By: Patsy Newitt, Becker’s ASC Review
ASCs have transformed from niche providers of outpatient procedures into a central pillar of healthcare delivery. Once seen as physician-owned alternatives to hospitals, ASCs are now at the center of payer strategies, health system partnerships and private equity investments.
Here are seven things to know about the new era of ASCs:
1. Employed physician models changing recruitment efforts
Travis Messina, CEO of Regent Surgical Health, told Becker’s that the ASC landscape today looks nothing like the one the industry was born into decades ago.
Physician employment patterns have shifted from largely independent to predominantly employed. In 2024, 42.2% of physicians were working in private practice, a significant drop from 60.1% in 2012, according to a report from the American Medical Association. Private practice now represents less than half of physicians in most medical specialties, with participation ranging from 30.7% in cardiology to 46.9% in radiology.
According to Mr. Messina, this shift has changed how ASCs recruit and engage providers. For younger physicians, the issue is not a lack of interest in ASCs, but limited resources and opportunities.
“Because of the high costs of everything, there’s usually a very significant buy-in required for younger physicians to become partners in private practice,” Shobhit Minhas, MD, orthopedic surgeon at Fox Valley Orthopedics in Geneva, Ill., told Becker’s. “I would also say it’s hard to find physicians now who are willing to take on the burden of ownership, especially younger ones. A lot of independent ASCs have been operating independently for 15 to 20 years, so they’re essentially governed by the older physicians still in practice. Younger physicians today understand the challenges — getting adequate margins, rising healthcare costs, declining revenue, etc. Do they even want to take on the burden or responsibility of ASC ownership, especially with those tight margins?”
2. Shifting payer mix
Mr. Messina also emphasized that payer mix is tilting toward Medicare and Medicare Advantage, introducing new reimbursement pressures and operational constraints.
The total number of Medicare-certified ASCs increased by 2.5% in 2023, reaching 6,308 facilities, according to data from the Medicare Payment Advisory Commission. That growth rate was slightly higher than the 2.2% annual average increase from 2018 to 2022. At the same time, the number of surgical procedures performed at ASCs per Medicare FFS beneficiary rose 5.7% in 2023, a sharp jump compared to 0.6% annual average growth between 2018 and 2022.
While Medicare FFS growth is promising, Medicare Advantage has emerged as a flashpoint. ASC leaders frequently cite reimbursement denials, escalating implant costs and administrative hurdles.
“With the inflationary curve on the rise and another looming cut to the physician fee schedule, it is imperative that we re-examine our payer contracts with all other payers in our market,” Andrew Lovewell, CEO of Columbia (Mo.) Orthopaedic Group, told Becker’s last year. “Many of the Medicare Advantage plans in our market are trying to pay below the Medicare physician fee schedule, and none of them are accounting for the implant costs associated with doing surgery in our ASC. I am also looking for steerage from the payers for ASC strategies in our market. As the low-cost/high-value provider in the market, we should see significant steerage to our facility but have not experienced that yet. With our clinical outcomes both surgically and non-operatively, we are the best value around.”
Commercial payers, meanwhile, are under pressure to reduce costs. Medical procedures can cost up to 58% more at hospital outpatient departments compared to physician offices or ASCs, according to Blue Health Intelligence. For example, colonoscopy screenings cost 32% more in hospitals, and knee arthroscopies average $3,412 at ASCs versus $5,226 at HOPDs, according to Sidecar Health.
3. New market forces
The ASC industry remains fragmented, with about 68% of centers still independent, as of 2023. But consolidation is accelerating. In June, St. Louis-based Ascension entered into a definitive agreement to acquire AmSurg, while Optum subsidiary SCA Health acquired one of the nation’s largest gastroenterology groups in early 2025.
“These operating changes require a completely different playbook,” Mr. Messina said, noting Regent has doubled down on IT, analytics and partnerships to stay ahead.
The ASC market has become a magnet for health systems, payers and private equity. Ascension Optum, Tenet and others are aggressively acquiring centers, and valuation multiples have stabilized at around eight times operating income according to VMG Health’s 2025 M&A report.
Private equity firms are also shifting strategy. Instead of building standalone ASC platforms, firms are increasingly integrating ASCs into physician practice networks to capture the full continuum of care. Minority stakes and add-on acquisitions are now the norm.
“Private equity continues to purchase groups and invest in numerous domains for care delivery. I remain deeply concerned, as current GDP spend in the U.S. on healthcare is approaching 20%,” Matt Mazurek, MD, assistant clinical professor of anesthesiology at St. Raphael’s Campus of Yale New Haven (Conn.) Hospital, told Becker’s last year. “Private equity investors expect return on investment. With this trend, it is easy to imagine GDP on healthcare to grow to 25% to 30%. These dollars are not necessarily going to translate to better care and quality or access.”
