Private equity’s quiet roll-up of surgery centers

New PESP research brief warns Wall Street consolidation may drive up costs and raise antitrust concerns

The Private Equity Stakeholder Project (PESP) today released a new research brief, Private Equity in Ambulatory Surgical Centers, authored by researcher Michael Fenne. The report details how private equity firms have expanded into the $30 billion ambulatory surgery center (ASC) sector, reshaping outpatient care delivery through consolidation, leveraged buyouts, and opaque joint ventures.

ASCs now account for more than 60% of outpatient procedural care in the U.S. While these facilities are marketed as lower-cost, convenient alternatives to hospitals, the PESP brief raises concerns that private equity ownership may reduce transparency and drive up costs through consolidation.

“Private equity firms now play a significant role in outpatient surgery,” said Michael Fenne, senior policy researcher at PESP. “These investments may bring many of the same risks we’ve documented across other areas of healthcare—debt burdens, short-term cost-cutting, and ownership webs that obscure accountability.”

The report outlines several case studies:

• AmSurg: Acquired by KKR in a $9.9 billion leveraged buyout, then sold off to multiple private equity investors out of bankruptcy  before nonprofit giant Ascension announced a $3.9 billion acquisition of the company in June 2025. 
• Regent Surgical Health: Backed by TowerBrook Capital and Ascension Capital, Regent manages joint-venture ASCs with nonprofits like Mass General Brigham and the Cleveland Clinic. 
• UnitedHealth/Optum: Quietly expanding its network by acquiring private equity-assembled ASC platforms such as PE GI Solutions, OrthoAlliance, and U.S. Digestive Health.. 
• Surgery Partners (Bain Capital): The third-largest ASC operator in the U.S., with Bain unsuccessfully attempting a $3.2 billion full takeover earlier this year. 

“By the time regulators review a large acquisition, much of the consolidation has already taken place through smaller, unreported deals,” Fenne continued. “This kind of stealth consolidation raises serious antitrust concerns, locking in market power for Wall Street firms and insurance giants, while leaving patients and communities with higher costs and fewer choices.”

The report concludes that stronger disclosure and oversight are needed to track private equity’s role in outpatient care. Without reform, ASCs, once promoted as patient-centered innovations, risk becoming yet another venue where Wall Street dictates the terms of healthcare delivery.

The full research brief is available at: pestakeholder.org/reports/private-equity-asc