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.
Major operators are steadily increasing their grip on the ASC landscape — according to a report from VMG Health, the percentage of Medicare-certified ASCs owned by major operators rose from 25.7% in 2011 to 35% in 2025.
At the same time, many independent centers have begun looking for partnership structures, not outright exits. A separate VMG Health survey found that 59% of independent ASCs would consider a strategic partnership rather than a full sale transaction. Among those ASCs open to partnerships, 71% said they would consider partnering with a health system, 31% with a management company and 29% with a private equity group.
Other ASC leaders say consolidation and physician acquisition are changing where growth comes from and forcing operators to recalibrate.
As more physician practices and centers become tied up in larger platforms, the pipeline of independent ASC opportunities may be shrinking.
Steve Hockert, chief development officer of Southlake, Texas-based Solara Surgical Partners, told Becker’s that Solara’s partnership with Orlando (Fla.) Health to launch a national ASC joint venture reflects a broader shift in strategy. The company is moving away from the historical model of building joint ventures primarily with independent physicians, and toward deeper health system affiliations.
“What was available then isn’t as available today,” he said. “You have to pivot with the changes to continue to grow and survive. Health system alignment is a priority focus. We don’t want to dismiss independent physician opportunities, but private equity consolidation and health system acquisitions have made those opportunities far less frequent.”
Several major ASC acquisitions in 2025 attest to this consolidation trend. Notably, St. Louis-based Ascension signed a definitive agreement to acquire AmSurg, a major ASC operator with roughly 250 locations nationwide. The transaction is valued at $3.9 billion and is expected to close in early 2026. Additionally, Optum subsidiary SCA Health acquired Exton, Pa.-based U.S. Digestive Health Management was purchased from Amulet Capital Partners.
ASC consolidation is occurring alongside a longer-running decline of physicians practicing independently. Between 2019 and 2023, the share of independent physician practices owned by hospitals, health systems or other corporate entities increased from 39% to 59%, according to a December 2025 report from the Progressive Policy Institute. Over the same period, the percentage of physicians employed by these entities rose from 62% to 78%.
As physician practices move under corporate or health system umbrellas, the path to independent ASC formation — and the pool of physician-led centers — narrows.
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.”
The regulatory environment could also influence the pace of consolidation. According to the Progressive Policy Institute, merger enforcement in deals involving hospitals and ASCs is “below average.” The analysis found that between 2017 and 2024, the rate of federal clearances for ASC and hospital transactions were 26% and 51%, respectively, far higher than the average of 13% across all sectors. At the “second request” stage of mergers, when cleared transactions receive an agency request for more information to further evaluate impact on competition, the rate for ASCs and hospitals was lower than the all-sector average.
“This gap worsens for the rates at which the agencies challenge merger transactions as illegal,” the report said. For ASCs, the challenge rate is eight times lower than average, and for hospitals, the rate is about five times lower than average. This signals that the FTC and Department of Justice approach consolidation involving hospitals and physician practices with more scrutiny in earlier stages, but “back off in later-stage investigations that could lead to merger challenges.”
