Private equity is reshaping ASCs, raising cost and antitrust concerns

Editor's Note

Private equity is driving a quiet but powerful transformation in the $30 billion ambulatory surgery center (ASC) market, heightening risks of higher costs and reduced competition, an October 2025 research brief from the Private Equity Stakeholder Project (PESP) reports. It warns that Wall-Street-backed consolidation and opaque ownership structures are reshaping outpatient surgery in ways that may ultimately disadvantage patients and communities.

ASCs reportedly now deliver more than 60% of outpatient procedural care in the US, marketed as lower-cost, convenient alternatives to hospitals. But as detailed in the PESP report, private equity ownership often prioritizes rapid returns through high debt loads, short-term cost-cutting, and incremental acquisitions that evade regulatory scrutiny. A 2023 study cited in the report found private equity-owned ASCs raised prices nearly 50% within 4 to 5 years, without corresponding increases in case complexity.

Case studies highlight how these dynamics play out. AmSurg, once a leading ASC operator, was taken private in a $9.9 billion leveraged buyout by KKR, later cycled through multiple investment firms, and ultimately sold to Ascension for $3.9 billion. By the time regulators could review that deal, much of the consolidation had already occurred through smaller roll-ups. Similarly, Regent Surgical Health, backed by TowerBrook Capital and Ascension Capital, has expanded its reach through joint ventures with nonprofits like Mass General Brigham and the Cleveland Clinic, blending investor-driven models with mission-driven health systems.

UnitedHealth’s Optum subsidiary has aggressively acquired ASC networks originally assembled by private equity, including PE GI Solutions, OrthoAlliance, and US Digestive Health. Many of these transactions were not publicly announced, raising concerns about “stealth consolidation.” Surgery Partners, the nation’s third-largest ASC operator, remains heavily tied to Bain Capital, which earlier this year attempted but failed to take full ownership in a $3.2 billion bid.

The PESP report concludes that stronger oversight and disclosure are needed to track how private equity financing shapes the ASC sector. Without reform, it argues, outpatient surgical care may evolve less as a patient-centered innovation and more as a financial asset class where Wall Street and large insurers dictate terms, reducing transparency and narrowing patient choice.