As outpatient surgical volumes rise and investment accelerates, CFOs face a pivotal moment to recalibrate capital allocation, manage workforce risks, and integrate ambulatory surgery centers into long-term financial strategy.
The ambulatory surgery center (ASC) model has shifted from a niche cost-saving move into a core element of many health systems' strategic playbook.
According to a recent report, ASCs generated approximately $45 billion in revenue in 2024, with projections to rise to about $57 billion by 2030. These volumes are expected to grow by roughly 9% between 2023 and 2028, driven by reimbursement shifts, aging populations, and technology that enables more complex procedures in outpatient settings.
For CFOs, this signals a structural inflection point rather than a short-term investment opportunity.
Some of the key implications from this shift lie in payment policy, technology that enables greater innovation, and demographic shifts.
The Centers for Medicare & Medicaid Services (CMS) recently approved two dozen new ASC procedure codes, expanding the range of treatments that can be done outside of hospital outpatient departments. Lower cost sites, site-neutral payment policies, and reimbursement that favors ASCs are creating margin growth potential. The reported cost for procedures in ASCs is less than half that of hospital outpatient departments, providing both system savings and higher margins for providers.
Technology advancements are also playing a role here. Advances in minimally invasive surgery, recovery drugs, and specialty expansions (orthopedics, cardiology, spine care) are enabling the shift of what were once inpatient or hospital outpatient procedures into the ASC setting. This shift overall supports volume growth and potentially higher throughput, lower fixed-cost burdens for providers, and generally better capital efficiency.
Investment and capital flows are also part of the ASC puzzle. Private equity, corporations, and health systems are moving aggressively. For instance, investment volume rebounded to ~$19.7 billion in 2024 and ~$18.9 billion in the first half of 2025. Consolidation is also rising; The number of ASCs under national operator partnerships grew from 1,339 in 2011 to 2,140 in 2024.
Demographic tailwinds are also a factor. With the population aging and Medicaid eligibility growing, there is continued demand for outpatient services, especially among older adults with chronic conditions.
Despite the momentum, the report flags a workforce vulnerability: The potential loss of up to 86,000 physicians (especially anesthesiologists) by 2036 threatens ASC staffing and therefore throughput and margin.
For CFOs
For CFOs, the ASC trend offers both opportunity and a strategic challenge.
ASCs represent a high-margin growth outside the high fixed-cost hospital environment, offering improved capital efficiency, lower overhead, and a favorable reimbursement tailwind. Integrating ASCs (whether via ownership, joint-venture, or partnership) can support the diversification of revenue streams, strengthen outpatient strategy, and align with value-based care models. , all of which will likely be increased during this time of federal funding uncertainty.
Some strategies CFOs can consider when approaching a ASC acceleration:
Capital allocation & investment assessment: CFOs must evaluate whether to deploy capital into building, acquiring, or partnering in ASCs. Meticulous ROI modelling should take into account volume, reimbursement risk, staffing constraints, regulatory changes and any upgrade costs for newer technologies.
Margin management & cost structure: Shifting volume to ASCs can reduce cost per case, but CFOs should monitor ASC operations, ensuring a maintained throughput and quality metrics, and make sure the move is not undermined by staffing shortages or any regulatory setbacks.
Reimbursement risks: The favorable payment environment won't last forever. CFOs need to monitor CMS and payer policy evolution, and ensure that the financial model of ASCs remains resilient under any shifting reimbursement.
Workforce sustainability and operational risk: Finance leaders must be detailed about embedding scenario planning and the cost of mitigation into budgets, e.g., how much additional staffing expense may be needed.
Strategic portfolio alignment: Lastly, ASCs should not be standalone investments. CFOs must align with the broader system strategy (referrals, brand, ambulatory network) and assess how the ASC footprint supports all revenue flows and retention of patients.
Marie DeFreitas is the CFO editor for HealthLeaders.
KEY TAKEAWAYS
Ambulatory surgery centers now generate more than $45 billion in annual revenue, with projections topping $57 billion by 2030.
Private equity and health system investments in ASCs surpassed $19 billion in 2024, signaling that scale, efficiency, and partnership models are vital for competitiveness in outpatient care delivery.
For CFOs, ASCs represent both opportunity and risk.