In 2022, Ascension ran 139 hospitals and was losing nearly $2 billion a year. By June 2026, it operated 90 hospitals and more than 300 ASCs.
The $3.9 billion acquisition of AmSurg was the final move in a significant strategic pivot from acute care giant to outpatient operator.
Here is how the Ascension-AmSurg deal unfolded:
Fiscal 2022 and 2023: Ascension’s financial losses force a strategic reset
The conditions that led Ascension to AmSurg began with a financial crisis. Ascension ended fiscal 2022 with a $1.8 billion operating loss and fiscal 2023 with a $3 billion loss, which included $1.5 billion in nonrecurring losses and impairment. To boost margins in fiscal 2024, the system said it would focus on improving acute care assets for complex patients while accelerating growth through ancillary services and ambulatory networks.
October 2023: AmSurg emerges as a standalone company
In 2023, AmSurg split from Envision Healthcare in October 2023, purchasing all the ASCs held by Envision after the company filed for Chapter 11 bankruptcy in May 2023. AmSurg emerged as a separate and independent entity with 250 surgery centers across 34 states, with Pacific Investment Management Co. becoming its new majority owner following the restructuring. Under CEO Jeff Snodgrass, AmSurg began rebuilding as a standalone operation and quickly resumed acquisition activity.
2022 to 2024: Ascension’s hospital sell-off begins
In 2022, Ascension began an operational transformation aimed at strengthening long-term sustainability following the financial strain of the COVID-19 pandemic. The effort included strategic divestitures, market exits and the rollout of a more disciplined operating model. The sell-off gathered pace over the following two years.
Key divestitures included the 2024 launch of a joint venture between Detroit-based Henry Ford Health and Ascension Michigan, which folded 10 Ascension hospitals into the partnership. In February 2024, Ascension sold Our Lady of Lourdes Memorial Hospital System in Binghamton, N.Y., to Sayre, Pa.-based the Guthrie Clinic. In June 2025, Ascension sold nine hospitals, four senior living facilities and related operations in the Chicago area to Prime Healthcare Services. In July 2025, it transferred four Michigan hospitals to Beacon Health System.
Over three years, Ascension reduced its hospital portfolio from roughly 139 facilities to 90 wholly owned or consolidated hospitals.
2024-2025: AmSurg rebuilds and expands
Post-independence, AmSurg’s strategy centered on broadening what had always been a relatively GI- and ophthalmology-heavy portfolio. The company leaned into a “collaborative model” that distinguished it from more acquisitive peers, partnering with health systems such as Baltimore-based LifeBridge Health and Escondido, Calif.-based Palomar Health through joint ventures rather than pure acquisition.
In January 2025, AmSurg acquired majority ownership interest in Texarkana Surgery Center in Texas. In April 2025, it acquired Pinnacle Surgery Center in Covington, La.
June 2025: Deal announced
People familiar with the discussions told Bloomberg that Ascension and AmSurg were in talks on a deal that could close in the coming weeks, though no agreement had been finalized and negotiations remained fluid.
St. Louis-based Ascension announced it had entered a definitive agreement to acquire AmSurg in a deal valued at $3.9 billion. The transaction would expand Ascension’s ASC footprint from 58 centers to more than 300 across 34 states.
“AmSurg has a great management team,” Ascension President Eduardo Conrado told Becker’s. “They’ve got an operational platform that mirrors their areas of focus, which is quality, clinical engagement, and patient experience — in a segment that’s growing 9% to 12% over the next five years.”
The transaction was expected to close in late 2025 or early 2026, pending regulatory approval.
September 2025: The strategic logic becomes explicit
By the time deal talks became public, Ascension’s ambulatory pivot was already well underway. Ascension reported an operating loss of $490.9 million, a negative 1.6% margin, for fiscal 2025 ending June 30, an improvement from a $1.8 billion operating loss the previous year.
“Our FY25 results reflect the disciplined execution of our strategy,” Ascension President Eduardo Conrado said. “Strategic initiatives, from expanding ambulatory and specialty services to investing in digital capabilities, are helping us meet patients where they are.”
Amber Sims, Ascension’s chief strategy and growth officer, told Becker’s the transformation was deliberate.
“Our new operating model, along with our divestitures, gave us the capacity to accelerate growth and expand care beyond traditional brick-and-mortar hospitals, allowing us to extend our impact in new and meaningful ways,” she said.
Nov. 3, 2025: Ascension executives frame the strategy publicly
At Becker’s CEO + CFO Roundtable in Chicago, Ms. Sims laid out the rationale.
“We truly think this AmSurg partnership will be transformational for our organization,” she said. “We really tightened our portfolio and recognized that we have to get ahead in the ambulatory business, because that’s where care is going. It’s where patients want to receive care, where payers want to seek care, and where providers want to provide care.”
February 2026: Closing delayed
Financial documents published in May 2026 confirmed the deal had not yet closed as of early 2026, noting “the transaction is expected to be finalized after all necessary approvals are obtained.”
Ascension leaders framed the ambulatory push as part of a broader effort to close access gaps that funnel patients toward the emergency department.
The delay came as Ascension continued restructuring its hospital portfolio, shrinking from approximately 140 hospitals to 90 wholly owned or consolidated facilities in 2022.
June 2: FTC issues consent order, requires 7 divestitures
The Federal Trade Commission published a consent order requiring Ascension to divest seven AmSurg ASCs in markets where the deal would “otherwise threaten competition,” including facilities in Tennessee, Florida, Oklahoma, Texas and Kansas. Six of the seven centers would be sold to SC Affiliates, a subsidiary of SCA Health and Optum. The seventh, in Panama City, Fla., would be transferred to Florida Gastroenterology Center.
The consent order also required Ascension to provide the FTC with prior notice before acquiring any ASCs in the metropolitan areas surrounding the divested centers for a period of 10 years.
June 4: Deal closes
Ascension completed the acquisition of AmSurg, officially expanding its ASC network to more than 300 centers across 34 states and positioning the health system as one of the largest ASC operators in the country alongside Tenet’s United Surgical Partners International and SCA Health.
“Healthcare is increasingly moving beyond the traditional hospital setting, and this acquisition positions us to lead that transformation,” Mr. Conrado, who assumed the CEO role at Ascension in January in addition to serving as president, said in a release.
Mr. Snodgrass framed the deal’s closing as a continuation rather than a conclusion.
“The Ascension acquisition provides an opportunity to continue building on this work,” he said. “Our operating and partnership model has always been built on what we term the ‘collaborative model’ — the acquisition will not change that.”
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.