Becker's ASC Review

5 ASC MANAGEMENT Inside the new era of ASCs: 5 trends to know By Patsy Newitt T he ASC market is undergoing a major transformation, fueled by clinical innovation, payer pressures and shiing investment dynamics, according to VMG Health's 2025 Healthcare M&A Report, released on April 22. Here are five trends shaping the ASC industry, according to the report: 1. Consolidation is reshaping the market e historically fragmented ASC sector, with about 68% of facilities operating independently as of 2023, is consolidating rapidly as healthcare giants race to scale their portfolios. In 2024, UnitedHealth Group (parent of Optum) and private equity firm TPG reportedly pursued acquisitions of Brentwood, Tenn.- based Surgery Partners. In January, Bain Capital — already a 39% shareholder — made a $3.2 billion nonbinding offer to acquire the company outright. VMG Health noted that folding Surgery Partners into Optum, which already owns SCA Health, would strengthen UnitedHealth's dominance in the outpatient market. ese moves highlight outpatient surgical platforms as a strategic priority for major players. ASC valuation multiples have stabilized around 8x EBITDA, indicating a maturing, increasingly competitive market. 2. Private equity has a new ASC strategy Private equity firms remain active in the ASC space but are shiing their approach. Instead of building standalone ASC platforms, firms are increasingly integrating ASC investments with physician practice management companies to better control the care continuum and diversify revenue, according to the VMG Health report. While new platform deals have been scarce, steady transaction activity through mid-2024 signals sustained interest. Minority stakes and add-on acquisitions are the new norm, reflecting a disciplined but aggressive investment strategy. 3. Operators betting big on higher-acuity specialties ASC growth strategies are now heavily focused on high-acuity, high- margin specialties like orthopedics, spine and gastroenterology. Tenet Healthcare's United Surgical Partners International reported a 19.4% year-over-year increase in total joint cases in 2024. Additionally, USPI is exploring opportunities to "migrate certain lower-acuity, higher-volume types of activities out of the ASCs," Tenet Healthcare CEO Saum Sutaria, MD, said in a recent earnings call. Additionally, Surgery Partners performed over 117,000 orthopedic cases in 2024, an 11% increase from 2023 and saw a 50% rise in total joint procedures. Operators are scaling aggressively: Tenet alone added nearly 70 ASCs to its portfolio in 2024 through both acquisitions and de novo development. According to VMG Health, success will increasingly depend on capturing complex surgical cases in lower-cost outpatient settings — and building national networks to support that shi. 4. Outpatient and ASC volumes are set for sustained growth e macro outlook for ASCs remains strong. Sg2's 2024 Impact of Change Forecast projects a 21% increase in ASC volume over the next decade, compared to a 17% rise for outpatient volumes overall. Several forces — payer incentives, consumer preferences, clinical advances and competition — are propelling this growth, especially in specialties moving complex procedures out of hospitals. Procedures performed in hospital outpatient departments can cost up to 58% more than those at ASCs or physician offices, according to Blue Health Intelligence. The expansion areas ASCs are targeting in 2025 By Cameron Cortigiano T he growth of orthopedics and the recruitment of the remaining independent physicians are two target areas for these CEOs. These two leaders recently connected with Becker's to share the biggest ASC and hospital trends that they are seeing in the industry. Note: Responses were lightly edited for clarity and length. Question: What growth plans does your ASC/organization have for 2025 and what strategic factors/trends are shaping those plans? Andre Blom. CEO of Illinois Bone & Joint Institute (Des Plaines): We are planning on adding two to three ASCs in 2025, refining our efficiencies and leaning more into the direct-to-employer market. We remain positive about the developing market of orthopedics in ASCs. Staffing and anesthesia concerns remain the primary factors we are trying to stay on top of. Patrick McEneaney, DPM. Owner and CEO of Northern Illinois Foot & Ankle Specialists (Crystal Lake): Since 2019, there has been a large shift of doctors moving from private practice to working for hospital systems. This number is nearing 80% nationally. This shift has led to these hospital employed surgeons performing their surgeries at the hospitals instead of surgery centers and there can be an unwritten pressure from the hospital for these doctors to do so. Because of this, recruiting is having to focus on the remaining independent surgeons. Additionally, we are seeing our patients sicker than previous years with more medical comorbidities. This has led to more of the patients having to be brought to the hospital for surgery because they are too high risk for the ASC. n

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