For other ASCs, private equity can allow for scale, capital access and physician recruitment.
“The devil’s in the details with private equity deals. There are significant trade-offs between liquidity, growth, capital, and long-term autonomy when evaluating a buyout,” Tan Chen, MD, orthopedic surgeon from Danville, Pa.-based Geisinger Musculoskeletal Institute, told Becker’s. “Liquidity is often attractive, providing immediate capital that can ease financial pressures and facilitate investments in technology or practice expansion. However, accepting PE funding often comes with pressures for rapid growth and profitability, which can shift focus away from patient care toward meeting short-term financial goals.”
4. The rise of technology and analytics
Historically, many ASCs ran on paper records, but technology is now a competitive differentiator. Regent, for example, has invested heavily in electronic medical records, advanced analytics platforms and data-driven operations.
According to the Ambulatory Surgery Center Association’s July 2025 survey, 76% of ASCs now use an EHR, up from 55% in 2021. Nearly 1 in 4 still rely on paper, although two-thirds plan to remain analog until regulations force a change. Cost remains the top barrier, with 49% citing expense.
For the first time since 2021, ASCA found data collection ranked as the most valuable EHR benefit, cited by 87% of users. Analytics are now viewed not just as compliance tools, but as levers for efficiency, payer negotiations and outcomes reporting.
“Organizations that don’t invest in technology will be left behind,” Mr. Messina said.
Technology is also reshaping transactions. Jim Freund, managing partner at Physician Transaction Advisors, told Becker’s that 30 years ago, transactions were largely about physical centers, but now conferences and deals are “almost entirely driven by technology services.”
5. The push to higher-acuity procedures
ASC operators are betting big on orthopedics, spine and gastroenterology — specialties with high demand and margins. Tenet Healthcare’s United Surgical Partners International reported a 19.4% year-over-year increase in total joint cases in 2024, while Surgery Partners performed more than 117,000 orthopedic cases in 2024.
This shift requires new partnerships. Regent, for example, is working with academic medical centers to move complex procedures outpatient safely and to strengthen payer reimbursement arguments.
At the same time, smaller centers are finding their own advantages. HST Pathways’ 2024 survey found two-OR centers saw 22% year-over-year revenue growth, while large centers with 15 or more operating rooms reported an 8% decline.
“A lot of the larger surgery centers, many of them are broad, multispecialty centers, which I think is a significant flaw in some respects, because when you’re trying to get ahead, it’s all about routine,” orthopedic surgeon Benjamin Stein, MD, told Becker’s. “If you look at it from a clinical perspective, catering to the clinical deployment of a single specialty means your staff — your sterilization departments, both operating room and recovery staff, anesthesia staff — will all be much more knowledgeable, efficient and targeted in the care they provide if they can focus on one specialty.”
6. Engagement becoming more important
While consolidation and technology dominate headlines, Mr. Messina emphasized the importance of engagement. Regent has achieved 94th percentile engagement scores among employees and physician partners, with physician Net Promoter Scores in the 90th percentile.
“If you have great engagement from team members, you’ll drive great outcomes. And great outcomes lead to operational, clinical, and financial success,” Mr. Messina said.
Other leaders echo this perspective.
“Surgeons shouldn’t view a surgery center as just a passive site of care,” Dr. Stein said. “It’s an extension of their practice. … If a surgeon looks at it through that lens and engages in contributing to decisions, they’ll succeed and build the best environment.”
7. Regulatory tailwinds are accelerating growth
Regulatory shifts are perhaps the most powerful accelerators of ASC growth. The elimination of the inpatient-only list, expansion of covered procedures, site neutrality and payer mandates are moving more procedures outpatient.
Sg2 projects ASC volume will grow 21% over the next decade, compared to a 17% rise in outpatient volumes overall.
On July 15, CMS proposed a 2.6% increase in ASC payments for 2026 and a phased plan to remove hundreds of procedures from the inpatient-only list. The transition will begin with 285 procedures, largely musculoskeletal, phased out over three years. CMS also plans to revise the ASC Covered Procedures List by eliminating five general exclusion criteria and reframing them as physician considerations. This would add 276 procedures to the list, while another 271 procedures would shift from inpatient-only to the ASC setting.
“The most important factor is the ASC covered procedures list. By approving the outward migration of more complex spine and orthopedic surgeries to ASCs, CMS is accelerating the shift to more cost-effective settings,” Shakeel Ahmed, MD. CEO of St. Louis-based Atlas Surgical Group, told Becker’s. “CMS has already added more than 200 CPT codes this year, and I expect this trend to intensify. One urgent issue is payment updates — ASCs need inflation-adjusted reimbursement to remain sustainable as costs rise.”