Independent ASCs are running out of room to go it alone, panelists said Oct. 29 at Becker’s 32nd Annual Business and Operations of ASCs in Chicago.
The deal flow backs that up. Ascension closed its $3.9 billion acquisition of Amsurg in June, expanding its network to more than 300 ASCs across 34 states. On Oct. 26, HealthSpan Partners, an affiliate of Cincinnati-based Bon Secours Mercy Health, agreed to acquire Brentwood, Tenn.-based Surgery Partners for about $5.7 billion, including debt. The deal would add more than 200 locations in 30 states and is expected to close in the first quarter of 2027, pending shareholder and regulatory approvals.
“It’s kind of join them or die on the vine,” Adam Schurz, administrator of Riverwoods Surgery Center in Provo, Utah, said during a panel. Mr. Schurz has worked in surgery centers for 25 years and also helps manage centers in Idaho and Colorado.
Geri Eaves, vice president of ambulatory services at Azana + MedHQ, said site-of-care migration is pushing more cases to ASCs, while a large share of freestanding centers remain independent. About 65% of ASCs nationwide are independent, physician-owned freestanding facilities, according to VMG Health’s 2026 report, which counts 6,468 Medicare-certified ASCs.
“So buyers are seeing a really, really long runway that they can take advantage of,” Ms. Eaves said.
Physicians looking for a succession plan are also driving deals, she said. Asked whether consolidation is driven more by opportunity or pressure, she said, “I think it’s a little bit of both.”
Physicians hold some ownership in about 90% of ASCs, according to an October white paper from Medicus Healthcare Solutions that draws on ASC Data figures. Hospitals have a stake in 27% of centers and corporate operators in 19%. Hospital-physician joint ventures alone account for 22%.
Corporate operators have been growing. The five largest corporate ASC operators, including AmSurg and Surgery Partners, expanded from 1,152 to 1,333 facilities between 2018 and 2023, according to the Medicare Payment Advisory Commission’s March 2025 report to Congress. United Surgical Partners International, Tenet Healthcare’s ASC arm, held interests in 538 ASCs as of June 30. Prices are climbing too: The median multiple paid for ASCs reached 7.9 times EBITDA in 2025, the highest in eight years, according to VMG Health.
Mr. Schurz said independents have already cut what they can.
“I get sick of hearing ‘be more efficient,’” he said. “We’re already as efficient as we can get.”
He said his payer contracts have paid between 75% and 90% of Medicare rates, while a hospital partner told him it could secure 190%.
“There’s only X amount of dollars that I have in my coffers to be able to fight this behemoth next to me,” he said.
He also said health systems “are all trying to claw back their doctors.”
“How does a large hospital system keep its revenue? Well, they’re going to buy up everything,” he said.
The share of physicians employed by hospitals or other corporate entities rose from 62% in 2019 to 78% in 2023, according to a December 2025 Progressive Policy Institute report.
Amanda Ryan, DO, an interventional cardiologist and physician owner of Advanced Ambulatory Surgery Center of Carlsbad in Carlsbad, N.M., said large health systems are less active in New Mexico. She pointed to malpractice and tax structure as reasons.
“We’re seeing a little more on the private equity management company side than we are the big health systems,” Dr. Ryan said.
Mr. Schurz expects the number of independent ASCs to keep shrinking.
“I see that number kind of dwindling out, whether you like it or not,” he said.
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.
