ASC M&A in 2026: Health Systems and PE Compete for Surgery Center Assets
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Ambulatory surgery center M&A remains active in 2026, with private equity and health systems both accelerating acquisition pace. Tenet Healthcare’s USPI deployed $125 million in Q1 2026 alone — acquiring seven ASCs and opening three de novo sites — while Surgery Partners targeted approximately $200 million in annual capital deployment. ASC transaction multiples reached 7.9x EBITDA in 2025, the highest in eight years, with best-in-class assets commanding double-digit multiples in select cases. Buyers are more disciplined than in the zero-rate era: strong physician alignment, clean financials, favorable payer mix, and cardiology or high-acuity orthopedic specialization generate the most competitive processes, while centers with compliance gaps or aging infrastructure face valuation discounts.
For physician groups and PE sponsors evaluating ASC entry or exit timing, 2026 offers active buyer demand at premium multiples — but execution discipline matters more than it did two years ago. Understanding what buyers prioritize (specialty mix, physician ownership structure, RCM cleanliness) is essential for maximizing transaction outcomes in a more discerning market.
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What are ASC transaction multiples in 2026?
ASC transaction multiples reached 7.9x EBITDA in 2025, the highest level in eight years, with best-in-class surgery centers commanding double-digit multiples in select cases. In 2026, buyers are applying greater discipline around case mix, payer contracts, and physician alignment before committing at premium valuations.
Who are the most active ASC acquirers in 2026?
Tenet Healthcare’s USPI and Surgery Partners are among the most aggressive buyers, with USPI deploying $125 million in Q1 2026 alone — acquiring seven ASCs and opening three de novo sites. Both health systems and private equity are competing for quality assets, driving competitive bidding for centers with strong case volume and favorable payer mix.
What makes an ASC attractive to buyers in the current market?
Buyers prioritize ASCs with diversified surgical specialties, strong physician ownership and alignment, favorable payer contracts, and documented clinical quality metrics. De novo development is also accelerating as an alternative when premium existing assets are unavailable at acceptable multiples.