Ambulatory Surgery Centers: The Shift Toward Specialized Outpatient Surgery
Anchor Viewpoints: September 2026
By Steen Watson, President, Anchor Health Capital
Ambulatory surgery centers (ASCs) have become an increasingly important part of the U.S. healthcare system. They provide focused settings for procedures once performed more commonly in hospitals. Advances in technology and surgical techniques continue to expand outpatient care, giving ASCs a larger role in where and how care is delivered.
In this edition of Anchor Viewpoints, we examine the ASC sector’s continued growth and the trends driving demand for outpatient surgery. We also consider why these facilities are becoming an increasingly important part of U.S. healthcare infrastructure.
What is an Ambulatory Surgery Center?
ASCs are specialized healthcare facilities for surgical procedures that do not require an overnight hospital stay. Common specialties include orthopedics, ophthalmology, gastroenterology, pain management, podiatry, and cardiovascular care.
Unlike traditional hospitals, ASCs are purpose-built for outpatient procedures. Providers can therefore concentrate resources, staffing, and clinical workflows on surgical care. Advances in minimally invasive techniques, robotics, anesthesia, and recovery protocols have also made increasingly complex procedures safe in the ASC setting.
Continued Market Growth
The ASC sector continued its steady expansion in 2025. According to ASC Data's "State of the ASC Market 2026" report, Medicare-certified ASCs reached 6,566 at year-end. That represented 2.6% annual growth and a net increase of 168 centers. Estimated market value reached approximately $45.6 billion.
Procedural capacity is growing faster than the number of facilities. Total operating and procedure rooms increased 6.7% to 19,714 in 2025. The additions included 310 operating rooms and 933 procedure rooms. Operators are not only developing new centers; they are also expanding existing facilities to accommodate higher patient volumes and more complex procedures.
Trends Shaping ASC Growth
Specialty-Driven Development
Specialty-focused facilities are a notable trend in the ASC market. ASC Data reported that single-specialty centers drove new development in 2025, led by pain, endoscopy, and orthopedics. Of the 108 single-specialty ASCs that became Medicare certified during the year, 26% focused on pain, 16% on endoscopy, and 11% on orthopedics.
ASCs are also accommodating increasingly complex procedures. Cardiovascular, orthopedic, and spine cases should remain important growth areas as more care moves from hospitals to outpatient settings. For 2026, the Centers for Medicare and Medicaid Services (CMS) added 573 codes to the ASC procedure list, expanding the range of eligible procedures.
As clinical capabilities expand, facilities must support more specialized equipment, infrastructure, and workflows. This reinforces the need for purpose-built environments tailored to specific service lines.
ASCs as Core Healthcare Infrastructure
The growing role of ASCs is also changing how health systems view outpatient surgery. Once considered an alternative to traditional hospital care, ASCs are increasingly being treated as a core component of healthcare delivery.
According to ASC Data's report, 63% of health system leaders are considering outpatient surgery joint ventures. The finding reflects growing interest in partnerships among health systems, physicians, and ASC operators.
Several factors support this shift. Patients value ASC convenience. Payers increasingly direct care to lower-cost settings. Technology also allows more complex procedures to move safely into outpatient environments.
For health systems, ASCs can support physician alignment and expand outpatient surgical capacity. They can also create additional access points across regional care networks. Together, these trends are moving ASCs from an alternative site of service to an integrated part of health system strategy.
Targeted Market Expansion
ASC growth is also becoming more targeted by market. California, Florida, and Texas recorded the largest net increases in Medicare-certified ASCs in 2025. Expansion decisions reflect population growth, surgical demand, physician alignment, existing capacity, and health system relationships. This concentration underscores the importance of selecting markets where these factors align and operators can build density.
Real Estate Characteristics
ASCs are typically purpose-built around the clinical and operational needs of outpatient surgery. Specialized infrastructure may include operating rooms, recovery areas, advanced medical equipment, and building systems tailored to particular procedures or service lines.
Physician groups, specialty operators, or physician group–health system joint ventures commonly own or operate these facilities. Because of the intensive build out and significant tenant investment, long-term lease structures are common. Specialization makes operator alignment particularly important. Long-term property use can depend on physician relationships, service mix, payer dynamics, and accreditation requirements. Certificate-of-need laws and other facility approvals may also affect where and how new ASCs are developed.
These characteristics distinguish ASCs as a specialized healthcare real estate segment. Facility design, operator strength, lease structure, and market selection are closely linked.
Conclusion
The continued expansion of ASCs reflects a broader shift in U.S. healthcare toward specialized outpatient settings. Procedural capabilities are expanding, and more complex surgeries are moving beyond traditional hospitals. As a result, ASCs are playing a larger role in how patients access surgical care.
For Anchor Health Capital, the sector aligns with our focus on specialty healthcare real estate. We seek properties that support essential medical services, are occupied by experienced operators, and reflect durable changes in care delivery. Continued development, specialty-driven growth, and the shift of complex procedures to outpatient settings give the ASC sector significant long-term relevance.
Sources
Ambulatory Surgery Center News and ASC Data. The State of the ASC Market 2026: How Outpatient Surgery Continues to Reshape the Health Care Landscape. May 2026.
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