St. Louis-based Ascension didn’t just acquire Amsurg’s more than 300 ASCs in its $3.9 billion deal that closed in early June, it acquired the machinery that runs them, and it’s telling the market it has no plans to touch it.
For Amber Sims, executive vice president and chief strategy and growth officer for Ascension, the calculus behind buying rather than building an ambulatory growth engine was straightforward.
“To build it ourselves, it would take way too long to get to where we needed to go,” Ms. Sims told Becker’s. Ascension had looked at its own ambulatory surgery chassis and concluded it wasn’t growing fast enough on its own, prompting the system to evaluate outside platforms rather than build out site selection, physician recruitment and joint venture development from scratch.
Business development and growth is one of only three synergies Ascension has named explicitly from the Amsurg deal, alongside managed care and supply chain. Unlike a typical post-merger integration, where the acquirer’s systems and staff absorb the target’s, Ascension has said it intends to keep Amsurg’s operating model and its growth function largely intact.
“We are not converting Amsurg into Ascension,” Ms. Sims said. “We are working on synergies, and three of those synergies include business development and growth, managed care and supply chain.”
How fast was Amsurg’s “growth engine” running before Ascension bought it? The company added two new centers in 2025 — Pinnacle Surgery Center in Covington, La., and Texarkana Surgery Center in Texas — plus one new health system partnership, with Palomar Health in Escondido, Calif. Outside of those moves, Amsurg’s base has held at roughly 250 ASCs across 34 states since Amsurg re-emerged from its split with Envision Healthcare in 2023.
For comparison, USPI, Tenet Healthcare’s ambulatory arm and the largest ASC operator in the country, added nearly 70 centers in 2024 alone and 11 more in the third quarter of 2025, according to VMG Health’s annual ASC market review. Surgery Partners opened eight de novo facilities in 2024 and deployed nearly $400 million on acquisitions and development the same year. Amsurg’s pre-deal pace was a fraction of either.
Ascension CEO Eduardo Conrado said he’s looking to leverage Amsurg’s presence in 10 markets while entering 25 more, betting on an ambulatory sector he’s pegged at a “10%-plus CAGR going forward,” compared with roughly 3% on the acute side.
The tailwinds back him up. VMG Health projects total ASC payments will climb to about $9.2 billion in 2026, up roughly $450 million from 2025, and CMS has added 289 procedures to the ASC-covered list for 2026 on top of 271 removed from the inpatient-only list.
Real estate data backs up that demand gap. ASC rents have climbed more than 8% even as ASC lease volume surged 145% between 2022 and 2025, according to a March CBRE report. Additionally, JLL’s 2026 Medical Outpatient Building Perspective found construction isn’t keeping pace, with about 93% of existing medical outpatient building space nationwide already occupied. The gap is widest in Sun Belt markets like Dallas-Fort Worth, Houston, San Antonio, Atlanta and Phoenix — several of which overlap with the kind of growth markets Ascension is targeting.
Dan Tasset, founder and chairman of Leawood, Kan.-based NueHealth, said the de novo case is about more than filling capacity gaps. Population migration to states like Texas is outpacing local ASC capacity, he said, and the federal government’s continued paring of the inpatient-only list is pushing more procedures into the ambulatory channel. But the bigger driver, in his view, is that many existing ASCs simply weren’t built for value-based care.
“If you designed a surgery center for the fee-for-service world with a big waiting area and an atrium and chairs nobody sits in,” he said, facilities like that are increasingly “antiquated and need to be redesigned.”
Executives outside Ascension and Amsurg are split on whether that bet pays off.
Benjamin Stein, MD, chairman and CEO of Capital Surgical Solutions, called the deal “a watershed moment for the ASC industry,” describing it as part of “a broader recalibration among health systems” moving away from inpatient and hospital outpatient department models and toward ambulatory surgery.
He framed the transaction as evidence that health systems are “recalibrating” away from inpatient and hospital outpatient department models and toward ambulatory surgery more aggressively than in past cycles.
Wes Battiste, CEO of Destin (Fla.) Anesthesia and an advisor at Avanza, was more skeptical, noting bluntly that “Ascension, even admittedly so, has had very little success developing their ASC portfolio with productive ventures” on its own.
Mr. Battiste said the broader shift is real — “these health systems are realizing the payors, physicians, patients and politics are going to drive the volume” — but said he hopes “Ascension is wise enough to allow AmSurg and its leadership to steer this ASC initiative and not attempt to convert the model into a hospital model.”
Ms. Sims said Ascension is already fielding inbound interest as a result of the deal. “We believe all health systems will need an ASC platform,” she said. “Many health systems are already engaging us on how we think about partnering together in new and unique ways, which honestly have yet to be imagined.”
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.
