The expansion of ambulatory surgery centres (ASCs) is being supported by several tangible changes across healthcare markets. Reimbursement policies are expanding the procedures that can be delivered in outpatient settings, healthcare systems are investing in dedicated elective-care infrastructure, hospital reforms are creating greater integration between inpatient and ambulatory services, and regulatory changes are affecting where and how new outpatient capacity can be developed.
Frost & Sullivan analysis indicates that the global ASC market is forecast to grow by more than 30% between 2024 and 2029. But what is enabling this expansion?
The answer increasingly lies in structural changes to how healthcare is reimbursed, where capacity is built, how hospitals are organised and how alternative sites of care are regulated.
Reimbursement Is Changing the Economics of Site of Care
One of the most powerful mechanisms influencing ASC growth is reimbursement.
As healthcare systems face increasing pressure to improve efficiency and manage costs, policymakers are increasingly examining whether reimbursement should follow the procedure rather than the traditional location of care.
The US is a clear example.
For 2026, the Centers for Medicare & Medicaid Services (CMS) finalised a 2.6% update to ASC payment rates. More significantly, CMS expanded the ASC Covered Procedures List, adding 289 procedures, while a further 271 codes removed from the Inpatient Only list were added to the ASC list.
CMS is also phasing out the Medicare Inpatient Only list over three years, beginning with the removal of 285 predominantly musculoskeletal procedures in 2026.
Together, these changes give providers greater flexibility to determine where appropriate procedures can be safely and efficiently delivered.
Germany is pursuing a comparable direction through its Hybrid-DRG system. The 2026 catalogue covers 904 OPS codes across 69 Hybrid-DRGs, compared with 583 OPS codes in 2025. These case-based payments apply irrespective of whether an eligible procedure is delivered on an inpatient or outpatient basis.
The direction is clear: reimbursement is increasingly supporting the movement of appropriate procedures into outpatient settings.
Healthcare Systems Are Building Dedicated Elective Capacity
Changing reimbursement creates an opportunity, but healthcare systems also need the capacity to act on it.
The UK provides a useful illustration. As of April 2025, 116 elective surgical hubs were operational across England, while 169 Community Diagnostic Centre sites were operational by March 2025. Those diagnostic centres delivered 6.8 million additional tests during 2024/25.
The significance extends beyond the individual facilities. Elective surgical hubs are designed around planned care, while community diagnostic centres move diagnostic capacity outside traditional acute hospital environments. Together, these developments support a more distributed model in which different stages of the patient pathway can be delivered in settings designed specifically for that activity.
For ASCs, this creates an opportunity to become part of a wider elective-care infrastructure rather than operating simply as an alternative to the hospital.
The Hospital Is Being Redefined
The growth of outpatient infrastructure does not mean hospitals are becoming less important. Instead, their role is becoming more specialised.
Hospitals remain essential for emergency care, intensive care, complex surgery and patients requiring extended stays, while healthcare systems are increasingly looking at how routine and predictable activity can be delivered elsewhere.
Germany’s Krankenhausversorgungsverbesserungsgesetz (KHVVG) illustrates this broader redesign. The reform introduces cross-sectoral healthcare facilities known as Level 1i hospitals, intended to connect inpatient basic care with ambulatory medical and nursing services.
This challenges the traditional division between inpatient and outpatient care. For ASC operators, it creates a more complex competitive and partnership environment: an ASC may compete with a hospital for particular procedures while simultaneously becoming part of a hospital-led or regionally integrated care pathway.
Regulation Can Reshape Market Entry and Capacity
Reimbursement is only one part of the equation. Regulation can also determine how quickly outpatient capacity develops, who can enter a market and where investment is directed.
In the US, Certificate of Need (CON) requirements remain an important example of how state-level regulation can affect healthcare facility development. Several states have been reassessing these frameworks, particularly where policymakers believe existing restrictions may limit investment or access to outpatient services.
