ASC development is accelerating across the Southeast as demographic, economic and regulatory pressures converge, Brian Blankenship, vice president of project development at Minneapolis-based Ryan Companies, wrote in a sponsored article published Oct. 9 in the Tampa Bay Business Journal.
The region now holds a 29.1% revenue share of the U.S. outpatient surgery market, according to Grand View Research. Ryan Companies is a developer and design-build contractor that works with surgery center and surgical hospital clients.
Here are five forces Mr. Blankenship identified:
1. An aging, growing population. Florida and the Carolinas lead the nation in domestic migration, and a growing population of residents 65 and older is driving volume for orthopedic, ophthalmic, gastrointestinal and cardiovascular procedures.
2. Site-of-care shifts. Commercial payers and CMS continue to steer procedures toward ASCs for cost savings. CMS added 271 codes to the ASC covered procedures list in November 2025, and many total joint replacements and cardiac procedures can now be performed with same-day discharge.
3. Long-term tenants. Specialized buildouts, including fire-resistant construction, standby generators, enhanced air filtration and medical gas piping, make relocation costly. ASC leases typically run 10 years or more.
4. Stable fundamentals. Surgery center leasing grew 145% from 2022 to 2025, according to CBRE, and medical office building occupancy reached nearly 94% across the top 125 U.S. markets in the second quarter of 2025, Northmarq reported.
5. Certificate-of-need reform. South Carolina repealed certificate-of-need requirements for ASCs and most other facilities in 2023. North Carolina’s 2023 reforms exempt ASCs from certificate-of-need review in counties with more than 125,000 residents.
Mr. Blankenship pointed to the Advanced Surgery Center at Brownwood in The Villages, Fla., as an example of those forces at work. The 28,000-square-foot multispecialty center, which opened in 2024, is a joint venture of Brentwood, Tenn.-based Surgery Partners, Leawood, Kan.-based ValueHealth and local physicians. Ryan Companies served as design-build contractor on the project, which serves one of the country’s fastest-growing senior communities.
He argued the region’s outpatient surgery growth reflects a structural shift rather than a temporary real estate cycle.
“For healthcare providers, developers and institutional investors, speculative building is in the rearview,” Mr. Blankenship wrote.
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.
