Updated: July 2026
Published by Physician Growth Partners
Consolidation in the ASC sector is accelerating. Health systems, private equity, and national operators are competing aggressively for high-quality physician-owned surgical centers and the window for achieving premium valuations is open right now.
If you own an ambulatory surgery center (ASC) as a physician or a management company, you own one of the most valuable businesses in healthcare. ASCs typically have high EBITDA margins, benefit from the ongoing shift of procedures from hospitals to outpatient settings, and attract interest from many buyers including hospitals, large publicly traded and private equity backed strategic operators, and private equity firms. All of these buyers are seeking to acquire from the same pool of a limited number of well-run ambulatory surgery centers, driving values higher in today’s market than we’ve seen prior.
The ambulatory surgery center sector is experiencing a period of rapid decentralization as healthcare delivery shifts away from traditional hospital settings. In the United States, the ASC market generated approximately $45.5 billion in 2023 and is on track to reach $57 billion by the end of the decade.1,2
There are roughly 6,500 Medicare-certified ASCs operating in the U.S. today. Despite the presence of large national management companies, the industry remains deeply fragmented – over 5,400 facilities operate independently, and physicians retain full ownership of approximately 52% of all centers.3,4,5 This fragmentation represents an enormous consolidation runway.
JPMorgan Research projects total outpatient surgical volumes will grow from 93 million procedures in 2023 to 110 million by 2033, with ASCs accounting for over 80% of that activity.6,7
The most consequential long-term trend is the shift of high-acuity procedures, including total joint replacement, spine surgery, cardiac catheter ablation, and other complex cases, from inpatient hospital settings to ASCs. CMS continues to expand the ASC-covered procedures list,8 and payers are actively mandating outpatient settings wherever clinically appropriate.
For well-positioned ASC owners, this is the central value creation thesis that every buyer in the market is trying to get in front of.
ASC valuations vary based on factors such as size, specialty mix, ownership structure, and buyer type. The illustration below shows the potential EBITDA multiple ambulatory surgical centers may be able to command.
Valuation by transaction type:
| Transaction Size | Typical Multiple |
|---|---|
| <$3 million in EBITDA | 5x – 8x EBITDA |
| $3M – $10M in EBITDA | 8.0 – 12.0x EBITDA |
| National Surgical Center Operators | 12.0x + EBITDA |
Recent reference points underscore how wide the premium has become for quality assets. Optum’s acquisition of Surgical Care Affiliates (SCA) occurred at approximately 16.5x EBITDA.10 Reports around AMSURG implied a multiple just north of 14x.11 The Ascension Health definitive agreement to acquire AMSURG – adding 250+ centers across 34 states – closed in Q2 2026 and represents the largest ASC transaction in recent memory.
Tailwinds Expected to Drive Continued Activity
Strong industry tailwinds are driving significant demand for independent ambulatory surgery centers, while rising labor costs, staffing shortages, financing challenges, and operational complexity are increasing pressure on independent operators.
As a result, scale and institutional support have become more valuable, leading many ASC owners to explore sales or partnerships at a time when buyer interest and valuations remain strong.
Key dynamics that continue to make independent ASCs highly attractive acquisition targets:
The ASC buyer universe is broad, competitive, and well-capitalized. For physician-owners, this depth of demand is directly value-accretive.
Physician Growth Partners tracks three primary buyer pools currently active in the market:
PGP is highly active in advising physician groups and surgery centers on transactions with ASC platforms, hospital systems, and private equity-backed MSO platforms. The firm has advised on more than 18 transactions involving surgery centers, both as part of larger physician practices and as standalone ambulatory surgery centers. In 2026, PGP continues to advise several standalone surgery centers in active transaction processes.
Below is a list of announced transactions since 2025:
| Date | Buyer | Target | Commentary |
|---|---|---|---|
| Jan 2025 | USPI | Choice Care Surgery | Independent ASC in Midland, TX. |
| Apr 2025 | AMSURG | Pinnacle Surgery Center | Multi-specialty ASC in Covington, LA. |
| Apr 2025 | Tri-City Medical Center | DISC Surgery Center at Carlsbad | Outpatient spine and orthopedic surgery center in Carlsbad, CA. |
| Jun 2025 | Welsh, Carson, Anderson & Stowe | Constitution Surgery Alliance | Multi-state ASC development and management platform. |
| Jun 2025 | Surgery Partners | Montpelier Surgery Center | Independent ASC in San Jose, CA. |
| Jun 2025 | Surgery Partners | Advanced Surgery Center | Independent ASC in San Jose, CA. |
| Aug 2025 | Sun Capital Partners | Irvine Medical Mgmt. (Anaheim ASC) | Outpatient surgical facility in Anaheim, CA. |
| Oct 2025 | Duly Health and Care; Surgery Partners | Valley ASC | Multi-specialty ASC in St. Charles, IL. |
| Oct 2025 | AMSURG | Surgery Center of Conway | Ophthalmology and retina focused ASC in Conway, SC. |
| Oct 2025 | General Atlantic | Legent Health | Multi-site orthopedic and spine surgical facility operator in Texas and Florida. |
| Dec 2025 | AMSURG | Advanced Center for Surgery | Multi-specialty ASC in Altoona, PA. |
| Jan 2026 | NueHealth | Hackensack Musculoskeletal Surgery Center | Orthopedic-focused ASC in Hackensack, NJ. |
| Jan 2026 | NueHealth | St. Joseph Center for Outpatient Surgery | Multi-specialty ASC in St. Joseph, MO. |
| Jan 2026 | NueHealth | The Surgical Center at Columbia Orthopaedic | Orthopedic surgery center in Columbia, MO. |
| Jan 2026 | NueHealth | Surgery Center of the Northland | Multi-specialty ASC in Platte City, MO. |
| Mar 2026 | USPI | Lync Health Partners | ASC development and MSO with an orthopedic ASC and walk-in clinic. |
| Mar 2026 | Baptist Health and Compass Surgical | Middleburg Surgery Center | Multispecialty ASC in Jacksonville, FL. |
| Mar 2026 | Surgery Partners | Preferred Vascular Group | Multi-site ASC operator focused on dialysis access procedures in GA & OH. |
| Jun 2026 | Ascension | AMSURG | National ASC operator with 250+ surgery centers across 34 states. |
PGP believes market conditions are favorably aligned across all key dimensions for ASCs to explore a potential transaction:
Peak buyer competition. The combination of health system interest in outpatient migration, private equity dry powder at record levels, and pure-play consolidators racing to build scale has created a seller’s market.
