The ASC industry is adding capacity even as some markets are showing signs of strain. Elective case volumes fell in the first two quarters of 2026, pressured by economic uncertainty and the loss of ACA subsidies for hundreds of thousands of patients, while reimbursement in many specialties continues to lag the actual cost of delivering care.
Cases keep migrating out of hospitals into outpatient settings, but whether that migration is running fast enough to support the supply being built is not yet clear.
Becker’s has reported on more than 30 ASC and physician practice closures in 2026, driven by reimbursement declines, staffing shortages and, in some markets, direct competition from nearby facilities. The longer-term picture is more complex. Pending site-neutrality policy and aging baby boomer demographics point to sustained demand for higher-acuity outpatient services.
Six ASC leaders recently connected with Becker’s to weigh in on whether the industry is building toward saturation or if it still has room to grow.
Note: Responses were lightly edited for clarity and length.
Question: As surgical volumes fall and cases shift elsewhere, is the ASC industry becoming over saturated relative to where case volume is actually going? Is this consolidation just relocating existing volume rather than growing the pie?
Mitesh Amin, MD. CEO of Aligned Cardio and President of Southpark Heart & Rhythm (Colonial Heights, Va.): I do think there is a risk of overbuilding ASCs if people assume that simply adding capacity will create additional procedure volume. It won’t. In many specialties, new ASCs may ultimately be competing for or redistributing a relatively fixed pool of cases.
Cardiovascular care, however, is somewhat different because we are still relatively early in the migration of procedures from the hospital to the ASC. There remains a significant amount of cardiovascular volume being performed in higher-cost hospital settings that can safely and appropriately move to the outpatient setting. As additional procedures become viable in the ASC, including more complex interventional and electrophysiology procedures, that creates a meaningful source of growth without requiring overall procedure volumes to grow.
For us, the key is starting with the physicians, the actual cases, and the needs of the community. How much volume exists today? Where are those patients currently going for care? How much can appropriately migrate? And is there an opportunity to provide that care closer to where patients live?
That last piece is important. A well-placed ASC can make cardiovascular care significantly easier for patients. Rather than navigating a large hospital campus, parking, registration and multiple departments, they can receive appropriate procedures in a smaller, more accessible setting closer to home. That convenience and simplicity can be particularly meaningful for an older cardiovascular population and their families.
So I don’t think the question is simply whether we have too many ASCs. The question is whether we’re putting them in the right communities and building them around demonstrated patient and physician needs. If you build around theoretical future volume, there is a real risk of oversaturation. If you build around community need, existing physician volume, and appropriate site-of-service migration, particularly in cardiovascular care, I believe there remains substantial opportunity.
Ray Brown. CEO of Lake Lucien Surgery Center (Maitland, Fla.): Those cases are related to self-pay elective, which just represents that the consumers at large are under a lot of financial pressure. That being said, you need to constantly revisit your case mix, case costing and look toward the horizon as far as tomorrow’s profitable case mix. I think volumes are very much trending in our favor.
Adam Bruggeman, MD. Texas Spine Care Center (San Antonio): I think there are two different things going on here. First, the loss of health insurance coverage for many Americans is leading to less surgeries. Second, surgeons are increasingly moving their cases to surgery centers and away from hospitals. I don’t think the pie is expanding at this time but instead shifting from inpatient to outpatient as techniques and postoperative protocols improve. Of note, as cases shift to outpatient, the administrative demand on practices increases as they make up for the traditional hospital services no longer provided like case management, physical therapy, wound evaluation/management, and other clinical and administrative tasks.
Patrick McEneaney, DPM. Owner and CEO of Northern Illinois Foot & Ankle Specialists (Crystal Lake): I think a few things are happening here. First of all, elective cases were down 6% nationwide during the first two quarters of 2026. These are hospitals and ASCs. Given the current economy, patients are postponing surgery or seeking other treatment options. Patients are having trouble affording surgery, don’t want to spend their money on surgery or don’t want to take time off work. Because of this, I think some patients are thinking twice before booking surgery.
Additionally, in Illinois, 450,000 people on ACA subsidies lost those subsidies in January. Statistics show that only slightly more than half of them picked up new insurance plans. We are also seeing more doctors join hospital systems. There can be unwritten rules on surgeons keeping cases at the hospitals instead of taking them to the ASCs. So, the volume is down for the previous reasons stated, but I think we will see more of it returning back to the hospital.
Scott Nordlund. Executive Vice President, Corporate Development and Partnerships of Sutter Health (Sacramento, Calif.): It is not a one-size-fits-all answer. You actually have to consider the type of surgery to answer the saturation question. With site-neutrality and changes in technology, we are going to see a more significant volume of higher acuity cases that will shift to ASCs. From that perspective, the ASC framework is underutilized, so there is not saturation. However, for the lower acuity outpatient procedures that have largely migrated already (ENT, minor orthopedics, ophthalmology, gastroenterology), you could argue that centers are approaching saturation points. They are now facing threats from office-based surgery providers that are siphoning off even simpler cases.
Both consolidation and growing the pie are happening. There is certainly a shift of existing cases from hospitals to ASCs, and that “relocation” trend has been underway for years and is set to accelerate with site neutrality. However, simple demographics are also creating more demand, with an aging baby boomer population driving new demand for orthopedic, GI and even cardiovascular procedures — effectively growing the pie for everyone in the ASC space.
Adam Spiegel. CEO of NorthStar Anesthesia (Irving, Texas): It’s difficult to characterize the ASC market broadly as oversaturated because the dynamics vary significantly by market. In some markets, capacity may be growing faster than case volume, while in others, procedures continue to migrate rapidly into the ASC setting.
The more important question is whether growth is sustainable at the individual ASC level. Facilities need to align their operating capacity, including operating room hours and anesthesia staffing, with actual and anticipated case volume. Extending hours or adding capacity without sufficient patient demand can drive anesthesia and other operating costs above the revenue those cases generate, leading to unprofitable economics.
As the industry continues to grow and consolidate, sustainable growth will depend on putting the right capacity in the right markets and continuously matching that capacity to where patients and procedures are actually moving.
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.
