Here's a growth breakdown of five of the largest ASC chains in the last five years:
United Surgical Partners International, Dallas-based Tenet Healthcare's ASC chain, has seen huge growth in the last five years, becoming the largest chain in the country. The company has added more than 160 ASCs since 2015, when they had 249 centers.
The company has a share of about 7 percent of the ASC market, with 410 surgery centers and 24 surgical hospitals in 34 states.
Tenet has been bolstering its ASC business to drive revenue. It has spent more than $2.5 billion in capital investment to scale USPI since December 2020 and expects to see 12 percent growth after acquiring interest in about 160 ASCs in less than two years, according to an earnings call.
At the end of June, Tenet acquired Dallas-based Baylor Scott & White Health's 5 percent equity position in USPI to own 100 percent of the company's voting shares.
USPI's net operating revenue jumped 31 percent to $2.7 billion. More than 3,400 physicians joined USPI, increasing the number of physicians in the company's network to more than 11,000, the most of any ASC chain.
Other major acquisitions included a $1.1 billion deal to buy SurgCenter Development — adding 85 ASCs to its network — and another $78 million paid to acquire ownership of eight Compass Surgical Partners ASCs.
USPI added 61 ASCs, including a 45-center, $1.1 billion acquisition from SurgCenter Development. In 2020, USPI reported 102 percent year-over-year surgical volume growth before the pandemic. In April, surgeries dropped to 20 percent of 2019 levels amid the COVID-19 pandemic, but by the end of the year, USPI centers reported surgical volume at 95 percent of 2019 volumes.
By the end of the year, USPI had nearly 350 facilities in 33 states.
In 2019, the company boosted its market share, from owning 5 percent to 6 percent of ASCs with 260 ASCs, according to its annual report.
The company also entered several joint ventures, including Hackensack (N.J.) Meridian Health and Vanguard Surgical Center as well as Dignity Health and the West Coast Joint and Spine Surgery Center in El Dorado Hills, Calif.
USPI reported $2 billion in net operating revenue, a 7.5 percent increase over 2017. The segment's adjusted earnings before interest, taxes, depreciation and amortization increased 13.3 percent to $792 million. USPI invested $240 million in ambulatory mergers and acquisitions, adding 27 facilities and seven health system partners.
While the company had ownership in around 5 percent of ASCs nationwide, USPI trailed AmSurg in number of ASCs, with 255 compared to AmSurg's 261, according to a report from VMG Health.
Brentwood, Tenn.-based Surgery Partners is one of the largest ASC companies in the U.S., with more than 180 facilities and 4,000 physicians.
Surgery Partners expects to grow its earnings by $375 million to $385 million. During the second quarter, the company's revenue jumped 13.3 percent over last year's second quarter, to $615.4 million.
Surgery Partners inked a deal with Privia Health, a Montana-based physician clinic technology company. In May, the company also announced a deal with ValueHealth to expand access to high-value surgical care.
Surgery Partners' growth in orthopedics is expected to merge with ValueHealth's musculoskeletal-focused programming to create a comprehensive suite of orthopedic services. The partnership will also try to capitalize on cardiology's migration to outpatient settings.
The company's adjusted EBITDA jumped 32.3 percent in 2021 over the prior year period, to $339.6 million. Surgery Partners also reported a 9.6 percent increase in same-facility case volume for the quarter and 17.6 percent for the year.
At the end of the year, Surgery Partners had 126 surgical facilities.
Surgery Partners reported full-year revenue for of $1.86 billion. The company also reaffirmed its full-year adjusted EBITDA guidance in the range of $250 million to $260 million.
Surgery Partners reported 116 ASCs and 17 short-stay surgical hospitals across 30 states to end the year.
Surgery Partners had more than 180 locations nationwide and 4,000 affiliated physicians. The company's revenues increased 3.4 percent to $1.8 billion from the prior year and adjusted revenues increased 2.8 percent to $1.9 billion. Same-facility revenues increased 7.6 percent over the prior year.
Surgery Partners' revenue increased 32.1 percent from the year prior to $1.8 billion and adjusted revenues increased 34.6 percent to $1.8 billion. The company also more than doubled the size of its physician recruiting team.
The company had 109 ASCs, the fifth most of the nation's surgery center chains at the time, according to a report from VMG Health.
Nashville,Tenn.-based HCA Healthcare operates 184 hospitals and about 2,000 sites of care, including ASCs, freestanding ERs, urgent care centers and physician clinics in 21 states and the United Kingdom.
HCA projects revenue will increase to between $60 billion and $62 billion in 2022.
The company reported revenue of $14.95 billion in the first quarter, up from $13.98 billion in the same period of 2021. The for-profit hospital operator said same-facility admissions, emergency room visits and inpatient and outpatient surgeries increased year over year.
In the second quarter, the company reported revenue of $14.82 billion, up from $14.44 billion in the same period last year.
After factoring in expenses and nonoperating items, HCA's net income in the first quarter totaled $1.27 billion, down from $1.42 billion in the same quarter a year earlier.
The company also plans to build five full-service hospitals in Texas, increasing its total number of hospitals to 50.
HCA's yearly revenue was $58.78 billion, an increase of 12 percent from 2020's revenue of $51.5 billion.
HCA facilities reported more than 1 million outpatient surgery cases, a 14.2 percent increase over 2020.
