When Vijay Bachani, MD, built New York Bariatric Group’s ASC platform, bariatrics was the business. Two years later, it isn’t.
“We built our ASC platform on bariatrics. GLP-1s changed that in about two years, faster than anyone’s strategic plan accounted for,” Dr. Bachani, president and chief growth officer of New York Bariatric Group in Roslyn Heights, told Becker’s. “We are rebuilding around orthopedics, spine, pain management, plastics and women’s health. The cases that are going to go through our rooms look nothing like the cases we were doing in 2022.”
The scale of the shift he’s describing shows up clearly in national data. A JAMA Surgery study published in May 2026, drawing on records from 11.7 million U.S. adults with obesity, overweight or diabetes diagnoses between 2022 and 2024, found GLP-1 receptor agonist use rose 140.4% over that period while metabolic bariatric surgery volume fell 34.1%. The decline wasn’t steady — it accelerated, from a 14.4% drop in 2022-2023 to a 23.0% drop in 2024 alone, according to the study, led by researchers at Harvard T.H. Chan School of Public Health and Analysis Group.
That acceleration is the part that should concern any ASC still leaning on bariatrics as a core line. A slow, linear decline is a business problem leadership can plan around. A curve that’s steepening year over year, the way Dr. Bachani describes it, is the kind of disruption that outruns a strategic plan.
“I do not think we are unusual,” Dr. Bachani said. “Most ASCs are one drug, one policy change or one new technique away from watching a core service line compress.”
There’s a reason to think bariatric surgery doesn’t disappear entirely, though. Thomas Tsai, associate professor of health policy and management at Harvard Chan and a co-author of the JAMA Surgery study, noted that insurance coverage for GLP-1 medications is becoming more restricted as payers balk at the cost, meaning surgery “may remain an important treatment option” for patients who can’t access or sustain the drugs long-term.
The pivot itself isn’t unique to bariatrics, either. It’s part of a broader pattern of ASC operators diversifying away from single-specialty dependence. Tenet’s United Surgical Partners International, the largest ASC operator in the country, added 211 new service lines in 2025 alone, up from 162 the year before, with executives explicitly framing the growth around higher-acuity specialties rather than raw case volume, according to VMG Health’s 2026 Healthcare M&A Report. Dr. Bachani’s rebuild toward orthopedics, spine and pain management tracks the same direction the largest platform in the industry is already moving.
Where the pace of that migration lands next, Dr. Bachani said, isn’t really up to the ASC.
“Payers set the pace on the other side of it,” he said. “They decide how fast a procedure actually migrates out of the hospital, and more of them are willing to contract directly around bundles and episodes than they were five years ago. The centers that can show real outcomes data and a predictable cost per episode will get to reinvent faster than the ones that cannot.”
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.
