As healthcare costs continue to rise, organizations are expected to sharpen investments around lower-cost care settings and operational efficiency, according to a report from Ankura’s Healthcare Real Estate Solutions.
Here are five real estate predictions expected to shape ASCs and outpatient growth in 2026:
1. More deals, but fewer new builds
Health system mergers and acquisitions are expected to intensify in 2026, driven by providers, payers and tech-enabled platforms. Rather than building new facilities, organizations will likely prioritize acquiring and retrofitting existing buildings, as construction costs remain high.
Key themes include:
- Integration investments: Newly combined systems will focus on deferred maintenance, infrastructure upgrades, and standardized design templates across multiple sites.
- Flexible financing: Leasing, tenant improvements and joint ventures may take priority over debt-heavy acquisitions, allowing systems to spread costs over time.
2. Payment tailwinds will fuel outpatient and ASC growth
With CMS finalizing a 2.6% ASC payment increase, and broader policy efforts pushing care into lower-cost settings, 2026 is expected to bring continued growth in ASC volume. The report predicts health systems and joint venture partners will expand ASC capacity to manage rising procedural demand, especially as more orthopedic and cardiology procedures shift outpatient. That shift could also drive facility changes, including more large outpatient operating rooms and more lower-acuity procedures moving into procedure rooms.
3. Site-neutral policies will push drug services toward consolidation
Policy changes could also reshape how and where drug administration services are delivered. The report points to site-neutral payment proposals, a potential 60% reimbursement cut for drug administration in off-campus HOPDs, and ongoing 340B recoupment as pressures that could drive systems to rethink their footprint.
In response, systems may:
- Consolidate drug administration services at HOPD sites where justified
- Shift cases that don’t require HOPD settings into smaller, lower-cost outpatient suite
4. GLP-1 adoption will shift capital priorities toward pharmacy infrastructure
As GLP-1 adoption expands and use cases broaden, organizations may shift capital priorities toward chronic disease management infrastructure, including integrated drug-delivery systems, pharmacy hubs and virtual care platforms.
The report also notes tightening 340B and contract pharmacy dynamics are pushing hospitals to build and operate on-campus specialty pharmacies, often as separate suites, to preserve compliance and capture.
5. Hospitals will invest in ownership of specialty pharmacy and care coordination space
The report predicts health systems will increasingly prioritize owning and controlling dispensing and care coordination spaces rather than relying on external networks.
This could drive accelerated growth in:
- On-campus specialty pharmacy build-outs
- Micro-distribution hubs for cold chain and last-mile home delivery (with secure loading and temperature monitoring)
- Pharmacy command centers near clinics to manage prior authorizations, benefits navigation and logistics
- Integrated telepharmacy to improve access and patient experience
