Although the ASC industry is largely fragmented, big players like Tenet Healthcare, HCA Healthcare and Optum are chipping away at ownership as procedures migrate to the outpatient setting.
Dallas-based Tenet, parent company of United Surgical Partners International, has been bullish on ambulatory growth. USPI is the largest ASC chain in the country, with 512 ASCs and 25 surgical hospitals spanning 38 states.
"We see a tremendous opportunity with our ambulatory platform," CEO Saum Sutaria, MD, said, speaking May 14 at the Bank of America Securities 2024 Health Care Conference. "We're in this unique space of innovation and ambulatory care growth, which creates a significant amount of value and savings for the system, but it's also unique in the sense that it's value-based care that actually creates value for shareholders.
In 2020, Tenet acquired more than 90 ASCs from SurgCenter Development for approximately $1.2 billion, paving the way to market dominance. In the first quarter of 2024, Tenet acquired 45 ASCs and plans to invest $450 million into growing its ambulatory business in 2024.
The next largest ASC chain is SCA Health, which Optum acquired for $2.3 billion in 2017. SCA Health has grown from 186 ASCs in 2019 to 320 in 2023.
While the company shed several ASCs in deals inked this year, SCA Health acquired at least two cardiovascular providers in 2023 — National Cardiovascular Partners and Pivotal Healthcare. In May 2022, Surgical Care Affiliates rebranded to SCA Health to focus on specialty care and updated its logo to symbolize growth momentum.
Optum, the country's largest employer of physicians, is focusing on physician deals and has spent $31 billion on acquisitions in the last two years. The group added 20,000 physicians in 2023 and inked three major physician group acquisitions.
In March, Optum announced plans to acquire bankrupt Dallas-based Steward Health Care's physician group, Stewardship Health. It also received approval to bypass a state review of its planned purchase of physician-owned Corvallis (Ore.) Clinic.
Nashville, Tenn.-based HCA Healthcare, another massive, for-profit system, employs or is affiliated with more than 47,000 physicians, and is also ramping up its ASC portfolio through HCA Surgery Ventures.
HCA posted $1.8 billion in income and $17 billion in revenue in the first quarter of 2024 and outpatient revenues made up 36.9% of the group's patient-based earnings. The company ended the first quarter with 121 ASCs, down slightly from 126 in the same quarter last year.
In January, Surgery Ventures announced that it acquired a majority interest in two Texas ASCs in the fall of 2023. The group added two freestanding endoscopy centers in the last year, ending the first quarter with 24 facilities.