Here’s a breakdown of the five biggest ASC companies, based on the most recent available information:
United Surgical Partners International
Tenet Healthcare-owned USPI is the largest ASC company in the country, with at least an 8.1% share of the market. As of March 31, USPI had ownership interests in 520 ASCs (380 consolidated) and 25 surgical hospitals (seven consolidated) across 37 states. With over 11,000 affiliated physicians, USPI performs more than 2 million procedures annually and added at least 57 ASCs in 2024, with 10 to 12 more centers expected in 2025.
Tenet has aggressively expanded USPI while divesting hospital assets to boost profitability and streamline operations. In 2024, Tenet sold 14 hospitals in California, South Carolina and Alabama for more than $4.8 billion, sharpening its focus on outpatient care. Today, USPI accounts for a significant portion of Tenet’s financial performance.
“Tenet is entering a new era with a greater proportion of our performance coming from our highly efficient ambulatory surgical business and a reduced debt profile,” CEO Saum Sutaria, MD, said during a recent earnings call. “We will have significant financial and capital flexibility to increase shareholder value over the long-term.”
SCA Health
Optum’s SCA Health operates 423 ASCs, according to a newly published report detailing parent company UnitedHealth Group’s 2,700 subsidiaries. UnitedHealth now directly employs or contracts with over 90,000 physicians, representing approximately 10% of the U.S. physician workforce.
SCA is also focused on expanding into more high-acuity cases. At the end of 2024, it announced plans to acquire OrthoAlliance, a musculoskeletal management services group. In January, Optum also agreed to acquire FlexCare Infusion, an ambulatory infusion network based in Oklahoma City. According to the company’s website, FlexCare has 30 clinic locations across Alabama, Arizona, and Oklahoma.
“While Optum is a giant corporation, it operates much like a PE firm, buying out more and more independent practices and surgery centers across the country, Allyn Wilcock, CRNA, owner of Snoqualmie, Wash.-based Advanced Anesthesia Services and Northwest Healing and Wellness.
AmSurg
AmSurg, one of the country’s largest ASC companies, was recently acquired by St. Louis-based Ascension. Headquartered in Nashville, Tenn., AmSurg partners with around 2,000 physicians and operates 250 ASCs..
“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.
Prior to the acquisition, AmSurg had been expanding its partnership opportunities. It partnered with Owings Mills, Md.-based LifeBridge Health and Pikesville, Md.-based Woodholme Group to open a gastroenterology ASC in Westminster, Md.
2025 has also been a major year of acquisitions for AmSurg. In January, it acquired majority ownership interest in Texarkana (Texas) Surgery Center. In April, it acquired Pinnacle Surgery Center in Covington, La.
HCA Healthcare (Nashville, Tenn.)
HCA Healthcare consists of 184 hospitals and more than 2,000 care sites, including 124 ASCs. HCA Healthcare Surgery Ventures, the company’s ASC arm, partners with more than 3,400 physicians.
CEO Sam Hazen said at the Morgan Stanley Global Healthcare Conference that the health system averages 13 outpatient facilities for each hospital — a figure he expects to grow to between 17 and 20 by 2030.
Mr. Hazen emphasized the company’s strategy to “extend the reach of our network for our patients, make it more convenient for them to start their process of care somewhere in the HCA system.”
Surgery Partners (Brentwood, Tenn.)
On June 17, Brentwood, Tenn.-based Surgery Partners, one of the country’s largest ASC operators with more than 200 centers in 33 states, rejected a buyout bid from Bain Capital, its largest shareholder, choosing to remain independent. Bain, which owns 39% of Surgery Partners, valued the company at $3.2 billion. The board, however, cited strong financials, market position, and growth potential as reasons to decline.
“Surgery Partners offers a unique, scaled platform in the high-growth outpatient surgical care market that leverages its proven joint venture model, strong M&A track record and favorable demographic and policy tailwinds,” Brent Turner, chairman of the independent committee, said in a June 17 release.
Many ASC leaders believe Bain saw limited future growth, while Surgery Partners sees long-term opportunity.
“I have done this dance a hundred times,” Shakeel Ahmed, MD, CEO of Atlas Surgical Group, told Becker’s. “Surgery Partners’ decision to walk away from Bain speaks volumes about where leadership sees long-term value creation. Our industry is still early in its maturity curve. We’re witnessing unprecedented migration of complex surgeries to outpatient settings, bundled payment models gaining traction, and increasing physician alignment. While private equity may see a ceiling, operators like Surgery Partners see a runway.”
Surgery Partners is focusing on orthopedic growth in 2025. In January, Laura Forese, MD, was named to the board of directors. Total joint replacements are driving increasing volumes, CEO J. Eric Evans said during a May 12 earnings call. Surgery Partners facilities saw more than 29,000 orthopedic cases in Q1 2025, a 3.4% year-over-year increase. Total joint replacements saw a 22% jump year over year, according to a Reuters transcript.
