Ambulatory surgery centers (ASCs) are quickly becoming essential components of health systems’ long-term growth strategies. Clinical, financial, regulatory, and competitive forces are converging to push more care beyond the hospital walls. As a result, health systems are revisiting their ambulatory strategies and evaluating how ASCs can support sustainable revenue, physician alignment, and expanded access.
What’s Driving the Shift
Multiple market dynamics are accelerating ASC development. Technology improvements and post-pandemic comfort with higher-acuity procedures in outpatient environments have made ASCs a viable option for surgeries previously limited to hospital settings. Meanwhile, federal and state policy changes are still encouraging the migration of care. Inpatient-only list removals, site-neutrality discussions, and more aggressive payer authorization requirements are steering lower-acuity procedures toward outpatient settings. Several states have also relaxed certificate-of-need requirements, creating new opportunities for ASC development.
Payers in some markets are directing certain procedures, like colonoscopies and endoscopies, to ASCs to improve cost efficiency. At the same time, patients increasingly prefer the convenience, ease of access, and streamlined perioperative experience that ASCs provide. Private equity–backed platforms and national ASC management companies continue expanding aggressively.
As competition intensifies, health systems without a defined ASC strategy face growing pressure to respond.
Additionally, the ASC model naturally aligns incentives for physicians, payers, and health systems, offering efficiency, financial partnership, and clinical autonomy. This alignment grows more important as physician employment and practice acquisition reshape market dynamics.
Key Barriers for Health Systems Entering the ASC Space
Despite strong tailwinds, health systems often encounter hurdles when building or expanding their ASC portfolio. They need strategic clarity. A clear articulation of goals, whether pursuing one center or creating a multi-market platform, is essential. Lack of early alignment on scope, structure, and scale can slow progress and increase friction.
Health systems often benefit from stepping back to evaluate their entire procedural portfolio, identifying cases likely to migrate and clarifying where ASCs offer the greatest value. Running a hospital and running an ASC are fundamentally different. Success requires responsiveness, collaborative decision-making, and competencies tailored to a highly efficient outpatient environment. Because many systems employ large numbers of surgeons and proceduralists, understanding how ASC development fits within existing financial and contractual structures is critical.
How Leading Health Systems Are Getting It Right
Health systems that excel in ASC development normally:
- Prioritize clarity and sequencing: They identify potential friction within core markets and expand into adjacent geographies first, building physician trust and early wins.
- Align structure with strategy: Whether partnering, acquiring, or developing de novo facilities, they establish governance and ownership models that support long-term growth.
- Stay grounded in local realities: ASC strategies must reflect local payer dynamics, state regulations, market demands, and demographic trends. What succeeds in one region may not translate to another.
Trends Shaping the Future of ASC Strategy
Looking ahead, ASCs are expected to see increased specialty focus, with single-specialty centers—particularly in musculoskeletal care, spine, cardiac, and electrophysiology—further accelerating. This shift pairs with broader changes in payer behavior.
As payers and policymakers intensify site-neutrality efforts, health systems will need to reassess managed care strategies across inpatient, emergency department, and outpatient settings for margin protection and long-term sustainability.
Simultaneously, ASCs are becoming an increasingly valuable tool for physician recruitment and retention. With ongoing workforce shortages, systems may expand syndication opportunities to attract high-quality surgical talent and strengthen alignment. Demographic trends, evolving patient expectations, and reimbursement pressures will also continue pushing procedural volume toward outpatient settings, creating both significant opportunity and growing urgency for health systems still refining their ASC strategy.
Preparing for What’s Next
The ASC environment is full of tailwinds, but precise execution determines success. Health systems that develop clear strategies, align with the right physician partners, build flexible structures, and plan for long-term financial and operational realities will be best positioned to thrive as the market continues to evolve.
Health systems that act now will shape the future of outpatient care. Connect with the experts at VMG Health for strategic guidance and practical next steps.
