On Oct. 26, Cincinnati-based Bon Secours Mercy Health agreed to acquire Brentwood, Tenn.-based Surgery Partners through its affiliate HealthSpan Partners in a take-private deal valued at about $5.7 billion including debt.
The transaction would add more than 200 ASCs, surgical hospitals and physician practices across 30 states, along with about 5,000 affiliated physicians, to a 47-hospital system — making the latest in a growing group of health systems that have shifted ambulatory care from a nice-to-have to a strategic imperative.
It most recently follows St. Louis-based Ascension’s $3.9 billion acquisition of Nashville, Tenn.-based Amsurg, which closed earlier this year, and comes as Dallas-based Tenet Healthcare keeps adding to United Surgical Partners International, its surgical arm and the nation’s largest ASC portfolio.
As payers steer procedures toward lower-cost sites of care and access becomes a prime concern for leaders, systems are looking to ASCs for expansion.
“To build it ourselves, it would take way too long to get to where we needed to go,” Amber Sims, executive vice president and chief strategy and growth officer at Ascension, told Becker’s.
The Amsurg deal took Ascension from 58 ASCs to more than 300. The system plans to use Amsurg’s presence in 10 of its existing markets while entering 25 more, and it is leaving Amsurg’s operating model largely in place.
Tenet has already shown what the model can earn. Its ambulatory arm, Dallas-based USPI, held interests in 538 ASCs and 26 surgical hospitals across 37 states as of June 30. USPI generated $5.2 billion in net operating revenue and about $2 billion in adjusted EBITDA in 2025, roughly a quarter of Tenet’s total revenue. The company plans to spend at least $250 million a year acquiring centers and deployed $125 million on seven ASC acquisitions in the first quarter alone.
Bon Secours Mercy Health enters the race from a different financial position. The system reported nearly $14 billion in total operating revenue in 2025 but $324 million in recurring operating income, a 2.3% margin. It will fund the Surgery Partners deal with cash on hand and new debt.
Surgery Partners will retain its name, brand and headquarters and will remain a secular organization rather than becoming part of Bon Secours Mercy Health’s Catholic ministry. Bain Capital affiliates, which own about 39% of Surgery Partners, will roll their shares into equity in the acquiring entity and remain significant partners.
Federal policy is adding to the pull. CMS added 289 procedures to the ASC covered procedures list for 2026 and removed 271 from the inpatient-only list, widening the volume that can move to lower-cost surgical settings.
In a statement, Bon Secours Mercy Health President and CEO John Starcher Jr. framed the acquisition as a way to reach more people in more communities across more care settings. Surgery Partners CEO Eric Evans called the sale the best path forward for the company and its shareholders.
Public shareholders will receive $23.50 per share in cash. That is below the $25.75 per share Bain proposed in January 2025 for the shares it did not already own. In June 2025, a special committee of Surgery Partners’ independent directors concluded the company would be worth more as an independent public company.
Since then, Surgery Partners has narrowed its focus. In March, investor Ortelius Advisors urged the company to sell all of its surgical hospitals. On Sept. 17, Surgery Partners completed the $797 million sale of its interests in two Idaho hospitals to Salt Lake City-based Intermountain Health, directing most of the net proceeds to debt repayment. It has nine ASCs under construction and more than a dozen in additional development.
The deal still awaits regulatory approval. To clear the Amsurg deal, the FTC required Ascension to divest seven ASCs across five metro areas: Nashville; Panama City, Fla.; Tulsa, Okla.; Waco, Texas; and Wichita, Kan. For 10 years, Ascension must give the agency 30 days’ notice before acquiring any interest in an ASC in those markets, even when the deal would not otherwise require a federal filing.
The Bon Secours Mercy Health transaction is expected to close in the first quarter of 2027, pending shareholder and regulatory approval. If it does, the system will own one of the five largest ASC platforms in the country. Surgery Partners ranked fourth by ASC count at the end of 2025, behind USPI, SCA Health and Amsurg.
For health systems still building one joint venture at a time, the question is whether that pace can keep up with competitors adding hundreds of centers in a single transaction.
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.
