Private equity in ambulatory surgical centers

The report examines how private equity (PE) firms consolidate the ambulatory surgery center (ASC) market through leveraged buyouts and 'roll-up' strategies, often increasing prices by nearly 50% within five years. It details a 'second wave' of consolidation where corporate giants like UnitedHealth and non-profit systems like Ascension acquire these PE-built networks, potentially bypassing antitrust scrutiny. Case studies on AmSurg, Regent Surgical Health, and Surgery Partners illustrate risks including high debt burdens, operational opacity, and pressures on clinical staffing and revenue.

• Private equity-owned ASCs significantly increase prices without increasing surgical volume, charging nearly 50% more per case within four to five years due to revenue-focused strategies.
• Private equity firms utilize 'roll-up' consolidation strategies, acquiring small facilities in series of transactions that fall below federal reporting thresholds to accumulate market power while avoiding antitrust scrutiny.
• A 'second wave' of consolidation is occurring where non-profit health systems and corporate entities acquire PE-assembled ASC platforms; for example, Ascension acquired AmSurg for $3.9 billion in 2025, and UnitedHealth's Optum has acquired multiple PE-backed chains including PE GI Solutions and OrthoAlliance.
• The PE business model in ASCs often involves high debt and short-term investment horizons, which can lead to financial instability, as seen when Envision Healthcare filed for Chapter 11 bankruptcy in May 2023 due to an unsustainable debt burden.
• Regent Surgical Health employs a specific PE-backed model of forming joint ventures with non-profit hospital systems to manage facilities, which allows PE firms to leverage established brands and enter new markets while potentially avoiding antitrust review.
• There are concerns that PE's short-term focus leads to cost-cutting measures, including layoffs and the replacement of experienced staff with cheaper labor, as well as pressure on physicians to increase revenues.

APA

Fenne, M. (2025). Private equity in ambulatory surgical centers. Private Equity Stakeholder Project. https://pestakeholder.org/wp-content/uploads/2025/10/PESP_Report_Ambulatory-Surgical-Centers_2025-compressed.pdf

Chicago

Fenne, Michael. Private equity in ambulatory surgical centers. Private Equity Stakeholder Project, 2025. https://pestakeholder.org/wp-content/uploads/2025/10/PESP_Report_Ambulatory-Surgical-Centers_2025-compressed.pdf.

Wikipedia

{{cite report |last1=Fenne |first1=Michael |title=Private equity in ambulatory surgical centers |publisher=Private Equity Stakeholder Project |date=October 2025 |url=https://pestakeholder.org/wp-content/uploads/2025/10/PESP_Report_Ambulatory-Surgical-Centers_2025-compressed.pdf |access-date=23 October 2026 |via=Climate Insights Directory}}

BibTeX

@techreport{fenne2025private, author = {Fenne, Michael}, title = {{Private equity in ambulatory surgical centers}}, institution = {Private Equity Stakeholder Project}, year = {2025}, month = oct, url = {https://pestakeholder.org/wp-content/uploads/2025/10/PESP_Report_Ambulatory-Surgical-Centers_2025-compressed.pdf}, urldate = {2026-10-23}, note = {Indexed by Climate Insights Directory} }