Report: Hospitals double down on ASCs as outpatient shift accelerates

Editor's Note

Hospitals and health systems are all-in on ambulatory surgery centers (ASCs), with ownership now the rule rather than the exception, according to the 6th Avanza Intelligence Hospital Leadership ASC Survey published in 2025. The report, produced in partnership with HealthLeaders Media, shows 82% of hospitals now own at least one ASC—up from just 41% in 2019. The growth underscores the increasingly central role of ASCs in outpatient surgical strategy, propelled by market competition, consumer demand, cost pressures, and evolving regulations.

As detailed in the report, 90% of hospitals and health systems plan to expand their ASC investments or affiliations, up from 71% just 1 year prior. Much of this momentum is driven by the ongoing migration of non-urgent and even complex surgical procedures out of hospitals and into more cost-efficient outpatient settings. Payors, too, are fueling this shift—63% of hospitals report direct pressure from insurers to move appropriate surgical procedures to ASCs, which deliver care at lower costs while maintaining high quality and patient satisfaction.

Most hospital systems aren't stopping at a single center. In 2024, 57% of those with ASC ownership operate two or more facilities, reflecting the strategic acquisition of physician practices with existing ASCs and the push to increase outpatient surgical capacity. Further, 75% of hospitals structure these centers as joint ventures with physicians, and two-thirds prefer holding majority ownership stakes, highlighting a delicate but evolving balance between operational control and clinical partnership.

According to the survey, hospitals are also increasingly building internal teams to manage ASC operations, with 54% now relying on dedicated in-house administrators, medical directors, and boards. This internal model allows for faster responsiveness to operational needs and helps ensure alignment with broader system goals. At the same time, hospital systems are selectively using external resources for support without ceding oversight.

Surgeon recruitment is another powerful motivator. The survey reports that 93% of health systems view ASCs as critical for attracting top surgical talent, particularly in specialties like orthopedics and ophthalmology. Physicians are drawn by ASCs' efficiency, autonomy, and investment opportunities.

For the remaining hospitals still without ASCs, regulatory barriers—especially certificate of need laws—remain a primary obstacle. However, most respondents without ASCs say plans are underway, suggesting continued expansion is imminent.