Nearly 9 in 10 hospitals and health systems now have at least one ASC, and the systems still without one are increasingly competing against peers that have already invested.
That’s according to the 7th Hospital Leadership ASC Survey from Avanza + MedHQ, conducted with HealthLeaders Media. It found 89% of respondents have at least one ASC that is affiliated, owned or under development, and 11% have none. In the survey’s 2025 edition, more than 80% of hospital systems owned at least one ASC, up from 41% in 2019.
Those that have ASCs are adding more. 53% of respondents have five or more, and 96% plan continued ASC investment.
Why some systems still don’t have one
Among respondents without an ASC:
- Regulatory obstacles, such as certificate-of-need laws: 35%
- Already operate a hospital outpatient department or short-stay hospital: 24%
- Have an ASC in progress: 24%
- No interest or not in strategic plan: 12%
- Under consideration, but not yet a priority: 6%
“The question is no longer whether to have an ASC,” the report said. “It’s how: build, convert, or partner.”
For systems already running a hospital outpatient department, the report called the choice between building a new ASC and converting the HOPD one of the more consequential calls in ASC strategy. A poorly sized or configured facility can carry financial and operational costs for as long as the building stands, it said.
Cases are already moving
Nearly all survey respondents reported pressure from commercial payers to move services into outpatient settings. Large for-profit operators are reporting the same shift.
Universal Health Services’ same-facility surgeries fell 0.7% year over year in the third quarter.. In the second quarter, total joint replacements at Tenet’s United Surgical Partners International rose 10%, and Tenet’s ASC segment revenue grew 9.3%, compared with 6% for its hospital segment.
Early movers are scaling
- Sacramento, Calif.-based Sutter Health aims to nearly double its 36 ASCs by 2030/
- On Oct. 26, Cincinnati-based Bon Secours Mercy Health agreed to acquire Brentwood, Tenn.-based Surgery Partners through its affiliate HealthSpan Partners in a take-private deal valued at about $5.7 billion including debt.
- Ascension is acquiring Amsurg and its 250 ASCs for $3 billion.
- Franklin, Tenn.-based Community Health Systems has 36 affiliated surgery centers.
Some hesitation persists.
“There’s still a thought process in some hospitals about not wanting to lose reimbursements,” Bernadette Purser, BSN, RN, senior administrator of ambulatory surgery at Richmond, Va.-based VCU Health, told Becker’s.
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.
