Dallas-based Tenet Healthcare’s United Surgical Partners International ended 2025 with ownership interests in 533 ambulatory surgery centers and 26 surgical hospitals as the health system’s decade-long pivot away from acute care toward ambulatory and specialty services continued to generate strong financial returns, according to its proxy statement filed April 16 with the Securities and Exchange Commission.
Seven things to know:
1. USPI added 34 ASCs and one surgical hospital in 2025, including six de novo centers and 28 acquired through controlling ownership interests. Many of the new centers specialize in higher-acuity services, with a particular emphasis on orthopedics. Same-facility revenue grew 7.2% in 2025, and Tenet invested about $339 million in USPI mergers and acquisitions, with a robust development pipeline already in place for 2026.
2. USPI remains the largest ASC operator in the country by a wide margin. According to VMG Health’s annual ASC industry report, published Feb. 3, no competitor comes close. Here are the five largest ASC operators by facility count:
- USPI: 533
- SCA Health (Optum’s ASC arm): 320
- AmSurg: 250
- Surgery Partners: 182
- HCA Surgery Ventures: 150
3. Key milestones in Tenet’s transformation include its 2015 merger with USPI; its $1.2 billion acquisition of SurgCenter Development in 2021, which added 85 ASCs and included a five-year agreement to develop at least 50 new centers; and the 2024 sale of 14 hospitals for more than $4.8 billion — a move CEO Saum Sutaria, MD, said marked Tenet =’s entry into “a new era” with a greater proportion of performance driven by its ambulatory business.
4. Tenet has significantly reduced its hospital footprint in recent years — selling 14 hospitals in 2024 alone — and is investing at least $250 million a year to acquire ASCs under USPI. The system now operates 49 acute care hospitals while USPI has grown to include 533 ASCs and 26 surgical hospitals across 37 states.
“We had an active year in the M&A and de novo activity lines as well, investing nearly $350 million in 2025 and adding 35 facilities to the portfolio,” Dr. Sutaria said Feb. 11 during the company’s fourth-quarter earnings call. “The pipeline for both M&A and de novo development remains strong as we look into 2026. We remain the preferred acquirer and developer of assets in this space.”
5. De novo development is an increasing focus Executives have described de novos as creating significant value in targeted markets because building from the ground up allows USPI to establish preferred positioning, with lower build costs and quicker turnaround than acute care facilities once physician partnerships are in place.
“Our transformed portfolio and disciplined operations have empowered us to expand margins and drive substantial cash flow generation, which has enabled us to further deleverage, strengthen our balance sheet and increase our financial flexibility,” the company said in its proxy report. “We are focused on introducing new services at a lower cost and offering an excellent patient experience in the most clinically appropriate setting. Our focus is on markets where we can provide a strong value to consumers and payers, and the evolution of our care delivery locations reflects our strategy to grow USPI.”
6. Tenet’s revenue topped $21.3 billion in 2025, with $16.1 billion coming from its hospital business and $5.2 billion from its ambulatory division. USPI’s net operating revenue rose from $4.5 billion in 2024 to $5.2 billion in 2025, with adjusted EBITDA reaching $2 billion. Across the enterprise, Tenet posted a $3.5 billion operating income (16.5% margin) on revenues of $21.3 billion in 2025. The company achieved a 21.4% adjusted EBITDA margin — up more than 200 basis points over the prior year — and finished the year with an EBITDA leverage ratio of 2.25x and about $1.7 billion in free cash flow after noncontrolling interest distributions.
7. Tenet expects continued growth in 2026, projecting USPI revenue of $5.5 billion to $5.7 billion and EBITDA of $2.13 billion to $2.23 billion. Companywide, Tenet forecasts revenue between $21.5 billion and $22.3 billion and net income of $2.6 billion to $2.8 billion.
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.