In a Nov. 7 episode of Becker’s Spine and Orthopedic Podcast, Earl Kilbride, MD, an orthopedic surgeon at Austin (Texas) Orthopedic Institute, discussed the issues shaping healthcare and ASCs in 2025.
Here are three key trends identified during the discussion:
1. Consolidation: “I’m in a six-man, small, independently owned private practice group, so one of the biggest threats to our survival is consolidation, whether that be with private equity or under the employed model,” Dr. Kilbride said.
ASC chains control about 33.5% of freestanding ASCs, with the remaining 66.5% still held by independents, according to VMG Health. But that number may soon start to slip. While ASC deal volume dropped by 50% in the first half of 2025 compared to the same period in 2023 and 2024, this decline may understate real activity because smaller transactions involving independent ASCs and joint ventures often go unreported.
According to another survey from VMG Health, 59% of independent ASCs would consider a strategic partnership rather than a full sale. Among those open to partnerships, 71% would consider working with a health system, 31% with a management company and 29% with a private equity group.
2. Reimbursement: While CMS has not yet finalized its final payment rules for ASCs in 2026, reimbursement remains a key trend to watch for ASCs who also deliberate the addition of new service lines and all of the equipment, staffing and facility investments required to continue growing.
Dr. Kilbride added that CMS’ decisions often influence those of commercial insurers.
“Whenever Medicare goes down, a lot of the commercial contracts are tied to some sort of Medicare factor, and so certainly that threatens the livelihood long term of any physician, much less a small private practice group,” he said.
3. AI and emerging technologies. The ASC industry is rather fragmented when it comes to new technologies, particularly AI. Some ASC leaders are heavily invested in AI and already in advanced stages of its development or implementation within organizations. The University of Maryland in Baltimore, for example, recently said they plan to develop the nation’s first AI-powered, “smart” ASC.
On the other end of the spectrum, nearly one in four ASCs still rely on paper charting rather than electronic health records, according to the Ambulatory Surgery Center Association’s July 2025 survey.
As ASC leaders consider how they will incorporate AI into their practice, Dr. Kilbride emphasized the importance of interoperability.
“How do we use AI in medicine? Is there a way that it can make us more efficient and work smarter, not harder?” he said. “We have to make sure that we vet a lot of the information that’s coming through in the AI platforms. And how do you incorporate that into, say, your EMR? How do you incorporate that into say, patient education and things of that sort?”
