Bon Secours Mercy Health affiliate HealthSpan Partners agreed Oct. 26 to acquire Surgery Partners in a $5.7 billion deal, including debt. It is the second time a health system has bought a national ASC operator outright, after Ascension’s purchase of Amsurg.
Becker’s asked 14 ASC and physician leaders what the deal means and what will decide whether it works.
Editor’s note: Responses have been lightly edited for clarity and length.
Peter Bravos, MD. Chief Medical Officer of Sutter Health Surgery Center Division (Sacramento, Calif.): Bon Secours Mercy Health’s agreement to acquire Surgery Partners, following Ascension’s purchase of Amsurg, confirms that ASCs have moved from the margins of health system strategy to its core. As surgery shifts to outpatient, the leading systems will deliver better care at lower cost, but scale alone will not differentiate them. The ability to build an integrated ambulatory platform that delivers value for patients, physicians and the health system will.
Janet Carlson, RN. Founder of Vertex Surgical Solutions: As a veteran RN executive who has spent years operating ASCs, I look at this deal through a different lens than the headline. A $5.7 billion transaction is not, by itself, evidence of value creation. The real test is what happens inside the centers: Will physicians retain meaningful clinical and operational influence? Will staffing, instrument availability and turnover capacity be protected or squeezed? Will enough capital be invested in the people (the most important assets), equipment and infrastructure needed to deliver safe, efficient care? And will the combined organization improve access without putting financial targets ahead of sound clinical judgment?
Scale can create opportunities, but it can also add layers, complexity and pressure on already lean ASC operations. The deal’s success should be measured by more than growth and financial returns. It should show up in patient access, quality, workforce stability, physician alignment and the day-to-day ability of each center to function well. Until those outcomes — and the risks, debt and protections for clinical decision-making — are clear, I’d call this a major transaction, not yet a proven win for patients, physicians or the teams doing the work.
The deal may create scale. Scale alone is not proof of value — or better care. Before calling this a strategic win, show the numbers, the risks and the safeguards. The headline says $5.7 billion. That number needs context. The reported value includes debt, while public shareholders are being offered $23.50 per share — and Bain, which owns roughly 39% of Surgery Partners, is rolling its stake into the new entity rather than cashing out. Those are materially different economic positions. The article doesn’t provide the valuation multiples, projected returns, expected debt burden or enough detail to assess whether the price is compelling or whether the financing leaves the combined company stretched. The overall concern with any of these ASC acquisitions/partnership deals is the consolidation game driving up the costs of care everywhere; it is untenable.
Lisa Cooper. CEO of Santa Cruz (Calif.) Surgery Center: Having spent many years managing a physician-hospital joint venture ASC in partnership with a large national healthcare system, I have had a firsthand perspective on both the opportunities and challenges that come with these relationships. I think this is a very strategic move by Bon Secours Mercy Health, and one that other large healthcare systems looking to expand their ASC presence should be paying attention to. While healthcare systems may be able to successfully develop an ASC division internally on a regional level, building the culture, expertise and infrastructure necessary to support a national ASC platform is an entirely different undertaking.
ASCs operate in highly localized markets, with different regulatory environments, reimbursement structures, physician relationships and referral patterns. A successful national ASC operator must be nimble enough to navigate those differences while maintaining the operational efficiencies that make the ASC model successful. One could make a strong argument that acquiring an established operator with a demonstrated ability to navigate these complexities is the most effective approach for a healthcare system seeking a national presence. I believe larger healthcare systems attempting to build these capabilities internally may underestimate the complexity of the relationships between physicians, their established practice patterns and the surgery centers where they operate. These relationships have often evolved over decades and cannot simply be manufactured within a traditional healthcare system.
Acquiring an established operator provides access to infrastructure, an operating culture and physician relationships that can take decades to develop organically and may prove difficult to reproduce within a traditional hospital system. As healthcare systems continue expanding into the ambulatory surgery market, I believe the true differentiator will be not only whether they recognize the importance of preserving the unique operating model that has made ASCs successful, but also whether they recognize and value the physicians who pioneered that model and remain central to its success.
