St. Louis-based Ascension is ramping up its push into outpatient care and ancillary services, signaling a strategic pivot after years of acute care divestitures and operational realignment.
The 95-hospital, Catholic health system is accelerating growth in outpatient services, investing in surgery centers, imaging, pharmacy and physical therapy sites. The strategy reflects a broader industry shift toward more convenient, lower-cost care settings.
At the center of the strategy is Ascension’s planned acquisition of Nashville, Tenn.-based AmSurg, an ambulatory surgery center operator with more than 250 facilities across 34 states. Ascension is reportedly in advanced talks to acquire the company for about $3.9 billion. If finalized, the deal would give Ascension an immediate competitive footprint in outpatient surgery — a setting increasingly favored by patients and payers.
The deal would also mark a bold step toward mirroring the playbook of one of the sector’s most aggressive ASC builders: Dallas-based Tenet Healthcare. Tenet’s outpatient subsidiary, United Surgical Partners International, now operates more than 480 ASCs and is the largest chain in the U.S.
AmSurg, which supports nearly 2,000 physicians, is the second-largest ASC operator by volume, behind USPI. The deal would also serve as a strategic counterweight to SCA Health, the third-largest ASC player and a subsidiary of UnitedHealth Group’s Optum. SCA owns or manages more than 370 facilities and sees more than 2 million patients annually, according to its website.
Beyond the potential AmSurg acquisition, Ascension is also expanding its footprint in other outpatient sectors. It is doubling down on growth in imaging centers, outpatient physical therapy sites and Ascension Rx: a pharmacy platform expanding through specialty drug services and a nationwide mail-order distribution center.
These moves come as Ascension offloads underperforming or nonstrategic hospitals. Over the past two years, the health system has sold or consolidated about 35 hospitals across multiple states. The changes are part of a sweeping financial turnaround plan that included portfolio reshaping and an operational overhaul. Now, with a more streamlined acute footprint, Ascension appears to be entering a new growth phase: one that’s firmly anchored in outpatient care.
Ascension reported an operating loss of $490.9 million (-1.6% margin) in the fiscal year ending June 30, improving on a $1.8 billion operating loss (-6.3% margin) in fiscal 2024.
“Our FY25 results reflect the disciplined execution of our strategy and the progress we have made across the organization,” Ascension President Eduardo Conrado said in a Sept. 17 news release. “That discipline is driving efficiency, strengthening operations, and positioning Ascension for sustained growth. Strategic initiatives, from expanding ambulatory and specialty services to investing in digital capabilities, are helping us meet patients where they are while elevating our overall performance.”