The company added four ASCs in 2021, reaching a total of 125 nationwide.
HCA's yearly revenue totaled $51.5 billion, a marginal increase from 2019.
The company reported a fourth quarter revenue of $14.3 billion in 2020, up 5.7 percent from the same period a year earlier, when revenue totaled $13.5 billion.
In response to the COVID-19 pandemic, the company introduced initiatives to cut operating expenses that the company said helped maintain its yearly revenue growth despite restrictions on elective procedures. It also created a hotline to assist patients who lost health insurance during pandemic.
The company's revenue grew 10 percent year over year, reaching more than $51 billion.
HCA's outpatient joint procedure caseload grew 4 percent, and same-facility outpatient cases were up 1.8 percent compared to 2018.
The company added freestanding emergency rooms, physician clinics and urgent care centers, expanding its overall network to around 2,000 sites of care connected with its 185 hospitals.
In 2018, HCA Healthcare reported revenue of $46.6, an increase of 6.9 percent from its reported income in 2017.
HCA saw a 3.2 percent increase in outpatient surgery procedures from the year prior, reaching 971,537 cases. In the fourth quarter of the year, the company saw 1.4 percent more outpatient procedures than the fourth quarter of 2017.
The company added three ASCs, bringing its total to 123 centers nationwide.
Deerfield Ill.-based SCA Health, formerly Surgical Care Affiliates, is one of the largest ASC chains in the country and operates under parent company Optum.
In May, Surgical Care Affiliates rebranded to SCA Health, with intentions to expand beyond ASC management into specialty care. The company also updated its logo to symbolize growth momentum and added a tagline: "The future of specialty care."
Also in May, Marie Edler, chief strategy officer at SCA Health, was elected as a board member of the Ambulatory Surgery Center Association.
Optum, which includes Surgical Care Affiliates, reported revenue of $155.6 billion in 2021. As of 2021, SCA operated more than 230 surgical facilities in 35 states. More than 8,000 physicians treat nearly 1 million patients nationally.
OptumHealth served 100 million people in 2021, compared to 98 million in 2020.
SCA Health launched the SCA Physician Development Institute to support musculoskeletal physicians and allied health professionals. The institute is an educational platform on the business side of medicine with a focus on the outpatient migration of orthopedic procedures.
Eighty-one SCA-affiliated ASCs made Newsweek's list of "America's Best Ambulatory Surgery Centers 2022."
Optum reported a 2020 revenue of $136.3 billion. SCA brought on more than 1,000 new surgeons in 2020.SCA centers also added more than 40 new service lines in 2020, which is double the number added in 2019.
OptumHealth served 98 million patients in 2020, up from 96 million in 2019.
The company acquired Lakewood, Colo.-based Pinnacle II in 2020 shortly after the COVD-19 pandemic began shutting down ASCs across the U.S. In February, two independent Connecticut ASCs sold majority stakes to SCA.
Optum reported revenue jumped 11.5 percent in 2019 to hit $113 billion. OptumHealth, which includes Surgical Care Affiliates, reported $30.3 billion in full year revenue for 2019.
In December, the company named Caitlin Zulla CEO of the company, replacing Tony Kilgore.
In 2019, Surgical Care Affiliates reported having more than 230 surgical facilities and 8,000-plus physicians who performed more than 1 million procedures per year at SCA facilities.
In 2018, OptumHealth reported revenues of $24.1 billion, a 17.4 percent increase year over year. OptumHealth also served 93 million people, a 6 percent increase over 2017.
Tony Kilgore replaced Andrew Hayek as SCA's CEO in January.
Nashville, Tenn.-based AmSurg is one of the largest ASC chains in the U.S. While it doesn't release revenue information, here are some key facts in the last five years.
AmSurg has more than 250 ASCs and 2,000 physicians in 34 states as of 2022. AmSurg focuses primarily on gastroenterology, ophthalmology and orthopedics cases and has 1,001 to 5,000 employees
In 2021, AmSurg ASCs performed more than 900,000 colonoscopies, 180,000 cataract surgeries and 95,000 orthopedic surgeries.
AmSurg was also at the center of a $2.5 billion Envision lender dispute when the company was moved to a new affiliate. Around 80 percent of AmSurg was moved to a new corporate subsidiary.
In 2020, Jeff Snodgrass was tapped to serve as president of AmSurg in 2020. Mr. Snodgrass previously served as president and CEO of Azura Vascular Care and National Cardiology Partners.
Before Mr. Snodgrass, AmSurg was headed by former CEO Christopher Holden, who held the role of president, CEO and director until 2020. Mr. Holden added the role of CEO of Envision Healthcare after the 2016 merger.
AmSurg published findings in 2020 that showed nearly 200,000 Americans missed their colonoscopies that year.
In 2019, AmSurg owned 258 ASCs in 35 states. The company was partnered with 3,500 physicians.
In 2018, Amsurg had a center count of 261, a slight decrease from 263 centers in 2017, according to a VMG Health report.
In October of 2018, private equity firm KKR completed its $9.9 billion acquisition of Envision, including AmSurg. Post-acquisition, KKR had around 300 ASCs in its portfolio and AmSurg had more than 2,000 physician partners in centers across the country focused primarily on endoscopy, ophthalmology and orthopedics. Prior to the acquisition, AmSurg reported $328 million in second quarter net revenue for 2018, with same-center revenue growth hitting 2.9 percent.