Megan Friedman, DO. Chair and Medical Director at Pacific Coast Anesthesia Consultants (Los Angeles): The $5.7 billion acquisition of Surgery Partners signals that health systems increasingly recognize outpatient surgery as a central component of their long-term growth strategy. I expect we will continue to see consolidation as organizations seek to expand their outpatient footprint, improve efficiency and capture a greater share of surgical volume.
However, the success of these acquisitions will depend on more than economies of scale. One of the greatest strengths of the ASC model has been its physician-driven approach to care, operational flexibility and efficiency. As health systems acquire and integrate these facilities, it will be critical to preserve those qualities rather than impose the administrative complexity often associated with larger hospital systems.
Physicians need to be actively involved in operational and strategic decision-making, not simply expected to adapt to decisions made at the corporate level. This engagement must extend beyond surgeons to include anesthesiologists and other clinical leaders who are integral to the daily operations of these facilities. Anesthesiologists play a critical role in patient safety, staffing, scheduling efficiency, patient selection and overall surgical throughput. Their involvement is essential to developing sustainable models of care.
Ultimately, the organizations that succeed will be those that recognize physicians as strategic partners, not simply providers of clinical services. Consolidation may create scale, but meaningful physician engagement across specialties is what will translate that scale into better patient care, operational efficiency and long-term sustainability.
Sean Gipson. CEO of Remedy Surgery Centers (Dallas): The announced acquisition involving HealthSpan Partners, an affiliate of Bon Secours Mercy Health, represents a significant development in the healthcare landscape and raises important questions for healthcare executives and system leaders. Beyond the headline valuation, this transaction highlights a broader strategic shift toward expanding outpatient care, strengthening physician networks and rethinking how healthcare organizations deliver value in an increasingly complex and cost-conscious environment. From an executive leadership perspective, several considerations stand out to me.
- Strategic positioning matters. Expanding outpatient surgical capabilities can create opportunities to improve patient access, enhance care coordination and potentially deliver services more efficiently. The strategic advantage, however, will depend on how effectively these capabilities integrate with existing care delivery networks.
- Financial discipline must accompany growth. A transaction of this magnitude requires rigorous attention to capital allocation, financing costs, operational performance and long-term returns. Scale alone does not create value; sustainable performance does.
- Operational integration will determine success. Aligning clinical operations, physician relationships, workforce priorities, technology and organizational culture is often more challenging than completing the transaction itself. Execution will be the real differentiator.
- Patient outcomes and mission alignment must remain central. For healthcare organizations with a community-focused mission, growth must be evaluated against more than revenue and market share. Access, affordability, quality, patient experience and community benefit should remain essential measures of success.
- Governance and accountability deserve close attention. When nonprofit healthcare systems partner with investment-backed organizations, leadership must establish clear performance expectations and ensure that financial objectives remain aligned with clinical quality and the long-term interests of patients and communities.
In my opinion, the most important question is not simply whether this acquisition expands market presence, but whether it creates a more effective, financially resilient and patient-centered care delivery model. For healthcare executives, this is a reminder that successful growth requires more than capital and strategic ambition. It requires disciplined execution, aligned incentives, strong governance and measurable improvements in the value delivered to patients. Ultimately, the true return on a healthcare investment should be measured not only in financial performance, but also in the quality, accessibility and sustainability of the care it enables.
Steve Hockert. Chief Development Officer of Solara Surgical (Southlake, Texas): Health systems are rethinking where care gets delivered, and a deal like this makes clear outpatient surgery is now at the center of it. Most systems won’t get there through a $5.7 billion acquisition. They’ll do it through joint ventures, new centers and converting existing outpatient departments. The systems that succeed will be the ones that embrace, not disrupt, the physician-led governance that makes ASCs work.
Les Jebson. Administrator of the Orthopedics and Sports Medicine Network at Prisma Health: The all-cash transaction represents a massive consolidation in the ambulatory and short-stay surgical facility sector, shifting Surgery Partners from a publicly traded entity into a privately held company. This acquisition represents the second blockbuster move in this space, topping Ascension’s $3.9 billion acquisition of Amsurg.
