The ASC Gold Rush: Where Smart Developers Are Finding the Best Opportunities
The ambulatory surgery center (ASC) market is experiencing unprecedented growth, with major health systems like Ascension reportedly in advanced talks to acquire AmSurg, an ASC operator with more than 250 facilities across 34 states. This follows Tenet Healthcare’s successful strategy of rapidly expanding USPI’s national presence, adding nearly 70 ASCs in 2024 alone.
But where are the real opportunities for ASC development? Our analysis of 2023 data reveals striking disparities in ASC density across states, pointing to both saturated markets and untapped goldmines. And while the numbers are compelling, turning that data into real-world outcomes requires a deep understanding of ASC strategy and industry-specific context.
The Leaders: States with Thriving ASC Markets
Some states have already embraced the ASC model with remarkable success. Maryland leads the nation with an impressive ASC density of just 18,062 people per ASC—nearly three times the national average. The state’s 342 ASCs serve a population of 6.2 million, creating a robust outpatient surgery infrastructure.
Georgia follows closely with 368 ASCs serving 29,108 people per facility, while Arizona rounds out the top performers with 191 ASCs and 37,442 people per ASC. These states demonstrate the market’s appetite for convenient, cost-effective outpatient surgical care.
What’s particularly telling is the hospital-to-ASC ratio in these leading states. Maryland boasts the lowest ratio at just 0.24—meaning there are more than four ASCs for every hospital. This dramatic shift toward outpatient care reflects both patient preference and economic reality.
The Opportunity States: Where ASCs Are Underrepresented
While some states have embraced ASCs, others present compelling development opportunities due to their high hospital-to-ASC ratios:
West Virginia tops the opportunity list with a staggering 9.75 hospital-to-ASC ratio—78 hospitals but only 8 ASCs. This represents enormous potential for surgical case migration from inpatient to outpatient settings.
Vermont follows with a 9.0 ratio (18 hospitals, 2 ASCs), while South Dakota (4.93 ratio), Oklahoma (4.80 ratio), and Iowa (4.76 ratio) all show significant room for ASC expansion.
These states likely represent markets where patients currently travel to hospitals for procedures that could be performed more efficiently and cost-effectively in ASCs. The key is understanding how to translate those gaps into strategic growth—something that requires more than data. It demands the ability to connect opportunity with operational and regulatory realities.
Why This Matters Now
The timing couldn’t be better for strategic ASC development. As financial pressures on hospitals intensify—from reimbursement constraints to rising labor and supply costs—health systems are reassessing where and how they deliver care.
Tenet’s transformation offers a clear playbook: the company sold 14 hospitals for $4.8 billion in 2024 while investing roughly $250 million a year in ASC expansion. This strategy has proven financially sound, with CEO Saum Sutaria noting that Tenet now derives “a significant portion of its financial performance from its highly efficient ambulatory surgical business”.
But making the right move requires more than following the trend. At G2 Group, we specialize in helping ASC developers and investors uncover, validate, and act on high-potential markets. Our proprietary data modeling uncovers insights others miss. Our regulatory navigation expertise ensures your project stays on track. And our co-management capabilities allow us to partner with clients from planning through execution—turning vision into operational success.
The Bottom Line
Smart ASC developers should look beyond saturated markets like Maryland and Georgia to focus on underserved states with high hospital-to-ASC ratios. West Virginia, Vermont, South Dakota, Oklahoma, and Iowa represent prime opportunities where the combination of existing hospital infrastructure and limited ASC competition creates ideal conditions for successful development.
At G2 Group, we help developers and investors do more than identify opportunities—we help them act on them. With strategic insights, market intelligence, and hands-on execution support, we guide ASC growth in the right markets, at the right time.
The ASC revolution is far from over—it’s just getting started in the right markets.