While still a largely independent field, consolidation is on the rise in the ASC industry, with a few major players building out substantial ASC chains.
Dallas-based Tenet Healthcare, parent company of United Surgical Partners International, began reducing its debt profile and shifting focus to its ASC portfolio five years ago. Now they are the largest in the U.S., with 7.1% of the ASC market share.
Tenet capitalized off outpatient migration by offloading some assets while investing in ASCs. The health system sold nine hospitals in California and South Carolina for a total of $3.9 billion and plans to sell its majority stake in five more Alabama hospitals for $910 million this fall. The company acquired 45 new centers in the first quarter and quietly purchased ASC chain Covenant Physician Partners.
"Of all the ASC platforms and [their] recovery … USPI … had the strongest recovery in 2023 from a volume perspective," CEO and Chair Saum Sutaria, MD, said Sept. 9 during the Wells Fargo Healthcare Conference. "But we look at that as a measure of strength and as a measure of preference of the USPI platform."
UnitedHealth Group's Optum is another major player in the race to acquire ASCs through their ASC branch Surgery Ventures. In 2023, Optum added nearly 20,000 physicians to its payroll, bringing its total to at least 90,000 affiliated physicians. The company operates 2,200 primary and specialty care offices in 16 states.
On Sept. 24 Nashville, Tenn.-based HCA Healthcare, which owns ASC chain HCA Surgery Ventures, received approval from the Santa Clara (Calif.) County's board of supervisors to sell off its 252-bed Regional Medical Center in East San Jose, Calif., for $315 million.
Of the $315 million allocated, $175 million will go to the acquisition of the hospital. An additional $80 million will fund the first few months of hospital operations while awaiting reimbursements. Up to $30 million is designated for acquiring independently owned medical office buildings near the hospital, $20 million for purchasing and implementing an electronic health record system and $10 million for broker fees and inspections.
HCA is one of the largest ASC operators in the country. The company finished 2023 with 124 ASCs and 24 endoscopy centers, and posted $17 billion in revenue and $1.8 million in income in the first quarter of 2024.