The same strategy is running at many health systems across the country: sell hospitals, buy ASCs, and the transactions are accelerating.
St. Louis-based Ascension is on track to become one of the largest ASC operators in the country. The system is acquiring Amsurg and its 250 ASCs for $3 billion, alongside an aggressive hospital divestiture strategy.
The deal follows years of asset shedding. Ascension sold nine hospitals, two ASCs and four senior living facilities in Illinois to Prime Healthcare for $375 million and exited the Michigan market entirely by selling three hospitals and an ASC to MyMichigan Health.
Community Health Systems has been executing a parallel playbook. In 2025, the company announced plans to divest seven hospitals while doubling down on ASC investment, with CEO Kevin Hammons pointing to acquisitions of specialty practices, including robotic surgery programs and a deliberate push to expand outpatient access points. In 2026, CHS opened new surgery centers in Birmingham and Foley, Ala., and acquired a majority stake in an ASC in Anchorage, Alaska, bringing its total to 36 affiliated centers. On the divestiture side, CHS has plans to sell nine hospitals across Alabama, Tennessee, Arkansas and Pennsylvania for more than $1.2 billion.
Tenet, parent company of United Surgical Partners International, is further along the same curve. CEO Saum Sutaria, MD, framed the move as a turning point, describing Tenet as entering “a new era” with a growing share of performance driven by its “highly efficient ambulatory surgical business.”
The pattern reflects a broader strategic shift. Health systems see ASCs as a way to protect market share, retain physicians and manage cost pressure in an increasingly outpatient-centric environment.
Why now?
The financial math has shifted. Hospitals carry high fixed costs, labor pressure and reimbursement exposure that ASCs don’t. With uneven margins, many health systems are re-evaluating their mix of physician assets instead of chasing large, headline-grabbing mergers — with more portfolio “right-sizing,” clinic sales, service-line joint ventures, and ASC partnerships, rather than blockbuster mergers, in the near term, according to a report from MGMA.
At the same time, the procedural shift is accelerating. High-acuity procedures including orthopedics, cardiology, and advanced spine are the biggest drivers of ASC growth as technology improves and patients seek lower-cost care. Surgery Partners reported a 50% jump in total joint volume, while Tenet’s USPI centers saw 23% growth in orthopedics.
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.