ASC financing is quietly shifting from all-or-nothing equity models to more nuanced ownership structures. Physician groups are increasingly exploring hybrid models, partial equity sales and governance arrangements that preserve both capital access and clinical control.
Here are five emerging trends driving this shift:
1. Consolidation continues to press physician groups: Corporate and chain acquisition activity in the ASC space shows no sign of slowing.
As large platforms expand, physician-led centers face intensifying pressure to adapt or partner. Corporate ownership is steadily rising in the ASC sector, even while physicians still retain majority stakes in many centers.
2. Hybrid ownership earns favor over total sell-outs: Fully physician-owned ASC models are increasingly being replaced by shared equity structures and joint ventures that balance financial flexibility with long-term alignment.
Some companies are adopting a “cafeteria-style” ownership model — one in which organizations charge for specific setup projects and then collect a management fee, Jack Bert, MD, a private practice orthopedic surgeon in Woodbury, Minn., told Becker’s in June.
He noted that in some cases, employed physicians are gaining partial ownership stakes in large health system ASCs to supplement their income — a “good-faith” arrangement remains rare, he said.
“These hybrid approaches give physician groups more flexibility and allow them to retain a stake in the ASC’s success even if they don’t hold full control,” Dr. Bert said.
3. Collaboration is key: Simply owning equity no longer cuts it — physicians increasingly demand meaningful control and voice in ASC operations.
“There has to be an alignment so those surgeons feel like they’re coming to a venue of surgery where they have real, meaningful input on controlling elements and elements that are are related to them — whether that be performing the surgery or managing their patients,” Benjamin Stein, MD, an independent orthopedic surgeon and co-founder and chairman of Capital Surgical Solutions, told Becker’s in May.
4. Tiered partnerships and flexible buy-ins lower barriers for new physicians: Many ASCs are rethinking ownership to attract younger surgeons wary of high buy-in costs.
Shobhit Minhas, MD, an orthopedic surgeon at Fox Valley Orthopedics in Geneva, Ill., told Becker’s that lowering upfront investment is essential.
“I would think it would be reducing the buy-in costs into an ASC,” Dr. Minhas said. “But also, at the end of the day, the ASC has to make money, and that physician needs to bring it in.”
He said tiered or “super partnership” models, where physicians earn equity over time based on performance, can balance opportunity with accountability. Financing options or extended payment plans can also help lower barriers while keeping ASCs financially stable.
5. Compliance guardrails shape ownership structuring: As ASC ownership structures diversify, regulatory compliance remains a key constraint. Federal safe harbor provisions prohibit centers or their owners from lending money or guaranteeing loans to help new physicians buy shares.
This means newer equity models must be carefully designed to balance flexibility with legal safeguards, ensuring that financial innovation doesn’t cross compliance lines.
