The ASC sector is rapidly consolidating. National operators, health systems and private equity firms are accelerating acquisitions, reshaping market dynamics and changing what it means to be an independent ASC.
Nearly 2,000 ASCs are now affiliated with a national chain — a sign of how much of the market has shifted away from physician-owned independence. Chain operators now control about 33.5% of freestanding ASCs, with the remaining 66.5% still held by independents.
The leaders in market share are familiar names: 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%.
While each operator’s strategy differs — from USPI doubling down on orthopedics to SCA expanding its gastroenterology platform through its acquisition of Exton, Pa.-based U.S. Digestive Health Management, the cumulative effect is clear: independent ASCs are becoming rarer.
The shift is also influencing the financial landscape. Multiples for ASC acquisitions are stabilizing at around 8× EBITDA, a signal that valuations are becoming more standardized as competition for deals heats up.
But the rush to consolidate raises questions. Physician leaders have pointed to trade-offs in autonomy, pricing and patient choice as facilities join larger platforms.
Others are asking what happens when the supply of independent ASCs runs thin. Some suggest the “endgame” could involve mega platforms or even REIT-style investors stepping in as the next wave of buyers.
Industry executives widely expect the consolidation curve to continue, with both large strategic acquisitions and smaller roll-ups of underperforming centers likely through 2025 and beyond.
For independent centers, the question is no longer whether consolidation is coming — but how soon they may be next.
