Image by Gerd Altmann from PixabayA new McKinsey & Company report paints a sobering picture of U.S. health care over the next several years, marked by margin pressure, policy disruption and uneven recovery.
Yet amid the turbulence, ambulatory surgery centers (ASCs) and outpatient care models are positioned for sustained growth.
“Post-acute and outpatient care continue as bright spots supported by segments such as home health, hospice, and [ASCs], with an aging population and continued site-of-care shifts fueling growth,” the McKinsey report reads. “In contrast, other outpatient areas such as diagnostic imaging centers and dialysis clinics are expected to experience relatively low growth.”
In the January analysis, McKinsey identifies ASCs as a bright spot for these and several other reasons. In addition to seeing accelerating site-of-care shifts and demographic tailwinds, for instance, ASCs are riding an opportunity wave from expanding procedural eligibility.
Combined, these factors place ASCs among the strongest performers in an otherwise strained provider landscape, according to McKinsey.
In particular, the report highlights growing procedural volume tied to orthopedics and cardiology. Other boons for ASCs include modest margin pressure (a positive compared to other parts of health care with more intense margin pressure).
“The U.S. [health care sector] is navigating a period of profound transformation, marked by persistent financial pressures, regulatory shifts and a changing care-delivery landscape,” the report continues. “Payers and providers face substantial headwinds, but growth opportunities are emerging in [health services and technology], specialty pharmacy, and new care models.”
Those findings echo what ASC operators and investors have increasingly experienced on the ground.
Several ASC leaders have touted the market’s strong position and healthy growth runway in recent interviews with ASC News.
“In 2026, the biggest driver will be the continued shift of high-acuity procedures into the ASC setting,” Steve Hockert, chief development officer for Solara Surgical Partners, told ASC News as part of its 2026 executive outlook. “Payers, employers and patients all want value, and ASCs are uniquely positioned to deliver that without sacrificing quality. We’re going to see more orthopedic, cardiovascular and spine migration than ever before. The groups that can combine clinical excellence with operational discipline will have a major advantage.”
Site-of-care shifts continue to favor ASCs
McKinsey’s clearest signal for the ASC market is its conviction that care delivery will keep moving away from acute hospital settings toward lower-cost, freestanding sites.
“Care delivery will continue to shift from acute hospital settings to ASCs,” the report states, noting that hospitals’ share of provider profit pools is expected to decline through the end of the decade.
For ASCs, this trend reinforces a long-running structural advantage. Hospitals are expected to face margin erosion from policy changes, including potential site-neutral payment reforms (which, of course, could be a challenge for surgery centers down the road, too), while ASCs continue to gain share in commercially reimbursed procedures.
The report also underscores the role of regulatory expansion in driving ASC growth, particularly in orthopedics and cardiovascular care.
“ASCs will gain volume from newly approved procedures such as orthopedic (for example, reconstruction of shoulder and ankle joints) and cardiovascular (for example, percutaneous coronary intervention) surgeries,” the report explains.
In fact, the shift of musculoskeletal procedures from inpatient to outpatient linked to the phaseout of the Inpatient-Only (IPO) List could alone be a multi-billion-dollar opportunity for ASCs, according to recent findings from Trilliant Health.
“If just 20% go to the outpatient setting and are reimbursed at that lower outpatient rate, revenue drops by over $1 billion,” Alli Oakes, vice president and chief research officer at Trilliant Health, previously told ASC News. “And with each 20% increase in migration to the outpatient setting, it’s another $1 billion in revenue lost.”
Despite favorable volume trends, McKinsey cautions that ASC margins are likely to compress modestly over time.
“ASC EBITDA margins are estimated to decline modestly from 24.1 percent in 2024 to 23.5 percent in 2029,” the report states.
Even so, those margins remain far stronger than most provider settings. Hospitals, by comparison, are projected to operate with EBITDA margins in the mid-single digits.
The gap underscores why private equity, management companies and health systems continue to view ASCs as a preferred growth platform, even as labor and reimbursement pressures intensify.
Scale, efficiency and technology
McKinsey’s outlook reinforces a theme ASC operators know well: growth alone will not be enough.
Health care leaders “must rethink traditional models, improve performance and embrace technology to remain competitive,” the report concludes.
For ASCs, that means sharper cost control, smarter staffing models and increasing reliance on technology, from revenue cycle tools to AI-enabled workflow solutions.
“I am most excited about the massive opportunity for operational innovation and efficiency gains driven by technology,” Chris Schriever, co-founder and CEO of ASCdata, previously told ASC News. “As financial pressure forces more ASCs to pivot away from manual processes, this creates a critical opening for more advanced efficiency models, such as using AI to optimize scheduling and streamline complex workflows.”
