St. Louis-based Ascension is reportedly exploring a major move to significantly expand its outpatient footprint — taking a page from the playbook of one of the sector’s most dominant players: Tenet Healthcare.
The Catholic nonprofit system is said to be in advanced talks to acquire AmSurg, an ambulatory surgery center operator with more than 250 facilities across 34 states. The deal would mark a major shift for Ascension, signaling a more deliberate push into ambulatory care as more complex procedures continue to migrate out of hospitals and into lower-cost, outpatient settings.
If finalized, the AmSurg acquisition would represent a clear nod to Tenet’s transformation strategy, which has focused heavily on scaling its ASC platform — United Surgical Partners International — into the dominant force in the space.
Tenet’s evolution offers a potential playbook for Ascension.
In 2022, Tenet acquired the remaining 5% stake in USPI from Baylor Scott & White Health — also headquartered in Dallas — for $406 million, giving it full ownership of the platform. Since then, the for-profit health system has rapidly expanded USPI’s national presence, adding nearly 70 ASCs in 2024 alone.
As of March 31, 2025, USPI owned or held interest in 520 ASCs and 25 surgical hospitals across 37 states, supporting over 11,000 physicians and performing more than 2 million procedures annually. USPI has continued to invest aggressively — roughly $250 million a year — in mergers, acquisitions and new development, including a robust partnership with Maryland-based SurgCenter Development.
This strategy has paid dividends: Tenet now derives a significant portion of its financial performance from its outpatient surgical segment, while shedding capital-intensive hospital assets. In 2024 alone, the company sold 14 hospitals for a combined $4.8 billion as part of a broader rebalancing of its portfolio.
“Tenet is entering a new era with a greater proportion of our performance coming from our highly efficient ambulatory surgical business and a reduced debt profile,” CEO Saum Sutaria, MD, said during a recent earnings call. “We will have significant financial and capital flexibility to increase shareholder value over the long-term.”
For Ascension, the potential acquisition of AmSurg represents an opportunity to expand the health system’s ambulatory care reach at scale, while positioning itself for greater flexibility in a shifting healthcare landscape.
Nashville, Tenn.-based AmSurg supports nearly 2,000 physicians and is the second-largest ASC chain in the ASC market, behind USPI . Its footprint of more than 250 ASCs across 34 states would give Ascension an immediate competitive presence in outpatient surgery — a setting that is increasingly favored by both patients and payers for its lower costs and efficiency.
The move would also mark a strategic counterweight to SCA Health, the third-largest ASC operator and a subsidiary of UnitedHealth Group’s Optum. SCA Health owns or manages more than 320 surgical facilities, serving over 1.4 million patients annually, according to its website.
As financial pressures on hospitals intensify — from reimbursement constraints to rising labor and supply costs — health systems are reassessing where and how they deliver care. For Ascension, following Tenet’s lead into ambulatory care could serve both strategic and financial aims: reducing reliance on inpatient margins, expanding access in more markets and driving long-term sustainability.
