As the ASC industry heats up with competition between hospitals, health systems, corporate entities and independent practices, smaller and mid-sized practices are getting creative in their approach to practice growth and consolidation.
Three-way or hybrid joint ventures
This development model typically involves a health system, a physician group and an ASC management company. This can provide leverage and resources for the practice while streamlining operations and preserving physician autonomy.
Mark Langston, chief development officer at Compass Surgical Partners, told Becker’s these ventures have become central to the company’s growth and a lifeline for practices facing consolidation.
Mr. Langston frames three-way JVs as a direct response to the “squeeze” on independent physicians and ASCs. He said small practices struggle in risk-based models, lack payer leverage and often can’t afford needed infrastructure.
“Independent physicians are really in a squeeze right now,” he said. “If you have an independent surgery center, it’s tough. If you’re in an independent practice, also tough. If you’re doing both—good luck in today’s world.”
Compass’ role in these arrangements is to align incentives between other partners and collaborate with health systems to build local strategies, reduce administrative burdens, optimize anesthesia coverage and recruit staff — all things that have proved challenging for independent ASCs to manage while staying afloat.
Physician-ownership with third-party assisted launch
While management services agreements between an ASC and its owning physicians and a third party company are common, some physicians are finding that MSOs are most useful in the initial launch of a project, as opposed to being long-term partners.
“ASC ownership models have evolved from 100% ownership by the physician group, to ‘cafeteria style’ ownership where a company will charge for specific projects in order to set up the ASC and then just charge a management fee,” Jack Bert, MD, a physician in Woodbury, Minn., told Becker’s.
“Which, in my opinion, is the fairest and most financially advantageous technique for a group that lacks the business acumen to initiate the project on their own,” he added.
Independent practice networks and alliances
The ASC industry remains fragmented, with about 68% of centers still independent, as of 2023. But consolidation is accelerating. In June, St. Louis-based Ascension entered into a definitive agreement to acquire AmSurg, while Optum subsidiary SCA Health acquired one of the nation’s largest gastroenterology groups in early 2025.
Some still-independent groups are joining forces to create physician-group and ASC networks to support sustainable growth and independence for small and mid-sized groups.
Pelto Health Partners is one of several companies Becker’s has reported on in 2025 that it is pursuing this development model. The group launched three years ago out of an initial partnership between three physician-owned orthopedic groups.
“We felt something needed to be done to keep independent groups independent, as many were being driven into hospital employment or selling to private equity,” Frank Aluisio, MD, of EmergeOrtho, who now serves as chair of Pelto’s board, told Becker’s. “Maintaining independence is important in prioritizing patients and the physician-patient relationship — not profits.”
Pelto aimed to create a “landing spot for small to medium-sized groups that were struggling,” Dr. Aluisio continued, and to help out with back-office functions.
Since its founding, Pelto has expanded to include at least six additional physician groups. But that growth has been measured and intentional, Dr. Aluisio said. Rather than rapidly scaling and risking infrastructure strain, the organization focused on thoughtful integration.
