Optum, Tenet and HCA Healthcare are huge players in the ASC industry with different strategies for growth.
Here is a breakdown of the three companies' ASC strategies:
Tenet Healthcare
Dallas-based Tenet Healthcare, parent company of ASC giant United Surgical Partners International, is betting big on ASCs.
"We continue to believe accelerating spend at USPI is the single most accretive thing to bring value within the company," Tenet CEO Saum Sutaria, MD, said in an Oct. 29 third-quarter earnings call.
With a 7.1% share of the ASC market, USPI is the largest ASC chain by number of physicians and centers. USPI's portfolio includes 520 ASCs (376 consolidated) and 24 surgical hospitals (seven consolidated) in 37 states.
According to Dr. Sutaria, USPI has nearly 20 centers in syndication and opened six ASCs in the third quarter, including a deal with Synergy Orthopedics to develop San Diego's largest dedicated musculoskeletal ASC.
The company acquired 45 centers in the first quarter, eight in the second quarter and purchased ASC chain Covenant Physician Partners.
Tenet is transforming its portfolio as it rapidly sells hospitals while adding ASCs. This year alone, Tenet has sold 14 hospitals for more than $4.8 billion.
USPI has grown nearly 126% since 2011, when it had 204 ASCs in its portfolio. By the end of 2019, USPI overtook AmSurg as the largest ASC chain in the country. It ended 2021 with 264 facilities compared to AmSurg's 258.
Tenet is also showing no signs of slowing, with plans to have 575 to 600 facilities by the end of 2025.
Optum
Optum, parent company of ASC chain SCA Health and a major employer of physicians, is prioritizing a different kind of growth: expanding its workforce rather than building new facilities.
On the hospital front, Optum is pursuing partnerships with health systems that outsource administrative tasks to the company. These collaborations increase the number of affiliated employees under Optum while allowing it to oversee large-scale operations, such as revenue cycle management, IT, informatics, analytics and inpatient care management.
This broad approach also extends to Optum's ASC operations. SCA Health manages a network of 320 ASCs, making it the second-largest operator in the sector.
In May 2022, SCA Health rebranded from Surgical Care Affiliates, signaling its plans to grow beyond ASC management. Similar to Optum's massive deals with physicians and healthcare providers, SCA Health seems to be targeting significant acquisitions.
The company quietly purchased at least two cardiovascular providers in 2023, National Cardiovascular Partners and Pivotal Healthcare. National Cardiovascular Partners comprises 21 cardiac catheterization and vascular labs.
Optum is also one of the potential buyers of Brentwood, Tenn.-based ASC operator Surgery Partners, the third-largest ASC operator.
HCA Healthcare
HCA Healthcare, based in Nashville, Tenn., ranks among the nation’s largest ASC operators through its Surgery Ventures division. By the end of 2023, HCA had 124 ASCs and 24 endoscopy centers, collectively handling 1,044,415 surgery cases — a 2.1% increase from the previous year.
HCA aims to expand by adding 100 outpatient facilities by the end of 2024, which will increase its total number of care sites to more than 2,600.
The health system's ASC strategy is driven by "greenfield developments" — new facility constructions — along with targeted acquisitions, CEO Sam Hazen said in a third-quarter earnings report.
The health system has an average of 13 outpatient facilities for each hospital. By 2030, the company expects that average to grow to between 17 and 20.
HCA wants "to extend the reach of our network for our patients, make it more convenient for them to start their process of care somewhere in the HCA system," Mr. Hazen said at the Morgan Stanley conference Sept. 5.
He said its approach is to "take as many outpatient facilities as we possibly can and make it closer to the patient."
On Aug. 13, HCA Healthcare won certificate-of-need approval to develop an ASC in Hanover, Va., after two consecutive rejections by state health authorities.
Also this year, HCA Surgery Ventures announced the opening of Silicon Valley Surgery Center in Campbell, Calif., through a joint venture deal with more than 50 physicians. HCA Surgery Ventures and 20 physician partners also opened a five-operating-room ASC in Kansas City, Mo.