The ambulatory surgery center (ASC) market is facing a period of recalibration in 2025. A confluence of macroeconomic pressures, shifting specialty performance and evolving investment strategies has shaped the pace and structure of dealmaking across the sector. While demand for outpatient care remains strong, M&A activity has cooled, at least on the surface.
To explore these trends, we interviewed Colin Park, Managing Director at VMG Health, a leading healthcare valuation and transaction advisory firm serving both buy-side and sell-side clients. Park’s insights reveal the forces currently shaping ASC M&A, the most resilient ASC specialties, how regulatory and cost pressures are influencing valuations in the space and what it takes to build lasting partnerships in today’s ASC landscape.
According to LevinPro HC data, eight ASC deals have been announced during the first half of 2025, compared to 16 during the same period in both 2023 and 2024. That represents a 50% year-over-year drop in deal volume. That drop stands out against a much smaller decline across the broader healthcare M&A market. Across the entire healthcare ecosystem, deal volume during the first half of 2025 is down just 1% from the same period of 2024, and 14% from 2023.
“Interest rates are still high, so money’s kind of expensive, which lowers the return when companies are borrowing to do transactions,” Park said. “There were also some big transactions announced, like USPI’s acquisition of Covenant in Q3 2024, and there’s a period of integration that follows, so there’s probably some lag before things start back up.”
While high interest rates may temper enthusiasm, the ASC market is far from stagnant. The integration lag Park describes points to a sector in transition rather than decline. Demand for outpatient services continues to surge, and both health systems and private equity groups are actively pursuing ambulatory growth strategies.
Private equity remains the dominant force in ASC acquisitions, accounting for three notable deals in the first half of 2025: Wellspring Capital Management LLC acquired Summit Spine & Joint Centers in April; Bain Capital-backed Surgery Partners, Inc. acquired Montpelier Surgery Center and Advanced Surgery Center in May; and Welsh, Carson, Anderson & Stowe purchased Constitution Surgery Alliance in June. These transactions underscore private equity’s strategic focus on consolidating high-value ASC platforms despite a broader slowdown in deal volume.
“Anecdotally, 2025 doesn’t feel necessarily slower, and we’re still seeing a lot of transactions,” Park noted “Some smaller ones we work on fly under the radar, so they’re not publicly reported.”
The steady flow of transactions, particularly smaller, unreported deals, highlights the ASC market’s adaptability. These quieter transactions often involve independent ASCs or joint ventures, signaling a wave of consolidation and collaboration. For investors, they also present opportunities that may not show up in public deal counts but are no less impactful in shaping market dynamics.
From a specialty standpoint, some service lines are proving more resilient than others.
“Musculoskeletal, ortho, total joint, that’s always the revered specialty that a lot of groups are looking at,” Park said. “But a good, busy GI center is hard to sleep on. The only specialty I’ve seen lose traction is cardiovascular, largely due to its payer mix. High governmental volume limits the upside in managed care contracting.”
These specialty trends are central to valuation. Musculoskeletal and gastrointestinal ASCs remain attractive due to high procedural demand and favorable reimbursement. In contrast, cardiovascular centers face headwinds as a heavy reliance on government payers can undercut revenue potential. For operators, aligning specialty mix with market realities and payer strength is key to maintaining enterprise value.
Looking ahead, Park remains cautiously optimistic about the rest of the year.
“It’s going to continue to be pretty busy, and if rates come down, you might see more lending and groups getting more aggressive with buying and investing in centers,” he said. “The Ascension deal with AmSurg is a huge headline, and we’re going to see continued health system investment in outpatient strategy, oftentimes with a management company in a joint venture.”
Deals like the Ascension’s June 2025 acquisition of AmSurg underscore a broader shift: health systems are increasingly looking to ASC platforms as a cornerstone of their outpatient strategies. These partnerships, often structured with a management company or private equity sponsor, are reshaping the competitive landscape by blending clinical oversight with operational and financial discipline.
As strategic partnerships continue to change the ASC landscape, evaluating a center’s true worth is becoming increasingly nuanced. Buyers and sellers must consider a broad range of financial and operational factors that go beyond headline deal terms.
“On the revenue side, you’ve got volume and payer mix. A big component is the physicians—are they aligned or do they have ownership? Is it a young group or an aging group with a succession plan?” Park explained. “For payer mix, are they heavy Medicare or do they have a healthy amount of commercial payers? Have they proactively managed their payer contracts to get good rates?”
Physician alignment and payer diversity remain essential for financial performance. Younger groups with strong commercial contracts often command stronger valuations, while aging practices without succession plans can raise red flags for buyers. Contract strategy, particularly on the commercial side, continues to differentiate high-performing centers.
But even the most promising revenue profile must be weighed against today’s cost pressures.
“On the expense side, anesthesia subsidies are at the forefront the last two years—centers avoiding those through a healthy payer or case mix are way better off,” Park noted. “Staffing costs post-COVID also haven’t come down in some markets, and supply costs or capital expenditures, like replacing scopes or HVAC, are really impactful.”
With margins under pressure, investors are looking beyond topline performance to understand how centers manage operational costs. The ability to control expenses while maintaining efficiency has become a key differentiator, especially as buyers prioritize long-term stability over short-term gains.
When asked what advice he would give to investors or operators in today’s ASC environment, Park emphasized the importance of partnership fit.
“My advice to investors or ASC operators looking to navigate the current ASC market is to figure out what you bring to the table as a potential partner,” Park said. “Physician-owned ASCs aren’t just looking for a check—they want a strategic partner. Find groups that line up with what you need, like a management company for managed care contracting or a private equity group to help with recruiting physicians or succession plans.”
As deal flow slows and costs rise, ASC operators and investors alike are rethinking what it means to be a good partner. Access to capital still matters, but it’s no longer enough. Groups that bring operational expertise, help with payer negotiations or support physician recruitment will be better positioned to build lasting value, especially in physician-led environments. In today’s ASC market, success increasingly hinges on alignment over acquisition.
