Dallas-based Tenet Healthcare’s United Surgical Partners International continues to double down on ASC high-acuity procedures and robotics amid a yearslong transformation away from acute care.
Here’s where Tenet CEO Saum Sutaria, MD, says the business is headed, in their own words, pulled from an April 30 earnings call:
Broad strategic positioning:
“Our diversified asset mix with a focus on ambulatory care gives us a significant strategic advantage in the market as we look ahead.” — Dr. Sutaria
USPI ended 2025 with ownership interests in 533 ASCs and 26 surgical hospitals, the result of a decade-long pivot away from acute care that has steadily shifted the center of gravity of Tenet’s business toward ambulatory and specialty services. Key milestones in that transformation include the 2015 merger with USPI; a $1.2 billion acquisition of SurgCenter Development in 2021 that added 85 ASCs and a commitment to develop at least 50 more; and the 2024 sale of 14 hospitals for more than $4.8 billion — a move Dr. Sutaria described as the beginning of “a new era.” Tenet now operates 49 acute care hospitals alongside a USPI platform of 533 ASCs and 26 surgical hospitals spanning 37 states, and is investing at least $250 million annually to grow that footprint.
An ASC model aligned with where policy is heading:
“We are trying to stay on the right side of the value equation — having efficient health systems being accessible at all times, efficient in what we are doing, and obviously providing surgical care at scale at, sometimes, half the cost of doing the same work in a hospital with USPI.” — Dr. Sutaria
The regulatory environment is moving in USPI’s direction. CMS finalized a 573-code expansion to the ASC Covered Procedures List for 2026, broadening the range of procedures that can be performed and reimbursed in outpatient settings. More significantly, CMS announced it is eliminating the Medicare inpatient-only list over the next three years, ending a longstanding policy that required certain complex procedures to be performed exclusively in hospital inpatient settings. The rollout of AI-supported prior authorization review is adding further momentum, reducing administrative friction that has historically slowed case migration to lower-cost settings. Taken together, these shifts represent the most favorable policy environment for ASC operators in years.
Acuity shift and total joint dominance:
“We are, on the outpatient side, probably the largest single provider of outpatient joint replacements when you collectively look at almost 570 assets at USPI, many of which do orthopedics, and we are still posting double-digit growth in total joint replacement surgeries within the ASCs off of a pretty high base.” — Dr. Sutaria
Investment in high-acuity procedures, with orthopedics chief among them, is the single biggest driver of USPI’s volume growth, and executives have made it clear that lower-acuity services are being deliberately wound down in favor of more complex, higher-margin work. The fact that double-digit total joint growth is still occurring across a platform of nearly 570 assets suggests the broader market shift from hospital inpatient settings to ASCs has significant runway remaining.
Robotics expansion:
“The types of things we are doing in urology, the types of things we are doing in robotics — we are probably up to over 150 robotic surgery programs in the ASCs that are general-surgery based. Those types of things are growing quickly.” — Dr. Sutaria
Robotics has become central to USPI’s ability to attract surgeons and expand into higher-acuity cases, closing the technology gap that previously made physicians reluctant to move complex procedures out of hospital settings. The platform now has over 150 robotic surgery programs across its ASCs, concentrated in general surgery and urology, with more in development. In the first quarter of2026, USPI also deployed $125 million to acquire seven ASCs and commenced patient care at three de novo centers, with same-facility revenue growing 5.3% year over year, led by double-digit volume increases in total joint replacements.
What makes USPI the acquirer of choice:
“Our business development team is terrific at helping these centers, oftentimes, go from single specialty to multispecialty or helping them design their OR operations — if they are already multispecialty — to be able to do those more efficiently.” — Dr. Sutaria
USPI continues to look to ASC acquisition for growth. Tenet has deployed $125 million in the first quarter of 2026 to acquire seven ASCs, representing half of its $250 million annual mergers and acquisition target for USPI. Additionally, USPI has doubled down on a growth strategy, operating nearly 570 assets.
De novo strategy:
“The assets that we are acquiring are also supportive of the service line strategies that we are interested in, and our de novos that we open will also have the opportunity to do this type of higher-acuity work.” — Dr. Sutaria
De novo development is an increasing focus Executives have described de novos as creating significant value in targeted markets because building from the ground up allows USPI to establish preferred positioning, with lower build costs and quicker turnaround than acute care facilities once physician partnerships are in place. The system also commenced care at three de novo surgery centers in the first quarter of 2026. Dr. Sutaria said Tenet has, “a robust pipeline of assets interested in joining USPI this year.” However, Dr. Sutaria also said the system remains highly selective.
Executives described de novos as representing “a significant value shift in markets” because building from the ground up allows USPI to establish preferred positioning. CFO Sun Park noted they carry lower build costs and quicker turnaround than acute care facilities once physician partnerships are syndicated.
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.