The Outpatient Gold Rush: 10 Things To Know

The outpatient acquisition wave is no longer just another healthcare trend. It has become the defining force reshaping ownership, staffing and competition across ambulatory surgery centers (ASCs), physician practices and urgent care.

More than 40 physician practice transactions closed during the first half of 2026. Seventy-one new ASCs opened nationwide in 2025. Meanwhile, the $3.9 billion Ascension-AmSurg transaction, completed in June, transferred ownership of roughly 300 ASCs in a single deal.

Here are 10 trends driving the shift—and what they mean for ASC operators.

1. The Buyer Landscape Has Never Been More Competitive

Health systems, private equity firms, payers and physician-led platforms are all pursuing outpatient assets, each with a different strategic objective. According to PwC’s Health Services Midyear Outlook, physician medical groups accounted for a record 46% of healthcare deal volume in the first quarter of 2026, generating nearly three times as many transactions as the next-largest subsector.

Payers are acquiring primary care practices to control patient access. Health systems are reducing inpatient footprints while expanding ambulatory networks. Private equity firms continue building existing platforms. As a result, a single practice may attract multiple buyers, each valuing it differently. According to Auxo Capital Advisors’ Urgent Care M&A Report, for example, a health system may place significant value on downstream referrals and market coverage that a financial buyer cannot.

2. Independent Practices Remain The Industry’s Top Acquisition Target

Independent physician practices continue to disappear through consolidation. Between 2019 and 2023, the share of physician practices owned by hospitals, health systems or corporate entities increased from 39% to 59%, while physician employment within those organizations rose from 62% to 78%, according to a December 2025 report from the Progressive Policy Institute.

The trend continued in 2024, when just 42.2% of physicians worked in private practice, down from 60.1% in 2012, according to the AMA’s Physician Practice Benchmark Report. Independent practices are not disappearing altogether, but the number of acquisition candidates continues to shrink, increasing competition for the practices that remain.

3. Payers Are Emerging As Major Outpatient Acquirers

Health insurers are becoming increasingly active buyers of physician practices. Humana’s CenterWell Senior Primary Care added more than 100,000 patients in 2025—a year-over-year increase of more than 25%—including approximately 32,000 patients through its acquisition of The Villages Health in Florida.

By owning primary care platforms, insurers can influence the front door of care for Medicare Advantage members, reduce downstream costs and capture more value across the care continuum.

4. Health Systems Are Shifting Capital From Hospitals To Outpatient Care

Health systems are increasingly redirecting investment away from hospitals and toward ambulatory care. In VMG Health’s 2025 Survey of health system executives, outpatient surgery ranked as the leading service line for joint ventures, with more than 60% of respondents identifying ASCs as a top growth priority.

Ascension reduced its hospital portfolio from roughly 140 facilities to 91 before investing $3.9 billion in AmSurg. Trinity Health New York is redirecting capital toward primary care centers, orthopedic facilities and ASCs, while CommonSpirit added 90 ambulatory sites over two fiscal years.

The strategy is becoming increasingly consistent across the industry: reduce hospital assets while expanding outpatient capacity.

5. New ASC Development Is Accelerating Alongside Acquisitions

Consolidation is not replacing new development—it is happening alongside it. Seventy-one new ASCs opened across the U.S. in 2025, with North Carolina and California each adding eight centers and Texas adding four.

” The inventory of mature, independently owned ASCs available for acquisition is becoming increasingly limited, prompting more organizations to pursue de novo development,” Steve Hockert, chief development officer of Solara Surgical Partners, told Becker’s.

6. Urgent Care Is Becoming Part Of The Broader Iutpatient Strategy

Urgent care is increasingly serving as an entry point into outpatient specialty care.

 “Orthopedic urgent care centers naturally complement ASCs”, said Alejandro Badia, MD, founder and CMO of Miami-based Badia Hand to Shoulder Center. “Collaboration between a convenient walk-in facility, for example an orthopedic urgent care center, and an ASC will drive musculoskeletal surgical volume while lowering overall healthcare system costs.”

According to Auxo Capital Advisors, urgent care acquisitions now mirror consolidation across physician practices and ASCs, with health systems, private equity-backed platforms, payer-affiliated organizations and physician-led groups competing for many of the same assets.

7. Specialty Consolidation Remains Strongest In Orthopedics, Cardiology And Gastroenterology

Certain specialties continue to attract the greatest acquisition interest. According to Focus Investment Banking’s 2026 Report, cardiology, gastroenterology and orthopedics lead physician practice M&A activity, with ophthalmology close behind.

During the first half of 2026, RadNet acquired two radiology groups, Ascend Vision Partners entered Oklahoma through three ophthalmology acquisitions, Vision Innovation Partners added two practices, and Atria Heart acquired Cardiovascular Consultants in Phoenix.

8. Three-Way Joint Ventures Are Becoming The Preferred Alternative To Full Acquisitions

Many independent physicians are looking for capital without giving up control.

“Independent physicians are really in a squeeze right now,” Compass Surgical Partners Chief Development Officer Mark Langston told Becker’s. “Small practices struggle in risk-based models, lack payer leverage, and often can’t afford needed infrastructure.”

As a result, three-way joint ventures involving physician groups, health systems and management companies are becoming increasingly common. These arrangements provide capital, operational expertise and infrastructure while allowing physicians to retain equity and governance—an approach that is becoming central to many health systems’ ASC strategies.

9. Regulators Are Taking A Closer Look At Outpatient Consolidation

As deal activity increases, regulatory scrutiny is also intensifying. The FTC required Ascension to divest seven ASCs before approving its acquisition of AmSurg, marking the agency’s first major intervention in an ASC-specific transaction. The decision also reinforced the FTC’s focus on local market competition rather than national market share, suggesting future transactions will face earlier and more detailed geographic analysis.

Private equity-backed roll-up strategies have also drawn increased attention. While individual acquisitions may not trigger federal reporting requirements, a series of smaller transactions can significantly reshape local markets before regulators evaluate a larger deal, according to the Private Equity Stakeholder Project.

10. The Opportunity For Independent Operators Is Narrowing—But It Remains Open

Independent ASC operators still have leverage, particularly in markets where buyers have limited alternatives. According to VMG Health, 59% of independent ASCs would consider a strategic partnership instead of a full acquisition. Among those respondents, 71% said they would consider partnering with a health system.

As consolidation continues and FTC scrutiny limits some acquisition opportunities, well-positioned independent operators may become increasingly valuable because they offer buyers scarce local market access without requiring another large-scale acquisition.

Source: Becker’s ASC Review