ASCs are entering a new phase of growth driven by new care pathways, staffing models and site-of-care shifts.
From partnerships with orthopedic walk-in clinics to CMS coverage for EP ablation, here are six opportunities ASC leaders are watching.
1. Build referral pipelines through partnerships with outpatient entry points
One of the biggest growth opportunities may be partnerships with outpatient facilities such as orthopedic urgent care centers and walk-in clinics, said Alejandro Badia, MD, founder and CMO of Miami-based Badia Hand to Shoulder Center.
“Once a patient is seen in a hospital emergency room, for example, that patient will likely undergo surgery at that facility, often whether urgent or not,” he told Becker’s. “Collaboration between a convenient walk-in facility, for example, an orthopedic urgent care center and an ASC, will drive up musculoskeletal surgical volume, while lowering overall healthcare system costs.”
These partnerships can route more musculoskeletal cases to the ASC, often before a patient enters a hospital system, and reduce reliance on surgeon-driven referrals by creating a steadier, clinic-based pipeline.
2. CRNA-only anesthesia models are gaining traction
As states broaden CRNAs’ ability to practice independently and anesthesia shortages deepen, more ASCs are moving toward CRNA-only models, leaders say. A Medicus Healthcare Solutions white paper found 75% of CRNAs reported practicing without physician oversight as of 2023, and CRNAs now provide the majority of anesthesia care in rural counties.
“Most of the ASCs in my area are also becoming CRNA-only,” Jesse Johnson, CRNA at Springdale, Ark.-based Chief Anesthesia Services, told Becker’s. “This helps keep costs down for anesthesia services.”
In Mr. Johnson’s market, most ASCs are for-profit and physician-owned, meaning they often lack additional staff to assist with complex cases.
Jeff Tieder, MSN, CRNA, clinical assistant professor in the nurse anesthesia program at the University of Tennessee at Chattanooga, echoed this shift. He said many ASCs are moving away from the traditional physician-supervised model. According to Mr. Tieder, CRNA-only models demand “streamlined workflows, cost-effective care and rapid patient turnover without compromising safety.”
“These demands are driving a transition toward CRNA-led and CRNA-only models, which align more closely with the clinical and financial objectives of these facilities,” he said. “The growing pressure to contain costs while maintaining safety is elevating the visibility and necessity of CRNAs. With the physician anesthesia shortage looming and reimbursement models shifting, CRNAs will continue to be at the forefront of innovative and sustainable anesthesia delivery.”
3. Membership-based surgical facilities offer a new access model
In dense urban markets where block time is scarce and buildouts are expensive, membership-based surgical centers are emerging as an alternative to ownership. Plastic surgeons Oren Tepper, MD, and Evan Garfein, MD, opened Greenwich Street Surgical, a 6,000-square-foot facility in New York City with three ORs, private pre- and post-op bays, anesthesia support and concierge-style recovery services.
The model aims to give surgeons predictable access, priority scheduling, block time and operational support without the fixed costs and administrative burdens of owning or leasing a surgery center long term. Dr. Garfein described the tradeoff as less ownership in exchange for flexibility and lower risk.
“Traditional ownership or long-term lease models lock surgeons into high fixed costs, construction expenses and ongoing administrative burdens,” he said. “Our membership model flips that equation, giving surgeons access to fully equipped ORs, concierge-level staff, and patient amenities, with the flexibility to scale their usage up or down as their practice evolves. The main tradeoff is that members don’t “own” the space, but for most, the benefits of flexibility, lower risk, and operational support far outweigh the limitations of ownership.”
4. A renewed push for independence is shaping new MSO and development models
Consolidation by hospitals, health systems and private equity continues, but some ASC leaders are seeing renewed interest in independence as physicians look to preserve autonomy and ownership.
Newer MSOs and development groups are positioning independence as the value proposition. Pelto Health Partners, for example, was created through a collaboration among Durham, N.C.-based Emerge Ortho, Indianapolis-based OrthoIndy and Seattle-based Proliance Surgeons to support private practice sustainability, particularly around contracting leverage, infrastructure and nonclinical operations.
Another new entrant, ASCend (Gillette, Wyo.), is focused on keeping rural ASCs locally owned and supporting physician-led centers in underserved regions, according to its leadership.
5. EP ablation is a major new frontier for ASC cardiology
CMS’ decision to approve electrophysiology ablation procedures in ASCs marks a significant step for outpatient cardiology and could accelerate the development of specialized cardiac ASCs. Medicare historically restricted EP ablation coverage to hospital outpatient departments due to concerns about supporting higher-acuity cardiac care outside the hospital.
“The addition of EP ablation is a big win for cardiology,” Tracy Helmer, administrator of Mesa, Ariz.-based Tri-City Surgical Centers, told Becker’s. “There’s been a lot of work with that over the last number of years to show the efficacy and safety profile for those particular procedures.”
A scientific statement published by the Journal of the American College of Cardiology in November describes electrophysiology as the next specialty poised for site-of-care migration, similar to interventional cardiology’s path before CMS expanded ASC coverage for cardiac catheterization and percutaneous coronary intervention in 2020.
Cardiology’s outpatient expansion is accelerating. In 2024 alone, 26 cardiology-focused ASCs were opened or announced, reflecting rapid growth in outpatient cath and EP capacity.
6. Sale-leasebacks are gaining appeal as a liquidity and valuation strategy
As ASCs look to improve liquidity, simplify ownership and strengthen valuation, sale-leaseback arrangements are drawing more interest. In a sale-leaseback, an ASC sells its real estate to an investor and signs a long-term lease, often 12 to 15 years, while retaining operational control of the surgery business, said Jon Vick, founding partner of Vick & Co. Leases are commonly structured as triple net.
For physician owners, the strategy can convert real estate equity into cash for debt payoff, partner buyouts, expansion or technology upgrades. Vick said sale-leasebacks can also improve cash flow in a high-rate environment when long-term rent is lower than short-term debt service, potentially boosting EBITDA and enterprise value ahead of a strategic transaction.
He added that timing matters: if physicians are considering selling a controlling stake in the ASC, completing the real estate transaction first can preserve control over lease terms. Owners also need to evaluate tax implications, including capital gains and options such as 1031 exchanges, depending on their goals.
