Nonprofit, health system-affiliated ASCs earn much higher margins than for-profit centers, according to a new study of Pennsylvania facilities.
Here’s what new research and recent data show about which ASCs make the most money.
The new study
1. Nonprofit ASCs were 20% of Pennsylvania’s ASC market in 2024 but brought in more than half of the market’s total net income, according to research published Sept. 25 in JAMA Health Forum by researchers from Texas Christian University’s Burnett School of Medicine and Johns Hopkins University. The study covered 257 ASCs: 204 for-profit and 53 nonprofit.
2. The median nonprofit margin was 37.8%, more than double the for-profit median of 16.4%. More than 26% of nonprofits had margins above 51%.
3. Median net income per visit was $592 at nonprofits and $197 at for-profits.
4. Nonprofits averaged 4,598 visits, compared with 3,613 at for-profits. Median net patient revenue was $8.48 million vs. $4.74 million.
5. Nearly all nonprofits had health system ties: 94.3% of nonprofit ASCs were affiliated with a health system, compared with 27% of for-profit centers.
6. Payer mix differed. For-profits got more revenue from Medicare, a median of 31.9% vs. 23.6%, and nonprofits got more from Medicaid, 3.4% vs. 1.6%.
Specialty mix
7. Of the nonprofit ASCs in the study, 62.3% offered multiple specialties, compared with 29.9% of for-profits. The most common nonprofit specialties were GI (73.6%), orthopedics (58.5%) and ophthalmology (50.9%).
8. Specialty choice shapes the type of profit a center earns. Established specialties such as ophthalmology, GI, pain and podiatry bring in “steady revenue growth through high-volume, lower-margin case returns,” Joe Peluso, administrator at Aestique Surgical Center in Greensburg, Pa., told Becker’s in 2025. Orthopedics, neurosurgery and cardiac cath bring “higher per-case returns and lower volumes with significantly higher margins.” He said total joints carry the highest revenue margin of any current specialty.
Statewide and industry margins
9. Margins are tightening statewide. Pennsylvania ASCs posted a combined statewide operating margin of 27.34% in fiscal 2025, down from 29.52% the year before, even as revenue per visit rose to $1,711, according to a Sept. 24 report from the Pennsylvania Health Care Cost Containment Council. Fourteen ASCs closed during the year.
10. A low-margin group remains. In VMG Health’s 2022 study, 10% of ASCs operated at margins of 5.2% or lower, and operating expenses took up a median 76.8% of revenue.
Operators
11. United Surgical Partners International had a 39% adjusted EBITDA margin in the second quarter of 2026, down slightly from 39.2% a year earlier, on $1.39 billion in revenue.
12. Surgery Partners’ adjusted EBITDA margin fell to 14.7% in the second quarter, down from 15.6% a year earlier, on $848.9 million in revenue.
Valuation
13. Buyers pay more for multispecialty centers. Single-specialty ASCs sell for 5x to 8x EBITDA, multispecialty centers for 6x to 10x, and regional or national multicenter platforms for 11x to 17x.
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.
