As healthcare consolidation accelerates, ASCs and hospitals are increasingly finding ways to work together, forming partnerships and joint ventures to drive mutual growth.
However, the nature of these relationships can vary significantly depending on the market — ranging from cooperative alliances to intense competition.
A 2024 survey of health system executives conducted by VMG Health found 60% of leaders were considering outpatient surgery joint ventures — the highest level of interest among all potential specialty partnerships. This growing trend reflects hospitals' focus on expanding their presence in the ambulatory care space, particularly as more procedures migrate from inpatient to outpatient settings.
In many markets, ASC-hospital relationships are evolving in a collegial and mutually beneficial manner.
"In most markets I've worked in, it's been positive," Brett Maxfield, CRNA, president and CEO of Maxfield Healthcare Solutions and president of the Idaho ASC Association, told Becker's. "There's enough demand that a collegial atmosphere develops, rather than a competitive one. Hospitals prioritize high-revenue cases, while surgery centers excel with high-volume, quick-turnover procedures."
Mr. Maxfield, who is actively engaged with both ASCs and hospitals in Southeast Idaho, described a particularly collaborative local dynamic, where ASCs and hospitals share employees, supplies and medications to support each other.
This team-based approach is evident in other regions as well.
"It's not a 'them versus us' mentality anymore," Karen Reiter, vice president of operations and payer management at Newport Beach, Calif.-based TriasMD and DISC Surgery Centers, told Becker's in September. "This ongoing collaboration is a great thing to see and will take us where we want to go."
Even independent ASCs can reap benefits from hospital partnerships, such as shared resources, co-ownership structures or strategic alliances with hospitals, private equity groups or physician networks, Ms. Reiter added.
However, in oversaturated markets, the dynamic can shift from collaboration to competition, especially in regions where hospitals rely heavily on surgical revenue to remain financially viable.
"In oversaturated markets, where hospitals depend on surgeries for revenue, the competition can become more intense, especially if surgeons move cases to ASCs," Mr. Maxfield told Becker's.
Some ASC leaders describe the relationship as outright adversarial.
"To call it adversarial would be an understatement," Shakeel Ahmed, MD, CEO of Atlas Surgical Group in St. Louis, told Becker's in June. "Competitors, like hospitals, are on edge. They're in a definite defense position and employ tactics that are oftentimes anti-business, anti-competitive and keep the ASC industry from reaching its full potential."
As the healthcare landscape continues to shift, ASCs and hospitals will need to navigate the balance between competition and collaboration. While some markets will foster partnerships and joint ventures, others will see heightened competitive pressures as hospitals seek to retain surgical volume.