Hospital ownership of ASCs has evolved from a trend to an established facet of the industry in recent years.
Here are 10 notes on the growing bond between ASCs and hospitals in 2025:
1. Ninety percent of hospitals and health systems plan to continue investing in or affiliating with ASCs — a growing trend driven by the shift to outpatient care, rising consumer demand, cost pressures and competition for surgical volume, according to Avanza’s Intelligence Hospital Leadership ASC Survey.
2. Becker’s has reported on at least five major health systems that have shifted their development focus to the outpatient setting so far in 2025.
3. About 75% of hospitals are structuring ASCs as joint ventures with physicians. Physician buy-in promotes engagement and cost-awareness. Even minority-ownership models remain attractive to physicians, especially when hospital-led deals offer access to better payer contracts and purchasing agreements, according to the survey.
4. The leading reason for ASC investment in 2024 was expanding outpatient surgical capacity. Enhancing physician relationships saw a notable rise this year, followed closely by responding to consumer trends, cost reduction, and retaining surgical volume within the system.
5. More than 60% of hospitals and health systems in the survey report that payers are pressuring them towards ASC options for appropriate cases. Twenty-five percent of surveyed hospitals and health systems said they are expanding their ASC footprint specifically due to payer pressure.
6. In 2024, 90% of hospitals and health systems planned to increase their investments in or affiliations with ASCs, a notable jump from about 70% in 2023.
7. Among hospitals and health systems that own ASCs, 57% now own two or more, up from 47% in 2023.
8. Of the survey respondents, 67% of hospitals prefer to hold a majority stake in ASC partnerships, an increase from 64% in 2023.
9. However, as hospital interest in ASC acquisitions and development increases, some ASC physicians are simultaneously realizing their value and positionality in such deals.
“I believe that healthcare systems are finally realizing that current healthcare costs are unsustainable and that outpatient surgery is much more cost-effective. It is then easier and cheaper to acquire than to build de novo,” Alejandro Badia, MD, a hand and upper limb surgeon at Badia Hand to Shoulder Center in Miami told Becker’s. “That being said, many surgeons are finally realizing the value, and power, that we do have in the healthcare marketplace and there is little reason for us to be acquired as long as we hire good administrators and nursing staff. The challenge will continue to be the payers and anesthesia services.”
10. John Peloza, MD, an orthopedic spine surgeon at Midwest Orthopedic and Spine in Chicago, recently told Becker’s that despite labor and supply chain challenges, the movement of surgical cases to ASCs will continue to accelerate — making them a possible threat to hospital and health systems.
“Healthcare systems and hospitals regard ASCs as a significant threat to their business model,” he said. “The most profitable segment of their revenue stream is moving to the outpatient environment, leaving them with high-cost, low-revenue chronic disease management. Therefore, they are adapting to this reality.”
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