The move is both bold and strategic, underscoring the massive broader migration of procedural services away from traditional inpatient settings. Effective integration in markets where there are both Bon Secours and Surgery Partners facilities will be key.
Thomas Jeneby, MD. CEO of Palm Tree Surgicenters, Chrysalis Cosmetic Surgicenter and Maximus Plastic Surgicenter (San Antonio): As you can see, conglomerations are forming. This has two possible consequences: If the conglomerate keeps each other’s culture, then economies of scale probably win and the surgicenters get a further reduction in pricing for supplies. If the cultures clash, then owner/operators who are already with each entity may suffer, with “new owners” making a name for themselves and creating a terrible culture. Hard to judge without knowing the companies!
Maher Kodsy, MD. Chair of the Department of Anesthesiology at University Hospitals Elyria (Ohio) Medical Center: It is a healthy phenomenon to observe nonprofit organizations affiliating with for-profit entities. With the uncertainty surrounding the future of Medicaid, nonprofit healthcare systems will endeavor to compensate for the revenue loss generated from patients covered through Medicaid. The future will likely witness acquisition, consolidation, collaboration, integration and other similar strategies. These actions are aimed at mitigating the potential turbulence in the future healthcare industry.
It is almost inevitable that small healthcare systems will struggle to sustain the expected wave of changes that will reshape the current healthcare landscape. For-profit enterprises have positioned themselves well to capitalize on this opportunity. Their expertise is in dire financial need to maintain the industry and optimize revenue. On the other hand, for-profit organizations require clients, volume and contracts to expand their market footprint before the changes negatively impact their profits.
Raghu Reddy. Chief Administrative Officer of MiOrtho Surgery Center and a member of the Ambulatory Surgery Center Association’s Education and Quality Committees (Southfield, Mich.): Until now, health systems have mostly partnered with operators through joint ventures. Here, a nonprofit system is buying the entire operator, signaling a much deeper commitment. HealthSpan Partners, an affiliate of Bon Secours Mercy Health, is taking a for-profit, private equity-backed company private, with the PE firm still at the table.
This will raise many questions among physician partners: how syndicated ownership will be treated, whether referral patterns will shift and whether the system’s ethical directives will affect any service lines. It also raises questions about payer leverage and competition, and independent ASCs will feel the pressure.
Even as outpatient volume grows, investors are underwriting reimbursement and leverage risk more conservatively. Consolidation, for whatever reason, brings scale for payer negotiations. Buyouts like this bring both favorable and not-so-favorable changes.
Tammy Smittle, RN, BSN. Chief Operating Officer and Chief Nursing Officer of Northwest Hills Surgical Hospital (Austin): I believe the Surgery Partners acquisition is another clear indication that the future of surgical care is increasingly outpatient, and major health systems recognize they must have a meaningful presence in that space. What makes this transaction particularly interesting is the continued convergence of health systems, private equity and physician-owned surgical facilities. Each brings something valuable to the table, but the success of these partnerships will ultimately depend on maintaining strong physician relationships and preserving the operational efficiencies that make ASCs successful.
I believe that this will not be the last consolidation. Increased reimbursement pressures, rising operating costs and increasing case complexity make it more difficult for smaller facilities to compete.
Leo Spector, MD. CEO and spine surgeon at OrthoCarolina (Charlotte): When a health system affiliate puts roughly $5.7 billion behind outpatient surgery, it tells you that everyone, hospitals included, is in agreement on where the future of surgery is headed — ASCs. The question has evolved from whether appropriate care should move to ASCs to how that care gets organized once it does.
ASCs work best when all stakeholders’ interests are aligned — patient, practitioner and payers. Surgeons caring for patients at ASCs need to have a real stake in their operation. An ASC depends on a committed surgical base whose consistency drives quality up and cost down. Whether an ASC is owned by a health system, an investor and/or surgeons, the successful ones will be those where the surgeons performing the cases have a real voice in how patient care is delivered.
Alan Wagner, MD. President and Founder of Wagner Kapoor Institute (Virginia Beach, Va.): Consolidation continues and removes the providers and patients further away from some key determinants of their access to, and quality of, care.
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.
