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VideoASC Acquisition Candidates Remain Scarce Despite Continued Growth: Health Care Valuation Implications
Health Care Valuation Services
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The number of U.S. ambulatory surgery centers (ASCs) continues to grow at a healthy pace. According to the Ambulatory Surgery Center Association (ASCA), the number of Medicare-certified ASCs in Q4 2025 reached 6,566, a 2.6% annual increase. This growth reflects continued strength in the ASC market. However, there are indications that large consolidators are not seeing the same acquisition backlog as in the past. In some markets across the U.S., acquisition targets in the form of independent ASCs are becoming increasingly scarce.
By the Numbers
The number of ASCs by specialty is growing at different rates across the market.
| Specialty | 2024 Q4 | 2025 Q4 | Change |
|---|---|---|---|
| Dental | 479 | 496 | +3.5% |
| ENT | 1,442 | 1,453 | +0.8% |
| Endoscopy | 2,037 | 2,081 | +2.2% |
| OBGYN | 1,157 | 1,153 | -0.3% |
| Ophthalmology | 2,149 | 2,162 | +0.6% |
| Orthopedic | 2,325 | 2,376 | +2.2% |
| Other | 2,360 | 2,436 | +3.2% |
| Pain | 2,252 | 2,371 | +5.3% |
| Plastic | 1,747 | 1,775 | +1.6% |
| Podiatric | 1,726 | 1,743 | +1.0% |
| Specialty | 2020 Q4 | 2025 Q4 | Change |
|---|---|---|---|
| Dental | 511 | 496 | -2.9% |
| ENT | 1,420 | 1,453 | +2.3% |
| Endoscopy | 1,918 | 2,081 | +8.5% |
| OBGYN | 1,179 | 1,153 | -2.2% |
| Ophthalmology | 2,087 | 2,162 | +3.6% |
| Orthopedic | 2,157 | 2,376 | +10.2% |
| Other | 2,132 | 2,436 | +14.3% |
| Pain | 2,077 | 2,371 | +14.2% |
| Plastic | 1,738 | 1,775 | +2.1% |
| Podiatric | 1,690 | 1,743 | +3.1% |
Source: Ambulatory Surgery Center Association (ASCA), ASC Data, Q4 2025 Insights Report
According to the ASCA data above:
- From 2024 to 2025, pain management was the specialty with the largest growth at 5.3%.
- Pain management leads all specialties over five years, with cumulative growth of 14.2% since 2020.
- Orthopedics grew 2.2% the most recent year and has expanded 10.2% since 2020, making it the second-fastest growing specialty over the five-year horizon.
Looking Beyond Growth
- New ASCs are not meaningfully increasing acquisition opportunities for consolidators.
- ASCs developed today are largely structured as joint ventures with corporate partners or health systems and do not enter the market as standalone acquisition candidates.
- Higher costs, lack of availability of capital and elevated construction costs are making it difficult for physician groups to develop de novo centers without institutional backing. New center development is occurring in partnership with corporate and/or hospital partners.
- As a result, fewer de novo ASCs are entering the market as independent assets.
Health Care Valuation Takeaways
- Industry growth is healthy and signifies investor, physician and patient confidence in trends in outpatient surgery and the long-term viability of the ASC sector.
- If the industry growth is not increasing the supply of independent acquisition targets for potential purchase by consolidators, multiples of a smaller number of independent ASCs will increase because of the scarcity principle.
- A smaller inventory of independent ASCs will lead to upward pressure on valuation multiples. Scarcity, particularly in high-growth specialties such as orthopedics and pain management, will command premium valuations.
While ASC growth remains strong, the pool of independent acquisition targets may continue to shrink as more new centers are developed through joint ventures and institutional partnerships. For buyers and investors, that scarcity could continue to support strong valuation multiples across the ASC market. For more information, contact us today.
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