The biggest buyers in outpatient surgery have changed over the past five years. Health systems that once treated ASCs as a side business are now buying national operators outright. Drug distributors are paying billions for the specialty physician groups that fill ASC schedules.
Ascension went from 58 ASCs to more than 300 when it closed its $3.9 billion acquisition of AmSurg this year. In October, Bon Secours Mercy Health agreed to take Surgery Partners private in a deal valued at about $5.7 billion. That deal would add more than 200 ASCs, surgical hospitals and physician practices across 30 states. Tenet’s USPI, the country’s largest ASC operator with interests in 538 centers as of June 30, plans to spend at least $250 million a year on acquisitions.
Here are 10 deals worth $1 billion or more that have reshaped the industry since 2021, starting with the most recent:
2026
- HealthSpan Partners and Surgery Partners: $5.7 billion. HealthSpan Partners, an affiliate of Cincinnati-based Bon Secours Mercy Health, agreed Oct. 26 to acquire Brentwood, Tenn.-based Surgery Partners in an all-cash deal. The deal is expected to close in the first quarter of 2027. If it does, it will be the largest ASC transaction in at least five years and the second time in about a year that a nonprofit health system has bought a national ASC operator.
- Intermountain Health and Surgery Partners’ Idaho hospitals: about $1.15 billion. Salt Lake City-based Intermountain acquired Surgery Partners’ ownership interests in Mountain View Hospital and Idaho Falls Community Hospital in Idaho Falls. The deal was announced July 24 and closed Sept. 17, and Surgery Partners received $797 million. The company has been selling larger hospital assets and shifting resources toward de novo ASC development.
- Ascension and AmSurg: $3.9 billion. St. Louis-based Ascension closed its acquisition of Nashville, Tenn.-based AmSurg this year, about a year after announcing the deal in June 2025. The deal added more than 250 ASCs across 34 states.
- Cencora and EyeSouth Partners’ retina business: $1.1 billion. Conshohocken, Pa.-based Cencora agreed in March to acquire the retina arm of Atlanta-based EyeSouth Partners. Once the deal closes, the affiliated retina physicians will join Retina Consultants of America, extending Cencora’s push into ophthalmology, one of the busiest specialties in ASCs.
2025
- Cardinal Health and Solaris Health: $1.9 billion. Cardinal Health announced in August that it would acquire Solaris Health, a urology management services organization, for $1.9 billion in cash through The Specialty Alliance. The deal followed Cardinal’s Specialty Networks and GI Alliance acquisitions and pushed the distributor further into specialties that do much of their surgical work in ASCs.
- Zimmer Biomet and Paragon 28: $1.1 billion. Zimmer Biomet acquired Paragon 28, a foot-and-ankle orthopedic device company, adding to its product line for the growing number of orthopedic cases moving into ASCs.
2024
- Cencora / Retina Consultants of America: $4.6 billion. Cencora agreed in November to acquire about 85% of Retina Consultants of America from Webster Equity Partners for $4.6 billion in cash. It was the first of several Cencora deals that together top $10 billion in physician acquisitions.
- Cardinal Health and GI Alliance: $2.8 billion. In November, Cardinal Health agreed to acquire a 71% stake in Dallas-based GI Alliance, one of the country’s largest gastroenterology platforms. GI is among the highest-volume ASC specialties.
- Cardinal Health and Specialty Networks: $1.2 billion. In January, Cardinal Health agreed to acquire Specialty Networks, a technology-enabled group purchasing and practice enhancement organization. Its partners include GastroGPO, Gastrologix, UroGPO and United Rheumatology. The deal was Cardinal’s first major move into specialty physician services and set up its later GI Alliance and Solaris Health acquisitions.
2021
- USPI and SurgCenter Development: about $1.2 billion. In November, Tenet’s United Surgical Partners International agreed to acquire ownership interests in 92 more SurgCenter Development ASCs. The deal followed a $1.1 billion deal for 45 SurgCenter centers in 2020 and helped make USPI the country’s largest ASC operator.
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.
