From three-way joint ventures to system-scale acquisitions, here are five transactions from the last year that show where the industry could be headed.
1. Surgery Partners + Baylor Scott & White
In December, Brentwood, Tenn.-based Surgery Partners partnered with Dallas-based Baylor Scott & White Health to jointly own a 16-bed hospital in Bryan, Texas. The two organizations will jointly own The Physicians Centre Hospital alongside physicians at the facility.
The deal reflects a broader trend of health systems increasingly partnering with ASC companies and operators to grow outpatient surgery using existing infrastructure. In a 2025 VMG Health survey of health system executives, outpatient surgery ranked as the top service line for joint venture partnerships, with more than 60% of respondents naming ASCs as a primary growth interest.
“The new joint venture integrates our patient-centric hospital with one of the nation’s most respected health systems and provides the opportunity to serve additional patients, attract new physician partners and broaden our breadth and depth of services,” Jennifer Baldock, executive vice president at Surgery Partners, said.
At the same time, many independent ASCs appear to prefer strategic alignment over full acquisition. A VMG Health survey released Oct. 9 found that 59% of independent ASCs would consider a strategic partnership rather than a full transaction. Among those open to partnerships, 71% said they would consider partnering with a health system, while 31% would consider a management company and 29% a private equity group.
2. Regent Surgical + Patches Kids Care
Nashville, Tenn.-based ASC company Regent Surgical has entered into a partnership with Patches Kids Care to develop ASCs, marking its first venture into pediatric care.
“Partnering to build the first pediatric-focused ASC in our portfolio is both a strategic milestone and a reflection of our commitment to advancing access to high-quality, specialized surgical care,” Travis Messina, CEO of Regent, said in the release. “By aligning with the experienced pediatric care providers at Patches, we will deliver a new standard of outpatient surgical care tailored to younger patients, while offering an enhanced experience to their families and supporting clinicians in a more efficient and flexible care environment.”
The deal comes as dental procedures gain more momentum in the ASC setting. CMS’ 2025 ASC Covered Procedures List represented a notable shift, with greater focus on dental and regenerative therapy procedures rather than expanded high-acuity offerings, according to a report from VMG Health. CMS approved 16 dental codes in 2025.
Interest in pediatric ASCs has grown rapidly in recent months. Private equity firm Great Hill Partners acquired a majority interest in Blue Cloud Pediatric Surgery Centers, the nation’s largest pediatric ASC operator specializing in dental and oral surgery. The company operates 32 accredited facilities across 12 states.
3. Ascension + AmSurg
Ascension entered into a definitive agreement June 17 to acquire AmSurg, a move poised to significantly scale the system’s ASC footprint. AmSurg, headquartered in Nashville, Tenn., partners with around 2,000 physicians and operates 250 ASCs, making it the nation’s second-largest ASC chain behind Tenet’s United Surgical Partners International. The deal is reportedly valued at $3.9 billion and expected to close in early 2026.
“This transaction reflects a broader recalibration among health systems, which are increasingly recognizing the imperative to pivot more aggressively toward the ambulatory surgical setting — and away from traditional inpatient and HOPD models,” Benjamin Stein, MD, chairman and CEO of Capital Surgical Solutions, told Becker’s.
Unlike private equity players, health systems bring integrated payer relationships, managed care contracts and value-based infrastructure, all crucial for ASC scalability in today’s payment environment.
“We have 58 ASCs. This is going to add another 250, so it’s going to give us a good presence in 34 states,” Ascension President Eduardo Conrado told Becker’s. “And AmSurg has a great management team. They’ve got an operational platform that mirrors their areas of focus, which is quality, clinical engagement and patient experience — in a [the ASC market] that’s growing 9% to 12% over the next five years. So, everybody’s very excited about coming up on this next step.”
4. SCA Health + U.S. Digestive Health Management
In January 2025, Optum subsidiary SCA Health quietly completed the acquisition of U.S. Digestive Health Management, one of the nation’s largest gastroenterology physician groups, from Amulet Capital Partners.
Formed in 2019 through the consolidation of three regional gastroenterology groups with private equity backing, U.S. Digestive Health has grown into a major platform in the Northeast, with more than 250 gastroenterology providers across 40 practice sites and 24 ASCs in Pennsylvania and Delaware.
The acquisition adds to a pattern of aggressive growth by Optum. As of July 17, UnitedHealth, Optum’s parent company, directly employed or contracted with more than 90,000 physicians, according to a new “Sunlight Report” by the Center for Health & Democracy, funded by Arnold Ventures. This accounts for about 10% of the entire U.S. physician workforce. Optum’s subsidiaries include 423 ASCs, more than 880 home health companies and 335 administrative/support entities.
Meanwhile, private equity activity in gastroenterology has slowed in deal frequency but increased in size. The number of GI PE deals fell by 50% between 2022 and 2023, dropping from 26 to 13. Still, large platforms such as GI Alliance, Gastro Health and United Digestive are expanding through add-on acquisitions and recapitalizations. GI Alliance’s $785 million investment with Apollo Global Management and Cardinal Health’s $2.8 billion majority stake in GI Alliance illustrate the scale of recent GI megadeals.
5. Bon Secours Mercy Health + Compass Surgical Partners
Cincinnati-based Bon Secours Mercy Health and Raleigh, N.C.-based Compass Surgical Partners expanded their joint venture footprint with plans to develop 30 new ASCs across Kentucky, Ohio, South Carolina, Virginia, Maryland, New York and Florida. The organizations also recently announced plans to open a cardiovascular ASC in Virginia.
As pressures mount on independent physicians and health systems, the three-way joint venture model, typically uniting a health system, a physician group and an ASC management company, is becoming a major tool for ASC development.
Mark Langston, CEO of Compass Surgical Partners, told Becker’s these ventures have become central to the company’s strategy and a lifeline for practices facing consolidation.
In 2024, 42.2% of physicians were working in private practice, a significant drop from 60.1% in 2012, according to a survey from the American Medical Association. Conversely, the share of physicians working in hospital-owned practices rose to 34.5% in 2024, an 11-percentage point increase from 23.4% in 2012.
Mr. Langston framed three-way JVs as a direct response to rising pressure on independent physicians and ASCs.
“Independent physicians are really in a squeeze right now,” he said. “If you have an independent surgery center, it’s tough. If you’re in an independent practice, also tough. If you’re doing both — good luck in today’s world.”
Three-way JVs can pool resources while maintaining physician equity and autonomy. Compass focuses on aligning incentives, embedding with health systems to build local strategies, reducing administrative burdens, optimizing anesthesia coverage and recruiting staff.
