Expansion of ambulatory care is central to St. Louis-based Ascension’s growth strategy, particularly through the planned acquisition of AmSurg, according to financial documents published May 15.
The health system is poised to become one of the largest ASC operators in the country by acquiring AmSurg and its 250 ASCs for $3 billion. While the deal was initially expected to close in late 2025 or early 2026, the filing confirmed it remains pending, noting “the transaction is expected to be finalized after all necessary approvals are obtained.”
Ascension leaders have framed the ambulatory push as part of a broader effort to close access gaps that funnel patients toward the emergency department. In a Feb. 16 LinkedIn post, President and CEO Eduardo Conrado argued that avoidable ED use among Medicaid and uninsured patients reflects a system problem, not a patient behavior problem.
“When primary care appointments are hard to secure, specialty referrals are delayed, medications are unaffordable or coverage is unstable, the emergency department becomes the default option,” he wrote.
Financially, the health system continues its turnaround. Ascension reported a $64 million operating loss (-1.1% margin) in the fiscal third quarter ending March 31 — an improvement from a $101 million operating loss (-1.7% margin) in the same period last year.
Total operating revenue for the nine months ending March 31 was $18.1 billion, down from $19.5 billion in the prior-year period, while total operating expenses fell from $20 billion to $18.3 billion.
Like Tenet Healthcare before it, Ascension has aggressively restructured its hospital portfolio, shrinking from 139 hospitals to 90 facilities since 2022. Recent divestitures include the transfer of four Michigan hospitals to Beacon Health System in July 2025 and the sale of nine hospitals, four senior living facilities and related operations in the Chicago area to Prime Healthcare Services in June 2025.
Despite the portfolio contraction, volume is recovering. Same-facility volume improved 9.3% year-over-year in the fiscal third quarter. Ascension Sacred Heart also reopened its updated cardiology clinic and opened a new ASC in St. Augustine, Fla., during the quarter.
The system’s quarterly report struck a similar tone: “Ascension is evolving alongside patient preferences, prioritizing the shift of select procedures to outpatient settings. The continued growth of ambulatory surgery center partnerships remain a pillar of this strategy, driving broader access to high-quality, patient-centered care.”
Amber Sims, Ascension’s executive vice president, chief strategy and growth officer, told Becker’s the deal will be transformational for the system.
“We really tightened our portfolio and recognized that we have to get ahead in the ambulatory business, because that’s where care is going,” Ms. Sims said during a Nov. 3 panel at Becker’s CEO and CFO Roundtable in Chicago. “It’s where patients want to receive care, where payers want to seek care, and where providers want to provide care.”
Benjamin Stein, MD, chairman and CEO of Capital Surgical Solutions, told Becker’s Ascension’s health system infrastructure gives it a long-term edge.
“Health systems such as Ascension are uniquely positioned to activate key downstream levers that maintain physician engagement,” he said. “They bring integrated payer relationships, managed care contracts and value-based infrastructure — all crucial for ASC scalability.”
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