The consolidation of independent ASCs by hospitals, health systems and other corporate entities has become the norm — but some arrangements are proving to be more fitting for ASC teams than others.
According to a survey released by VMG Health in October 2025, 59% of independent ASCs would consider a strategic partnership rather than a full sales transaction. Among ASCs open to partnerships, 71% would consider partnering with a health system, 31% with a management company and 29% with a private equity group.
Daniel Decker, MD, a urologist and co-founder of Vitality Urology Clinic in Mountain Home, Ark., recently joined Becker’s to discuss the ownership model leading his organization to success — and how other leaders can find similar arrangements.
Editor’s note: This response has been lightly edited for clarity and length.
Question: Hospital joint ventures, physician-led partnerships, PE-backed platforms — hybrid ownership is no longer the exception in the ASC space. Which model is working best for your organization and why?
Dr. Daniel Decker: Having had experience with the various ASC ownership models, there are certainly pros and cons to each. However, there is one that seems to be the most sustainable and promising.
Hospital joint ventures inevitably seem to get bogged down with hospitals exerting control on a desire to maintain site of care leverage as to where procedures/surgeries are performed. This is a well-documented healthcare detriment of increased costs without improvement in (and often decline in) surgical outcomes. Until equitable site neutrality becomes a reality, this model has inherent flaws.
Pure physician/surgeon ownership models generally lack the insight from other specialties and the talent of business and administrators seeing the big picture often missed by busy clinicians. Essentially this model can become somewhat myopic.
Hybrid ownership with PE-backing improves upon that, but it also can become susceptible to variability of long-term sustainability versus short-term profits dependent upon a particular PE agenda.
From a broad perspective, the model that engages physician/surgeon ownership to become good stewards of clinical care and also balances competing business realities makes the most sense. A good example of this is a partnership with a [management services organization] such as [U.S Specialist Management]. This is a physician-owned entity with minority management and equity stakes in ASCs that benefits from multi-specialty surgeon input. Additionally, it employs business and administration experts in ASC management, along with the needed scale to leverage national vendor contracts on a multi-state and site level for variable-sized ASCs.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.