From payer dynamics to innovation, the ASC industry is being reshaped by shifting market share, rapid expansion and new quality benchmarks. While independent ASCs still make up most of the market, chain operators are driving much of the growth and investment.
Here are five themes defining the industry in 2025:
1. Market share dominance
Around 33.5% of freestanding ASCs are now owned by chains.
A breakdown of leading chains finds Dallas-based United Surgical Partners International holds 8.1% of the ASC market, Deerfield, Ill.-based SCA Health 5%, Nashville, Tenn.-based AmSurg 3.9%, Nashville, Tenn.-based HCA Healthcare 2.3% and Brentwood, Tenn.-based Surgery Partners 2%. The remaining 66.5% are independent centers, confirming a strong majority remains unaffiliated.
2. Expansion over the past decade
Since 2011, the five companies have added more than 500 centers combined. USPI has seen the fastest growth, more than doubling its portfolio during that period.
3. Payer dynamics shaping growth
ASCs are facing growing pressure from declining reimbursements, prior authorization challenges and shifts toward bundled and value-based payment models. Accelerated payer disruptions — from denials and delays to reimbursement cuts — are squeezing financial margins. Larger chain operators are better positioned to negotiate favorable terms, while independent centers often lack the scale to counter these headwinds.
4. Recognition for quality
Recognition in the ASC industry is increasingly tied to performance metrics and growth strategies, rather than third-party rankings. USPI added nearly 70 centers in 2024, demonstrating consistent expansion aligned with quality initiatives.
Surgery Partners, meanwhile, invested nearly $400 million in acquisitions and de novo centers in 2024, reinforcing its reputation for expanding high-quality specialty services nationwide.
5. Innovation shaping the future
USPI’s parent company, Tenet Healthcare, launched Commure’s ambient AI platform across its physician network to streamline documentation workflows and reduce administrative burden.
Surgery Partners expanded its high-acuity capabilities by adding 14 surgical robots to its portfolio, underscoring its commitment to orthopedic and general surgery innovation.
SCA Health is focused on physician integration and growing its higher-acuity musculoskeletal business — including consolidations and the OrthoAlliance acquisition — as part of its 2025 strategy.
