As the ASC industry heats up with competition between hospitals, health systems, corporate entities and independent practices, ASC leaders are faced with difficult choices as they debate maintaining independence, partnering up or selling off their practice to survive.
According to a survey released by VMG Health Oct. 9, 59% of independent ASCs would consider a strategic partnership rather than a full sales transaction. Among ASCs open to partnerships, 71% would consider partnering with a health system, 31% with a management company and 29% with a private equity group.
This trend has developed as hospitals and health systems become increasingly interested in ASCs. In a 2024 VMG Health survey of 141 health system executives, including CEOs, CFOs and COOs, outpatient surgery ranked as the top service line for joint venture partnerships, with more than 60% of respondents indicating ASCs were a top interest for their growth.
Karen Reiter, vice president of operations and payer management at Newport Beach, Calif.-based TriasMD and DISC Surgery Center, told Becker’s that this trend marks a departure from the competition typically seen between ASCs and large, integrated health systems.
“It’s not a ‘them versus us’ mentality anymore,” Ms. Reiter said. “This ongoing collaboration is a great thing to see and will take us where we want to go.”
ASCs are also finding space for creativity and negotiation in how these partnerships are structured, including three-way and hybrid joint ventures between ASCs, hospitals and health systems.
Mark Langston, chief development officer at Compass Surgical Partners, told Becker’s these ventures have become central to the company’s growth and a lifeline for practices facing consolidation.
Mr. Langston frames three-way JVs as a direct response to the “squeeze” on independent physicians and ASCs. He said small practices struggle in risk-based models, lack payer leverage and often can’t afford needed infrastructure.
“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.”
Compass’ role in these arrangements is to align incentives between other partners and collaborate with health systems to build local strategies, reduce administrative burdens, optimize anesthesia coverage and recruit staff — all things that have proved challenging for independent ASCs to manage while staying afloat.
Other groups remain intent on maintaining their independence, and are doing so through networks of other independent ASCs. These networks can share resources and support sustainable growth and independence for small and mid-sized ASCs.
Pelto Health Partners is one of several companies Becker’s has reported on in 2025 that it is pursuing this development model. The group launched three years ago out of an initial partnership between three physician-owned orthopedic groups.
“We felt something needed to be done to keep independent groups independent, as many were being driven into hospital employment or selling to private equity,” Frank Aluisio, MD, of EmergeOrtho, who now serves as chair of Pelto’s board, told Becker’s. “Maintaining independence is important in prioritizing patients and the physician-patient relationship — not profits.”
Pelto aimed to create a “landing spot for small to medium-sized groups that were struggling,” Dr. Aluisio continued, and to help out with back-office functions.
Since its founding, Pelto has expanded to include at least six additional physician groups. But that growth has been measured and intentional, Dr. Aluisio said. Rather than rapidly scaling and risking infrastructure strain, the organization focused on thoughtful integration.
