet Healthcare’s aggressive outpatient growth model.
Ascension is in advanced talks to acquire Nashville-based ASC chain AmSurg in a deal valued at approximately $3.9 billion. AmSurg, which became an independent entity after separating from Envision Healthcare during its 2023 bankruptcy, operates more than 250 ASCs across 34 states and partners with over 2,000 physicians.
The potential acquisition marks a pivotal moment in Ascension’s shift toward a more intentional ambulatory care strategy. With an increasing volume of procedures — from orthopedics to cardiology — transitioning to outpatient settings, health systems are investing in ASC networks to capture demand, reduce costs and expand access.
Hospital and health system ownership of ASCs has nearly doubled over the past five years, according to Avanza’s Intelligence Hospital Leadership ASC Survey. Today, 90% of hospitals and health systems plan to continue investing in or affiliating with ASCs. The driving forces include the shift to outpatient care, rising consumer expectations, cost pressures and mounting competition for surgical volume.
“Nowadays, patients don’t want to go to the hospital. Hospitals are for sick people. Coming to a clean and efficient ASC is what patients want,” Duke Hasson, MD, a total joint replacement specialist, who recently joined Newport Beach, Calif.-based DISC Sports and Spine Center, told Becker’s. “They don’t want to sit there and be in a hospital for extended periods of time. They want in and out. People always do better sleeping in their own bed, being in their own house, being around familiar settings.”
If finalized, the AmSurg deal would mirror Tenet Healthcare’s strategic evolution. Tenet has aggressively expanded its ASC platform, United Surgical Partners International, while divesting hospital assets to boost profitability and streamline operations.
Tenet sold 14 hospitals in California, South Carolina, and Alabama in 2024 for more than $4.8 billion, sharpening its focus on outpatient care. Today, USPI accounts for a significant portion of Tenet’s financial performance, operating 520 ASCs and 25 surgical hospitals across 37 states. With over 11,000 affiliated physicians, USPI performs more than 2 million procedures annually and added at least 57 ASCs in 2024, with 10 to 12 more centers expected in 2025.
“Tenet is entering a new era with a greater proportion of our performance coming from our highly efficient ambulatory surgical business and a reduced debt profile,” CEO Saum Sutaria, MD, said during a recent earnings call. “We will have significant financial and capital flexibility to increase shareholder value over the long-term.”
Ascension’s move could have ripple effects across the ASC market. While it presents opportunities for strategic partnerships and investments, it also signals increased competition for physician alignment and surgical volume, particularly for independent centers and physician-led groups.
Brentwood, Tenn.-based Surgery Partners, another major ASC chain, is also navigating acquisition interest. Bain Capital Private Equity submitted a nonbinding acquisition proposal to the company in early 2025, further highlighting the consolidation trend.
For Ascension, acquiring AmSurg offers a pathway to scale quickly in the ASC market, reduce dependence on inpatient revenue and position the system for long-term sustainability. With hospitals facing tight reimbursement, workforce shortages and escalating supply costs, shifting toward high-efficiency, lower-cost outpatient models is becoming more than a strategic option — it’s a necessity.
By following Tenet’s lead, Ascension has the potential to diversify revenue streams, expand its national footprint, and deliver care in settings that better meet the expectations of modern patients and payers alike.
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