Image by István Kis from PixabayAMSURG launched in 1992 as a pioneer in the ambulatory surgery center (ASC) industry. Since then, the company has journeyed down a path full of twists and turns.
Another one could be coming up.
Citing sources with knowledge of the matter, Bloomberg reported on May 30 that AMSURG is in “advanced talks” to sell its business to Ascension Health in a $3.9 billion deal. Neither AMSURG nor Ascension Health responded to requests for comment from Ambulatory Surgery Center News.
The Nashville, Tennessee-based AMSURG is an outpatient surgery center management company with more than 250 ASCs across the country.
Ascension Health is one of the largest faith-based health systems in the U.S., with well over 100 hospitals in its network, plus thousands of other sites of care. That includes ASCs, though surgery centers currently make up a relatively small portion of its overall operating portfolio.
In recent years, Ascension has undergone significant restructuring, including divesting several hospitals and senior care facilities to streamline operations. In Illinois, for example, Ascension sold nine hospitals, two ASCs and four senior living facilities to Prime Healthcare for $375 million. Ascension exited the Michigan market completely by selling three hospitals and an ambulatory surgery center to MyMichigan Health.
In the first nine months of its fiscal year 2025, Ascension reported a recurring operating loss of $381 million. For the third quarter alone, the recurring operating loss was $68 million, which was a $1.4 billion improvement from Ascension’s 2024 fiscal fourth quarter.
Amid its recent challenges, the nonprofit health system has made expanding beyond the traditional hospital a strategic priority.
“We are removing barriers to care, improving patient experiences, and building a more connected system that is better equipped to serve every community today and into the future,” Ascension President Eduardo Conrado said in a statement when the health system released its third quarter financial results on May 16.
A deal with AMSURG could materialize in a matter of weeks, according to Bloomberg’s report.
Walking a winding path
After launching in 1992, AMSURG expanded steadily, mainly focusing on single-specialty ASCs in the gastroenterology and ophthalmology spaces early on. Five years later, the company went public, with a period of accelerated growth fueled by a mix of M&A and de novos.
In the 2000s, AMSURG expanded its ASC network to cover more specialties. By 2007, it had at least 150 centers across its footprint.
A major milestone for AMSURG then arrived in 2014, when it acquired Sheridan Healthcare in a more than $2.3 billion deal that significantly expanded AMSURG’s service lines. Another turning point came just two years later, when AMSURG merged with Envision Healthcare.
Envision Healthcare – and AMSURG within it – was then acquired by KKR in a roughly $9.9 billion leveraged buyout. Over time, Envision struggled with rising debt, changing reimbursement and payer disputes, particularly around surprise-billing regulations.
AMSURG, however, continued to operate its ASC platform. In May 2023, Envision filed for Chapter 11 bankruptcy. As part of that process, AMSURG separated from Envision and became a standalone independent ASC company once again.
“I appreciate the collaboration with Envision leaders that has brought us to this point,” AMSURG President and CEO Jeff Snodgrass said when the separation became finalized. “We have built strong momentum as an organization that will propel our path to growth.”
Since its spinoff, AMSURG has been an active player in the M&A and joint ventures game.
In July 2024, the company acquired an ownership interest in River Road Surgery Center. A month later, it announced a JV with LifeBright Health and the Woodholme Group to open the EndoCentre of Westminster.
More recently, at the start of 2025, AMSURG acquired Texarkana Surgery Center. In April of this year, it bought Pinnacle Surgery Center.
“We’re standing up and becoming our own new standalone entity,” AMSURG COO Keith Hennegan told ASC News in August. “The biggest things we’re excited about are investing in our culture, our systems and our teammates, overall, which ultimately benefits our patients. Another key focus has been getting the growth engine going again.”
The big picture
For Ascension, a deal with AMSURG would jump-starts its ambulatory care strategy, giving it a big boost when it comes to the lower-cost, alternative care settings that its leadership team has been prioritizing.
Dealreporter reported in May that Ascension and other bidders were pursuing AMSURG.
Generally, hospitals and health systems have ramped up their ASC investments.
“Health systems purchasing networks of ASCs is not a new phenomenon, as many progressive systems have been doing this for years,” Scott Fraser, founder and managing partner of Fraser Healthcare, told ASC News.
The trend is more of “a natural evolution in health care delivery,” Fraser said, as health systems are responding to both fee-for-service Medicare and large private payers – as well as self-insured employers – directing elective surgeries to the lower-cost ASC setting.
“Ultimately, this is a great thing for health care delivery and lowering health care expenditures in the U.S., as we are seeing the increased migration of higher-acuity surgeries to ASCs,” he continued.
From a big-picture perspective, AMSURG reportedly being close to a sale means that two of the market’s ASC giants – AMSURG and Surgery Partners – are up for grabs. Bain Capital Private Equity submitted a go-private takeover proposal to Surgery Partners in late January, proposing to buy all of the company’s outstanding shares it doesn’t already own for a cash consideration of $25.75 per share.
“The Bain Capital proposal is non-binding, and there can be no assurance that any definitive offer will be made, that any agreement will be executed or that this or any other transaction will be approved or consummated,” Surgery Partners wrote in a Jan. 28 announcement.
TPG Inc. (Nasdaq: TPG) and UnitedHealth Group (NYSE: UNH) were previously named as interested suitors for Surgery Partners.
“I expect an acceleration in health systems acquiring ambulatory surgery centers to respond to payers, patients and provider needs,” Fraser said.