Operational complexity is accelerating. EHR mandates, quality reporting, managed care contracting complexity, and staffing challenges, among others.
Buildout costs have increased. New surgical centers require significant capital investment, and development costs have increased substantially since the pandemic. This has further supported acquisitions over de novo development and increased valuation premiums for existing facilities.
Procedure migration to an Outpatient Setting. The shift from inpatient procedures to ASCs is still in its early stages, with substantial growth opportunities ahead.
Succession and liquidity planning. Given the increasing complexity of healthcare, many independent owners are pursuing transactions or recapitalizations to reduce risk and diversify their portfolio.
The widening technology and operational gaps between independent ASCs and larger platforms are making scale increasingly important. Rising costs related to staffing, EHR systems, revenue cycle management, and compliance are prompting many independent owners to explore partnerships or transactions to reduce risk, realize the value of the business they have built, and gain access to operational expertise.
The most suitable buyer will depend on the ASC’s specialty mix, geographic location, and the owner’s long-term objectives. Different buyer groups provide different advantages, such as preserving autonomy, enhancing operational support, maximizing upfront liquidity, or offering future equity upside.
Because valuation outcomes can vary widely, properly positioning your ambulatory surgery center and approaching the right buyers are essential to maximizing value. It is equally important to identify a partner that allows you to retain local control while providing the resources needed to support continued growth.
Physician Growth Partners provides confidential advisory services to ASC founder-owners exploring their strategic options.
No obligation. Completely confidential. Typically 30 minutes.
Sources & Citations
1. U.S. market generated approximately $45.5 billion in 2023 IBISWorld, Ambulatory Surgery Centers in the US Industry Report, 2025.
2. U.S. market on track to reach $57 billion by end of the decade IBISWorld, Ambulatory Surgery Centers in the U.S., September 2024. As cited in CLA Connect, Why Ambulatory Surgery Centers Are on the Rise, July 2025. https://www.claconnect.com/en/resources/articles/25/ambulatory-surgery-centers
3. Roughly 6,500 Medicare-certified ASCs operating in the U.S. IBISWorld, Ambulatory Surgery Centers in the US Industry Report, 2025.
4. Over 5,400 facilities operate independently IBISWorld, Ambulatory Surgery Centers in the US Industry Report, 2025.
5. Physicians retain full ownership of approximately 52% of all centers HealthValue Group, Navigating Growth: Trends and Strategic Considerations in the U.S. ASC Industry, 2025, citing ASC Data, 2025. https://healthvaluegroup.com/navigating-growth-trends-and-strategic-considerations-in-the-u-s-asc-industry/
6. JPMorgan projects outpatient surgical volumes will grow from 93 million procedures (2023) to 110 million by 2033 JPMorgan Research, Healthcare Services Outlook, 2024.
7. ASCs accounting for over 80% of outpatient surgical activity Toward Healthcare / Precedence Research, Ambulatory Surgical Center Market, 2025. https://www.towardshealthcare.com/insights/factors-influencing-the-ambulatory-surgical-center-industry (Note: Confirm this is specifically about ASC share of outpatient volume, not all surgeries broadly.)
8. CMS continues to expand the ASC-covered procedures list CMS, ASC Covered Procedures List Updates, FY 2025–2026.
9. The total addressable market for inpatient surgical procedures eligible for outpatient migration is estimated at approximately $130 billion. VMG Health, Surgery Partners: A Case Study on Private Equity in the ASC Market, March 2025. https://vmghealth.com/insights/blog/surgery-partners-a-case-study-on-private-equity-in-the-asc-market/
10. Optum’s acquisition of Surgical Care Affiliates at approximately 16.5x EBITDA Optum / SCA Health, Surgical Care Affiliates Acquisition (multiple references).
11. AMSURG acquisition implied a multiple of approximately 14x EBITDA UBS Equity Research on Surgery Partners, as reported by Investing.com, June 2025. https://in.investing.com/news/analyst-ratings/ubs-reiterates-buy-rating-on-surgery-partners-stock-amid-takeover-rejection-93CH-4881392
Physician Growth Partners · This content is provided for informational purposes only and does not constitute legal, financial, or investment advice. All transaction data sourced as cited. © 2026 Physician Growth Advisors, LLC. All rights reserved.