ASC development is becoming increasingly lucrative for health systems and hospitals as more complex procedures move to the outpatient setting.
Although the ASC industry is largely fragmented, Tenet Healthcare, HCA Healthcare and Optum are leading the charge in big chain ASC development.
Dallas-based Tenet, parent company of United Surgical Partners International, has been focusing on ASC development for years. The health system operates more than 445 ASCs — the most of any system — and 24 surgical hospitals.
USPI, the largest ASC chain in the country, also employs more than 11,000 physicians, including 6,000 physician partners, across the 35 states it serves.
In 2021, USPI acquired Towson, Md.-based SurgCenter Development and its more than 90 ASCs, strengthening its market share. USPI also plans to inject more than $250 million into ASC mergers and acquisitions and work with SurgCenter to develop at least 50 more ASCs, according to terms of the transaction.
Its closest competitor is Deerfield, Ill.-based SCA Health, which UnitedHealth Group's Optum acquired for $2.3 billion several years ago. SCA Health boasts about 320 ASCs with 1.43 million patient encounters annually.
Unlike Tenet, Optum is focusing on physician acquisition over ASC acquisition. The company is the largest employer of physicians in the country, with a portfolio of 70,000.
Optum snagged Middletown, N.Y.-based Crystal Run Healthcare, a multispecialty physician group with more than 400 providers. It also acquired Houston-based Kelsey-Seybold for $3 billion, Dallas-based Healthcare Associates of Texas for $300 million and Auburndale, Mass.-based Atrius Health for $236 million in the last year.
SCA Health is expanding its focus past ASC management into specialty care. In May 2022, Surgical Care Affiliates rebranded to SCA Health and updated its logo to symbolize growth momentum and added a tagline: "The future of specialty care."
"When I joined the organization in 2015, we were an ambulatory surgery center company singularly focused on partnering with surgeons in their ASCs," Caitlin Zulla, CEO of Optum Health's east region and former CEO of SCA Health, told Becker's last year. "Since then, we've evolved to support physician specialists more holistically across the specialty care continuum."
Nashville, Tenn.-based HCA Healthcare, another massive, for-profit system, employs or is affiliated with more than 47,000 physicians, but is also ramping up its ASC portfolio.
HCA comprises 2,300 ambulatory care facilities, including more than 150 ASCs, freestanding emergency rooms, urgent care centers and physician clinics, according to its first-quarter earnings report.
The company is continuing to double down on developing outpatient facilities and increasing outpatient procedure migration, it said in its first-quarter earnings call. The company has a "more significant investment" in its ASC development pipeline, as well as possible acquisitions in the works, CEO Sam Hazen said.