For much of the past decade, ASC dealmaking followed a more straightforward pattern of majority stake acquisitions between a corporate entity and a physician group
But a new wave of ASC mergers, acquisitions, joint ventures and other deal structures has changed that narrative — with several new ownership models competing to scale up their outpatient investments.
Private equity’s exit math is breaking
Only 18% of a 2021 private equity buyout cohort had exited by year four, compared with 32% of a 2017 cohort at the same point, according to PitchBook’s 2026 US Private Equity Outlook, cited in a recent VMG Health report. Regulatory scrutiny in New York, Minnesota and California and elevated interest rates have slowed sales further, and health systems are increasingly seen as the most likely next buyer for aging PE-owned platforms.
Nonprofit systems are underwriting PE, not just selling to it
St. Louis-based Ascension’s joint venture with TowerBrook Capital Partners has grown into a fund holding roughly $1.17 billion in portfolio companies — including Trimedx, Compassus, US Acute Care Solutions, PT Solutions Holdings and Regent Surgical Health — built off the roughly $3.9 billion Ascension-AmSurg ASC acquisition last year.
“The FTC is defining ASCs as highly localized monopoly markets,” Sean Gipson, CEO and ASC division president of Remedy Surgery Center told Becker’s regarding the deal.
Insurers are becoming the biggest ASC owners
A Brookings Institution analysis of the five largest U.S. health insurers, covering 126 million Americans, found UnitedHealth Group’s Optum Health — which owns Deerfield, Ill.-based SCA Health — generated $100.5 billion in 2025 revenue, while CVS Health’s Aetna and Caremark businesses together topped $300 billion. Researchers cautioned the arrangement creates “abundant opportunities to game regulations, hide profits through tunneling, and foreclose markets to rivals.”
Drug distributors are buying the specialists who prescribe their drugs
Cencora, McKesson and Cardinal Health have spent a combined roughly $14 billion acquiring specialty physician practices in oncology, retina and gastroenterology over the past two years, led by Cencora’s $5 billion deal for OneOncology and $4.4 billion acquisition of Retina Consultants of America. All three specialties run on a buy-and-bill model, letting a distributor that owns the practice capture margin on both the drug supply chain and the clinical encounter.
New platforms are competing for physicians without asking for equity
A newer wave of platforms — including ASCend, Compass Surgical and Commons Clinic — letting physician ownership lead the way. Their pitch centers on shared infrastructure and back-office support without a transfer of practice control.
“Independent physicians are really in a squeeze right now,” said Mark Langston, chief development officer of Compass Surgical.
Consumer capital is discovering fertility clinics
L Catterton — the private equity firm known for its investment in Peloton — has taken a 42.5% stake in US Fertility, a 121-clinic network, co-leading the deal alongside Amulet Capital Partners. The investment, bringing up to $1.7 billion in combined capital, arrives as private equity now controls the majority of the U.S. IVF market: Roughly 33% of SART-member fertility clinics were PE-affiliated by the end of 2023.
Rapid growth isn’t the goal for everyone
Not every operator is chasing scale. Philip Cooksey, chief financial officer of Avon, Conn.-based Constitution Surgery Alliance, told Becker’s the company has deliberately stayed out of the growth race playing out around it.
“There’s a lot of growth happening for growth’s sake out there; that’s not what we’re interested in,” Mr. Cooksey said.
One deal, up close
In Amherst, N.Y., the physician owners of Atlas Surgery Center have proposed selling a 60% stake for $54 million to Ambulatory Partner Holdings, a deal that would leave medical decision-making with the physician owners. Elad Levy, MD, a neurosurgeon involved with the center, framed it as part of a broader shift for his specialty.
“Neurosurgery is the only subspecialty that has not embraced the outpatient arena,” Dr. Levy said. “We set out to change that.”
For health system and ASC leaders evaluating a partner, the question this era poses isn’t whether to sell — it’s which of several very different ownership models the buyer on the other side of the table actually represents.
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.
