Hospitals are generating more revenue, but a continued migration toward outpatient care and rising operating costs are accelerating one of healthcare’s biggest strategic shifts: investment in ambulatory surgery centers.
Kaufman Hall’s latest “National Hospital Flash Report” found outpatient revenue per calendar day increased 8% year over year through May, outpacing the 5% increase in inpatient revenue. At the same time, adjusted patient days rose 1% while inpatient discharges remained relatively flat, underscoring the industry’s steady shift away from traditional inpatient care.
The financial backdrop is becoming increasingly challenging.
Through May, operating revenue per calendar day increased 6% year over year, but total expense per calendar day climbed 7%. Labor expense rose 4%, while nonlabor expense increased 9%, reflecting continued inflationary pressures across hospital operations.
“Traditional hospital care delivery is fundamentally shifting,” Kaufman Hall analysts wrote. “As outpatient growth continues year-over-year in May, health systems may consider proactively adapting portfolios and operations to support the future of U.S. healthcare delivery.”
The report also warns that health systems must rethink how they deploy resources as care delivery evolves.
“Both labor and non-labor expenses remain elevated overall through May as compared with last year. As more care shifts to outpatient settings, health systems should evaluate how they strategically plan, align and deploy resources to maximize effectiveness,” analysts wrote.
Those trends are already reshaping the healthcare transaction market.
Health systems, private equity firms and payers are racing to acquire outpatient assets, particularly ASCs. Physician medical groups accounted for a record 46% of all healthcare transactions in the first quarter of 2026, generating nearly three times as many deals as any other healthcare subsector, according to PwC’s Health Services US Deals 2026 Midyear Outlook published June 17.
ASCs remain one of the industry’s most sought-after assets.
A recent VMG Health survey found outpatient surgery ranked as health systems’ top service line for joint venture investment, with more than 60% of executives identifying ASCs as a primary growth priority. Separately, Avanza’s Intelligence Hospital Leadership ASC Survey found roughly 75% of hospitals structure ASC investments as physician joint ventures.
Last month, St. Louis-based Ascension grabbed headlines after completing its $3.9 billion acquisition of Amsurg, expanding its ASC network to roughly 300 facilities nationwide. This month, Amsurg continued that momentum by acquiring five endoscopy centers in North Carolina, further expanding its outpatient footprint.
Amber Sims, Ascension’s executive vice president and chief strategy and growth officer, told Becker’s in November the health system had to “get ahead in the ambulatory business, because that’s where care is going.”
“It’s where patients want to receive care, where payers want to seek care, and where providers want to provide care,” Ms. Sims said.
Other systems are making similar bets, though not at the scale of Ascension.
Cleveland Clinic recently partnered with Regent Surgical to develop ASCs in several markets. Cincinnati-based Bon Secours Mercy Health teamed up with Compass Surgical Partners to develop more than 30 ASCs across multiple states. Newark, Del.-based ChristianaCare and Atlas Healthcare Partners formed a joint venture to bring an ASC network to Delaware and surrounding states.
Fort Wayne, Ind.-based Parkview Health has also aligned with Surgery Partners — the country’s fifth-largest ASC operator — to develop and acquire surgery centers across Indiana through a physician-focused joint venture.
The strategy is about more than following patients into outpatient care.
Owning or partnering with ASCs can increase reimbursement rates, strengthen physician alignment, capture downstream referrals and shift procedures into lower-cost settings. Those financial advantages are becoming increasingly attractive as hospitals tackle slowing inpatient growth and persistent cost inflation.
“With some data suggesting a lingering ‘new normal‘ for hospitals, healthcare organizations need to be very strategic about diversifying services and managing expenses to build financial stability,” Erik Swanson, managing director and data and analytics group Leader at Kaufman Hall, said in a Feb. 10 report. “Demand in outpatient services is on the rise, and hospitals without an outpatient footprint will struggle.”
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.
