North Carolina has seen some of the ASC activity so far in 2025, with more than eight new centers opened or announced.
Fueling this boom is a major reform to the state’s certificate-of-need laws, set to take effect by the end of 2025. The legislation will repeal CON requirements for ASCs in counties with populations exceeding 125,000, starting Nov. 21, 2025. While affected centers will still need to meet charity care obligations and submit annual data reports, the loosening of regulatory barriers is expected to spur significant growth.
Experts suggest that the regulatory shift will intensify competition across the state’s healthcare market.
“This may vary region by region,” said Richard Saver, a professor of law at the University of North Carolina at Chapel Hill who also works in the university’s social medicine, medical, and public health departments. “In highly competitive markets like the Research Triangle or other parts of the state, major health systems will continue to compete with one another. If CON is overturned, it could create competitive pressure to lower barriers to entry.”
Leo Spector, MD, CEO of Charlotte, N.C.-based OrthoCarolina, echoed this sentiment, emphasizing the potential for cost savings.
CON reform will “help lower costs because essentially MRIs and ASCs are a commodity, but they are ones that have been protected by CON. As a result, prices on them have stayed higher than they would in an open market,” Leo Spector, MD, CEO of Charlotte, N.C.-based OrthoCarolina, told Becker’s.
“With the removal of CON and the ability to have surgeons open up those ASCs, we know that it’s going to lower costs at those ASCs because they will no longer be controlled in the way they were previously,” he said.
North Carolina’s ASC surge mirrors broader trends across the Southeastern U.S., where outpatient care is growing rapidly. A July report from Research and Markets identified the Southeast as holding the most substantial share of the national ASC market. This growth is driven by an increasing preference for outpatient procedures and a high volume of physician-owned centers.
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.