The South has become the epicenter of ASC growth, and major operators are increasingly treating the region not as a secondary market but as the next strategic frontier.
Steve Hockert, chief development officer of Solara Surgical Partners, told Becker’s the company plans to place “more of a strategic focus on the southeast quadrant of the U.S.” over the next five years.
“If you looked at our market penetration, you’d notice a sort of east-to-west fault line, with most of our activity South of that,” he said. “That wasn’t by design — it just happened that way.”
Going forward, however, Florida and the broader Southeast will be a priority, Mr. Hockert said, and the strategy may evolve from ground-up growth toward more acquisitions.
“There may be consolidation opportunities, and we’ll likely shift partially toward an acquisition-based growth model over the next five years, with emphasis on that region,” he said.
Solara’s outlook aligns with broader industry trends. A July report from Research and Markets identified the Southeast as holding the largest share of the national ASC market. That growth, the report noted, is fueled by increasing demand for outpatient procedures and the region’s high volume of physician-owned centers.
In 2025 alone, more than 20 ASCs opened across the South, with certain states emerging as hotbeds for development. Becker’s reported on eight new ASCs in North Carolina in 2025 — tied with California for the most in the nation. Texas followed with four new centers, while Alabama and Mississippi each saw three new ASC openings.
The pace of development reflects more than healthcare demand. Several Southern states are simultaneously emerging as favorable environments for business growth and physician stability.
In 2025, North Carolina, Texas, Florida and Virginia were named the four best states to start a business, according to CNBC. In addition, Florida and Mississippi were ranked among the top 10 states for physicians to reach financial independence, according to Marit Health.
Meanwhile, North Carolina has continued to attract surgical talent. A report from healthcare education and engagement platform Conexiant named North Carolina one of the best states for surgeons, citing an annual mean income of $426,470 and an estimated cost of living of $41,148.
High procedural demand, favorable economics and workforce attraction have turned several Southern markets into prime territory for ASC investment.
Navigating certificates of need
Another factor reshaping the South’s ASC landscape is certificate-of-need reform. Over the last several years, a number of Southern states have repealed, adjusted or signaled plans to alter such laws.
Georgia has emerged as a prominent example of how certificate-of-need policy changes can quickly unlock new development activity. In 2024, the state advanced CON reforms that exempt certain single-specialty ASCs from review if they are owned by a single physician or practice and remain under specific capital expenditure and operating room thresholds.
The reforms also allow non-owner physicians within the same specialty to practice in exempt centers and permit joint ventures with hospitals, including external management arrangements. The Georgia Department of Community Health is expected to issue additional recommendations that could bring further policy changes.
But certificate-of-need policy remains a constraint in other high-growth states.
North Carolina’s booming population and business-friendly environment have fueled ASC partnerships and expansion, yet certificate-of-need laws will continue to present a barrier. Though the state was initially expected to repeal its CON system, a state trial court upheld the constitutionality of the laws, rejecting an ophthalmologist’s long-running challenge.
The case was dismissed in Wake County Superior Court on June 11, 2021. On Oct. 18, 2024, the North Carolina Supreme Court issued an unsigned, unanimous ruling allowing the challenge to move forward. Ultimately, judges rejected arguments that CON laws create monopolies and confer “exclusive emoluments” to incumbent providers.
ASC companies, health systems expand in South
As the region becomes more attractive due to its business environment and shifting certificate-of-need policies, ASC companies and health systems are increasingly positioning the South as a long-term growth priority.
This year, Choice Care Surgery Center, a physician-owned ASC in Midland, Texas, joined Tenet’s United Surgical Partners International. In 2024, USPI also expanded in Florida through a partnership with the Tampa-based Florida Orthopedic Institute.
ASC companies are also focusing on the South. This year, Choice Care Surgery Center, a physician-owned ASC in Midland, Texas, joined Tenet’s United Surgical Partners International. In 2024, USPI inked a partnership with the Tampa-based Florida Orthopedic Institute.
Additionally, Surgery Partners and Baylor Scott & White Health formed a joint venture to co-own the Physicians Centre Hospital, a 16-bed physician-owned surgical facility in Bryan, Texas. Raleigh, N.C.-based Compass Surgical Partners, Bon Secours Mercy Health and local physicians opened an orthopedic ASC in Newport News, Va.
Academic health systems are also investing more heavily in outpatient growth across the region. In 2024, Becker’s reported on 12 academic centers building out their ASC networks, seven of which were based in the South.
Bernadette Purser, BSN, RN, senior administrator at VCU Health in Richmond, Va., told Becker’s that ASCs are an important tool in expanding patients’ access to surgical services in the region.
“We continue to grow, expand and invest in our ASCs in order to meet our patients where they are,” she said. “For example, we recently broke ground on a new ASC/medical office building being built in Chesterfield, Va., which includes four operating rooms and two procedure rooms. It’ll be multispecialty and include endoscopy. This follows a similar center that we opened in Henrico, Va. Both of these are designed to reach our patients in the communities they live and create more access to our high-quality care.”
