As more complex, higher-acuity surgeries continue to shift from inpatient hospitals to lower-cost outpatient settings, a growing number of health systems are doubling down on ambulatory surgery centers, through strategic joint ventures, acquisitions and partnerships.

Driven by payer pressure, patient preference, and physician alignment, ASCs are emerging as a central pillar in health systems’ long-term growth strategies. In addition to reducing costs and improving access, these ventures are also helping systems expand market share, attract top surgical talent and accelerate innovation in outpatient care delivery.

One of the most notable moves yet: St. Louis-based Ascension is reportedly in advanced talks to acquire Nashville, Tenn.-based AmSurg, a national ASC operator with more than 250 centers across 34 states. The deal would mark a significant shift in Ascension’s outpatient strategy and transformation. 

Here are 12 health systems that announced ASC acquisitions, partnerships or joint ventures over the last three years:

1. Cleveland Clinic partnered with Franklin, Tenn.-based Regent Surgical to develop surgery centers in various U.S. markets. Cleveland Clinic is the majority owner of the joint venture and will have branding on all ASCs.

2. Newark, Del.-based ChristianaCare and Atlas Healthcare Partners — a Phoenix-based surgery center developer and operator — entered into a joint venture in August to bring an ASC network to Delaware and surrounding states. ChristianaCare said the joint venture will bring collaboration and innovation opportunities to a new network of ASCs in the mid-Atlantic. 

3. Tacoma, Wash.-based MultiCare Health in July launched a joint venture with Atlas “to develop, manage and scale our ASC network quickly and effectively,” according to Mark Mariani, MD, vice president of MultiCare Surgery Centers. 

4. In June 2024, Escondido, Calif.-based Palomar Health and AmSurg formed a joint venture with the health system’s Poway (Calif.) Surgery Center. The partnership aims to expand care access and accelerate improvements in quality outpatient care. Poway Surgery Center is a freestanding facility with five operating rooms and providers procedures in specialties including gastroenterology; orthopedics; and ear, nose and throat.

5. In February 2024, Fort Wayne, Ind.-based Parkview Health formed an ASC joint venture with Brentwood, Tenn.-based Surgery Partners. The joint venture will work with physicians to build and acquire ASCs with a focus on increasing access outside of Parkview’s core service area.

6. Dallas-based Methodist Health System, a 12-hospital system, teamed with Nashville, Tenn.-based Surgery Partners in August 2023 to acquire and open ASCs in North Texas. Surgery Partners, one of the country’s largest ASC chains, manages the Methodist Mansfield (Texas) Ambulatory Surgery Center, and the two organizations are working together to acquire and develop new ASCs in the region. 

7. In May 2023, Cincinnati-based Bon Secours Mercy Health System partnered with Raleigh, N.C.-based Compass Surgical Partners to develop more than 30 ASCs across multiple states. Compass is working with Bon Secours Mercy Health of Ohio to develop the ASCs throughout the system’s footprint, which includes Kentucky, Ohio, South Carolina, Virginia, Maryland, New York and Florida. The network could expand into other states, such as North Carolina.

8. Columbus-based OhioHealth and Surgery Partners in April 2023 agreed to create a company that will grow ASC joint ventures across Ohio. The partnership is using a phased approach for growth, beginning with expansion opportunities within the 50 counties OhioHealth serves, followed by an opportunity review of the remaining 38 counties. It will foster relationships with top surgeons in the state, offering them an opportunity to further invest in their practice, patients and community.

9. Salt Lake City-based Intermountain Health in April 2023 signed a collaboration agreement with Surgery Partners for the management of the system’s existing ASCs in Utah and Idaho and the development of surgery centers in other markets. 

10. Renton, Wash.-based Providence is expanding its network of ASCs after deepening its partnership with USPI in February 2023. USPI and Providence first partnered in 2004 and operate several joint venture centers together. USPI is working with Providence to boost the quality, convenience and access to the system’s ASCs in California and Washington. 

11. In June 2022, Grand Rapids, Mich.-based Corewell Health invested in Atlas as a capital partner. The health system partnered with Atlas to develop and operate an orthopedic ASC at the BHSH Spectrum Health Integrated Care Campus at East Beltline in Grand Rapids. 

12. Phoenix-based Banner Health also partnered with Atlas in May 2022 and aims to grow the number of ASCs in its network to 50 by the end of 2025.