Ambulatory Surgery Center (ASC) Valuation Multiples and M&A Trends 2025

The ambulatory surgery center (ASC) industry has experienced significant growth over the past decade, driven by the shift toward outpatient care, advancements in minimally invasive surgical techniques, and cost-efficiency benefits for both patients and payers. ASCs specialize in providing same-day surgical care, including diagnostic and preventive procedures, across a wide range of specialties such as orthopedics, ophthalmology, urology, neurosurgery, gastroenterology, otolaryngology, and pain management. These facilities are increasingly attractive to healthcare providers and investors due to their ability to deliver high-quality care at a lower cost compared to traditional hospital settings, often resulting in significantly higher profit margins despite lower reimbursement rates. The industry’s growth is further supported by favorable regulatory changes, such as the expansion of Medicare-covered procedures eligible for ASC settings, and the increasing demand for convenient, patient-centered care.

Key Growth Drivers

Key growth drivers for the industry include the following:

• Cost Efficiency: ASCs offer a more cost-effective alternative to hospital-based outpatient surgeries. The lower overhead costs, streamlined operations, and efficient use of resources result in significant savings for both patients and payers, making ASCs an attractive option for many surgical procedures.

  
  

• Advancements in Medical Technology: Technological advancements in minimally invasive surgical techniques, anesthesia, and pain management have expanded the range of procedures that can be safely and effectively performed in ASCs. These innovations reduce recovery times and enhance patient outcomes, further driving the demand for ASC services.

  
  

• Favorable Regulatory Environment: Regulatory changes and government policies that promote outpatient care and value-based healthcare models have encouraged the growth of ASCs. Initiatives such as the Medicare Ambulatory Surgical Center Payment System and the removal of certain procedures from the inpatient-only list have facilitated the expansion of ASCs.

  
  

• Patient Preference for Convenience and Comfort: Patients increasingly prefer ASCs due to the convenience, shorter wait times, and more personalized care they offer compared to hospitals. The comfortable, patient-centered environment of ASCs enhances the overall patient experience, contributing to their growing popularity.

  
  

• Shift Toward Outpatient Care: There is a broader trend in the healthcare industry toward outpatient care, driven by the need to reduce healthcare costs and improve efficiency. As more procedures are deemed safe for outpatient settings, the demand for ASCs continues to rise, supported by evidence of comparable or better outcomes for many surgeries performed in ASCs.

  
  

• Demographic Trends and Aging Population: The aging population, particularly the baby boomer generation, is driving demand for surgical procedures, many of which can now be performed in ASCs. As this demographic continues to age, the need for cost-effective, efficient surgical care will further fuel the growth of the ASC market.

Surgery Center M&A Trends

From an M&A perspective, the ASC sector is highly fragmented, presenting numerous opportunities for consolidation and strategic partnerships. Private equity firms, hospital systems, and physician groups are actively acquiring and developing ASCs to capitalize on the sector’s strong financial performance and alignment with value-based care models. Key drivers of M&A activity include the pursuit of scale, geographic expansion, and the integration of ancillary services to enhance revenue streams. However, successful transactions require careful consideration of regulatory compliance, physician alignment, and operational efficiency to maximize returns. As healthcare continues to evolve, ASCs are poised to play a pivotal role in the delivery of cost-effective, high-quality care, making them a compelling focus for investment and strategic growth initiatives.

The number of announced ambulatory surgery center M&A deals has fluctuated in recent years, without a declining trend. Much of the M&A activity in the segment is dominated by hospitals, physician groups, and joint venture entities - where public announcements are infrequent.

ASC EBITDA Multiples

• Non-Controlling Interests:

  Non-controlling interests in ASCs, often those owned by individual physician-investors, can vary significantly based on the terms of the operating agreement, but usually range from 3x to 6x EBITDA.

  
  

• Single Specialty Centers:

  EBITDA multiples for single specialty centers typically range from 5x to 8x EBITDA, depending on the specialty, the concentration of surgeries and associated revenue by physician, payer mix, age of the equipment, and other center specific factors.

• Multi-Specialty Centers:

  EBITDA multiples for larger, multi-specialty centers can range from 6x to 10x EBITDA, depending on size, local market conditions, specialty mix, payer mix, growth rate, and the stability of the cash flow.

  
  

• Large Management Companies and ASC Operators:

  Regional and national ASC operators that own and/or manage multiple centers can command multiples in the 11x to 17x EBITDA range, especially if they have business development teams with the demonstrated ability to grow quickly through partnerships with surgeons.

Ambulatory Surgery Center EBITDA Multiple Trends

The Scope Research Healthcare M&A Database includes ASC EBITDA multiple benchmarks from controlling and non-controlling interest transactions involving a wide variety of single specialty and multi-specialty centers, as well as for deals involving a handful of national operators. The following chart compares the EBITDA generated by the acquired center to the multiple for a sample of recent transactions involving single location multi-specialty centers.

Factors Impacting the EBITDA Multiple for ASCs

Acquisition multiples are a function of perceived risk and growth. Key considerations within the healthcare staffing industry include the following:

• Out-of-Network (OON) Revenue: High percentages of out-of-network revenue (20% or more) can lower the multiple, sometimes by multiple turns, due to uncertainty surrounding the durability of profit margins under this model. 

• Specialty and Case Mix: Multi-specialty centers may have higher multiples than single-specialty centers, and some specialties command significant higher multiples for single specialty centers than others. 

• Growth Potential: Centers with excess capacity or well-defined expansion plans, in attractive markets, with the demonstrated ability to recruit new surgeons can attract higher multiples. 

• State Certificate of Need (CON) Laws: Centers with in states that require CONs may command a premium. 

• Location and Competition: Strong local market conditions and limited competition (including other ASCs as well as HOPDs and inpatient ORs) can also positively influence the multiple. 

About Scope Research

Scope Research compiles a variety of healthcare M&A databases and provides healthcare valuation services. The Scope Research Healthcare M&A Valuation Database currently has financial details for 116 ambulatory surgery center deals going back to 2010, 86 of which include reported EBITDA multiples. The data can be purchased individually, while our affordable annual subscriptions provide access to all of our healthcare M&A databases and segments, updated continuously.

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Contact Will Hamilton at will@scoperesearch.co with questions about our healthcare M&A databases.

About HealthFMV

HealthFMV specializes in appraising healthcare businesses and services arrangements, including ambulatory surgery centers.

Read more about ambulatory surgery centers valuations, or reach out to whamilton@healthfmv.com with valuation -related questions about your specific situation.