The cost of running an ASC has never been higher. Anesthesia stipends, labor costs and supply inflation get most of the attention, but the rent line on the income statement could be moving faster than almost any of them.
ASCs are commanding the highest rent increases of any outpatient facility type, with rents climbing more than 8% year over year while ASC leases in that period surged 145% from 2022 to 2025, according to a March 2026 CBRE report. The combination of more leases and higher rates per lease is landing on ASC balance sheets at a moment when margins are already under pressure from multiple directions.
Demand for medical outpatient space has been especially acute in the Sun Belt, but construction is not keeping pace: about 93% of that space nationally is now occupied, according to JLL’s 2026 Medical Outpatient Building Perspective report.
The gap is sharpest in Florida and Texas. In Orlando, outpatient visits are projected to grow 16.4% through 2029 while construction of new sites is projected to grow only 3.8%. Dallas-Fort Worth, Houston, San Antonio, Atlanta, Phoenix, Washington, D.C., and Boston were also identified as high-gap markets, according to the report.
When 93% of available space is occupied and demand is outpacing new construction in most major markets, landlords have leverage. ASCs expanding into new markets or renewing existing leases in high-demand geographies are negotiating from a weaker position than they were five years ago.
Not all specialties face equal exposure. In single-specialty leasing, orthopedics accounts for 22% of leases, followed by oncology at 11%, cardiology at 7%, and ophthalmology and cosmetic surgery at 6% each, according to a 2026 Colliers report. Fertility, dermatology and urology each account for 5% to 6%, while gastroenterology, gynecology and nephrology represent smaller shares.
The orthopedic dominance reflects the procedure migration story. Total joint replacements and spine cases moving out of hospital settings require larger footprints with more specialized infrastructure than a typical GI or ophthalmology ASC. Larger space plus higher per-square-foot rates equals the steepest lease exposure in the industry.
Leasing, tenant improvements and joint ventures may take priority over debt-heavy acquisitions in 2026, allowing health systems and operators to spread real estate costs as they expand ASC capacity, according to a January 2026 analysis.
That shift toward leasing over ownership, driven partly by higher borrowing costs and partly by the capital demands of building new centers, means more operators are entering the lease market at precisely the moment when rents are at their highest and vacancy is at its lowest.
The procedure migration that makes ASCs strategically essential requires the physical infrastructure to absorb those cases. Building that infrastructure in a market where 93% of available space is occupied and rents are rising at 8% per year will be an underappreciated operational challenge heading through 2030.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
