Image by Couleur from PixabayThe health care industry anticipates substantial growth in outpatient services over the next decade as technology progresses, and an aging population demands more frequent and complex care.
That’s based on a new report by Colliers on the growth of ambulatory surgery centers (ASCs).
Outpatient care is expanding into new regions and service areas to enhance efficiency and patient treatment, creating new opportunities for partnerships and acquisitions for both national and regional hospital systems, according to the report. As more complex care requires longer inpatient stays, hospitals are freeing up space by shifting some procedures to outpatient settings, such as ASCs.
Due to this and other factors such as efficiency and cost, the ASC industry is expected to grow 9% in volume by 2028, surpassing the 7% growth projected for hospital outpatient department volumes.
Providers are responding to the rising demand for services, creating opportunities for geographic expansion and fostering partnerships among providers, health systems and investors.
In 2024, ASCs generated $45 billion in revenue, a figure forecast to increase to $57 billion by 2030, researchers noted. This growth is fueled by new technologies, including greater adoption of robotics and more favorable reimbursement rates from Medicare, Medicaid and private insurers. Expansion is anticipated across various service lines.
The drivers of profitability in the market are specifically advances in orthopedics, cardiology and advanced spine surgery. These three specialties are projected to account for 43% of volume growth between 2023 and 2028.
Source: Grand View Research
As of 2023, orthopedics held the largest share of the ASC market, followed by gastroenterology, according to Grand View Research.
Medicaid and Medicare reimbursements prioritize lower-cost procedures, and the average cost of ASC procedures is less than half that of hospital outpatient departments, as highlighted in the report. Additionally, ASCs save Medicare approximately $4.2 billion annually and help consumers save an average of $684 per procedure.
Recent approvals by the U.S. Centers for Medicare & Medicaid Services (CMS) of 24 ASC-located procedure codes for reimbursement will enable more patients to choose ASCs over hospitals, benefiting both consumers and insurers.
M&A activity
Revenue growth is essential for expansion. In health care systems, it becomes a balancing act to choose the right capital investment: partnership, merger, acquisition or new internal allocations.
In the first half of 2025, eight ASC deals were announced, according to Levin Associates.
Private equity (PE) continues to be the dominant force in ASC acquisitions, with three major deals during this period, including Wellspring Capital Management’s acquisition of Summit Spine & Joint Centers, Bain Capital-backed Surgery Partners Inc.’s purchase of Montpelier Surgery Center and Advanced Surgery Center, and Welsh, Carson, Anderson & Stowe’s acquisition of Constitution Surgery Alliance.
The number of ASCs under partnership with a national operator has increased from 1,339 centers in 2011 to 2,140 by 2024, with the five largest operators, led by United Surgical Partners, accounting for most of the centers.
Larger health systems continue to operate actively, with some expanding their ASCs through strategic acquisitions.
In June, Ascension Health agreed to acquire AmSurg for nearly $3.9 billion, adding 250 ASCs across 34 states to its network. The deal is expected to close by the end of the year.
Tenet Healthcare’s (NYSE: THC) ASC network, United Surgical Partners International, also added six new centers as part of a joint venture with Choice Care Surgery Center in Midland, Texas. Tenet plans to invest $250 million annually in M&A within ASCs to pursue growth opportunities.
PE has become especially interested in the trajectory of ASCs and is shifting its focus from physician practice portfolio companies to direct ownership in ASCs, driven by the scalability of platforms and the ability to capitalize on increasing demand.
Source: Pitchbook
In 2024, PE investment reached $19.7 billion before decreasing to $18.9 billion during the first half of 2025. This investment volume includes the sale of independent ASCs as well as PE partnerships or joint ventures, according to Collier’s.
Obstacles to growth
The Colliers report did note some obstacles for ASCs in the coming years.
The health care industry’s continuing workforce shortage sees a loss of 86,000 physicians by 2036, with anesthesiologists being the most considerable portion of those exiting. Researchers said this segment is being hit the hardest due to the workforce reaching retirement age and a limited number of residency spots.
To combat this staffing decline, health systems are investing in efficiencies, offering flexible work arrangements and collaborating with other systems to recruit and retain physicians and other key employees.
A shift in strategy is facilitating the relocation of some procedures from ASCs back into the provider’s office.
“It might stand out to some folks that ASC volume is going to grow substantially,” Marianne Skorupski, director of national office research at Colliers told ASC News. “It is worth noting the evolution of what is moving out of ASCs into the doctor’s office. The transition of procedures from hospital to ASC to office is a direct result of technological and medical advancements.”
Specialties such as dermatology, ophthalmology, pain management and orthopedics are moving minimally invasive procedures into offices to save costs for providers and systems while freeing up ASCs for more advanced cases.
