Brentwood, Tenn.-based Surgery Partners’ acquisition of Preferred Vascular Group reflects larger trends across the ASC landscape as companies race toward scale and specialization.
The ASC industry is steadily expanding. According to the Medicare Payment Advisory Commission’s annual report to Congress released March 12, the number of ASCs nationwide grew more than 2% per year on average between 2019 and 2024, while the volume of ASC surgical procedures per fee-for-service beneficiary increased 3.5% in 2024 alone, accelerating from an average annual rate of 1.3% from 2019–2023.
That growth is increasingly accruing to larger players. Nearly 2,000 ASCs are now affiliated with a national chain, and chain operators now control roughly 33.5% of freestanding ASCs, with the remaining 66.5% still held by independents.
While the ASC industry remains largely fragmented, consolidation is reshaping the market, and some leaders say the pace is limiting new opportunities. Compass Surgical Partners CEO Mark Langston described the dynamic as “an evaporation effect,” arguing that once independent physicians, practices and surgical sites are absorbed, they don’t return to the open market for a long time.
Industry leaders also point to cost inflation and reimbursement constraints as a consolidation accelerant, especially for smaller, physician-led centers.
“We are experiencing a continued shrinking of margins driven by rising operational costs — staffing, supplies, compliance and technology — while reimbursement rates decline or remain flat,” Louise McCarthy, RN, executive director of nursing and administrator of Clearwater (Fla.) Endoscopy Center, told Becker’s. “This imbalance threatens the sustainability of smaller, physician-led ASCs and may accelerate consolidation.”
Surgery Partners already supports more than 200 centers across 33 states. Its acquisition of PVG, an eight-center platform focused exclusively on dialysis access procedures, signals that major operators are growing to gain footholds in high-volume, underserved specialty markets.
The dialysis access space, which Surgery Partners pegs at a $6 billion market with more than 2 million procedures annually, is clinically specialized, scalable and increasingly migrating out of the hospital setting.
What makes the PVG deal particularly instructive is its specificity. Rather than a bolt-on acquisition of a multispecialty ASC, it’s a platform organized around one specialty. This kind of focus has historically been the province of independent physician groups, but that dynamic is changing.
The 2025 ASC M&A landscape reflected targeted private equity investment in specialty-focused platforms rather than broad-based roll-ups, according to a report from VMG Health.
Cardiothoracic and vascular surgery is among the most capital-intensive specialties to sustain independently. High overhead, expensive equipment and heavy hospital dependency make these groups particularly exposed to the economics of independence. A 2022 analysis in The Annals of Thoracic Surgery found that rising practice costs combined with declining reimbursement were placing established independent cardiothoracic practices at risk for closure or purchase by hospital systems.
PVG’s 16-physician team will remain in place under the new structure, with management continuing to lead day-to-day operations. This is a common feature of these transactions, designed to preserve clinical culture while unlocking the capital and infrastructure of a larger parent.
The broader trend is hard to ignore. Between 2019 and 2023, the share of physician practices owned by hospitals, health systems or other corporate entities jumped from 39% to 59%, while physician employment by these entities rose from 62% to 78%, according to a December 2025 report from the Progressive Policy Institute.
“Running an independent practice has become brutally difficult,” Alvaro Macias, MD, associate professor of clinical anesthesia at the University of California San Diego, told Becker’s. “Insurance billing complexity, low reimbursements, electronic records mandates, regulatory requirements, staffing challenges — all of it favors scale. Young physicians graduate with $200,000 plus in debt and often prefer a predictable salary over entrepreneurial risk. Large organizations negotiate better rates with insurers and spread administrative costs across more providers. It is a continuous loop that, for now, cannot be broken.”
As large operators continue to seek specialty platforms with proven clinical models and room to grow geographically, the pipeline of acquisition targets — particularly in procedurally intensive specialties like vascular, orthopedics and ophthalmology — remains deep.
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.