The strategic significance is therefore not simply whether more ASCs can be built. Changes to market-entry requirements can affect the timing of new capacity, which providers can expand, and the competitive intensity of a market.
For companies participating in the ASC ecosystem, understanding where regulatory barriers are being reduced — and whether reimbursement, workforce and patient demand support expansion — can help identify markets with greater potential.
Consolidation Is Changing the Shape of the Market
A further structural change is occurring at the ownership level.
ASC activity is increasingly moving beyond individual facilities towards larger networks and integrated operating platforms. Hospital systems, physician groups and private equity-backed organisations are seeking scale through acquisitions, partnerships and new centre development.
Scale enables greater standardisation of procurement, equipment, clinical processes, technology platforms and operational practices. It can also create centralised capabilities that individual facilities would struggle to replicate.
For suppliers, this changes the commercial opportunity.
Purchasing decisions may increasingly involve network-level leadership, procurement teams, clinical governance functions and corporate operators rather than individual facility decision-makers. Suppliers that can demonstrate value across an entire network may therefore gain significant scale, while highly customised solutions may face greater barriers as operators seek standardisation.
The Next Phase Will Be Defined by Scale and Standardisation
These changes are creating a different type of ASC market. The next phase is likely to involve more sophisticated operating models, broader networks and greater integration with wider healthcare systems.
ASC operators will need to manage higher throughput while maintaining clinical quality. Technology and equipment suppliers will need to demonstrate not only clinical effectiveness but also operational and economic value.
The economics of the ASC model increasingly depend on repeatability. A solution that works well in one facility has value. A solution that can be standardised across 20, 50 or 100 facilities can have considerably greater strategic importance.
What This Means for Healthcare Companies
For companies looking to participate in ASC growth, the opportunity is broader than simply selling into a growing number of facilities. Three strategic questions are particularly important.
Where are the revenue and profit pools?
Companies should assess where outpatient capacity is being created, which procedures are moving into ambulatory settings, which provider models are expanding and where attractive revenue and profit pools are emerging. Markets where reimbursement reform, infrastructure investment and regulatory change are occurring simultaneously may offer particularly attractive opportunities.
Is the operating model fit for the ASC market?
Participating in the ASC market may require a different operating model from serving traditional hospitals. Companies should assess whether their commercial, service and delivery models are sufficiently lean, scalable and value-focused to support high-utilisation outpatient environments. As ASC networks grow, suppliers may need to support standardised deployment across multiple sites rather than highly customised solutions.
How can value be demonstrated to ASC customers?
Clinical performance alone may not be enough. ASC operators are increasingly focused on throughput, efficiency, utilisation, labour requirements, total cost of ownership and standardisation. Companies therefore need to clearly demonstrate how their products, technologies or services improve clinical and operational performance while supporting the economic objectives of the ASC.
The winners in this market are unlikely to be defined solely by product quality. They will be defined by their ability to understand where value is being created, align their operating model with the economics of outpatient care, and demonstrate measurable value to increasingly sophisticated ASC operators.
A New Healthcare Infrastructure Is Taking Shape
The ASC opportunity is part of a broader transformation in healthcare infrastructure.
Reimbursement policies are making outpatient delivery more economically attractive. Elective surgical hubs and community diagnostic centres are creating dedicated capacity. Hospital reforms are redefining the relationship between inpatient and ambulatory care. Regulatory changes are influencing where new facilities can be developed, while consolidation is creating larger operators capable of standardising care across multiple locations.
These forces reinforce one another: reimbursement creates the economic incentive, infrastructure provides the capacity, regulation influences how that capacity develops, and consolidation creates the scale to operate it efficiently.
Together, they are changing the architecture of surgical care.
For ASCs, this creates an opportunity to move from being an alternative location for selected procedures to becoming an integrated component of regional and national healthcare systems.
For healthcare companies, it creates an equally important opportunity to rethink how products, technologies and services are designed for a healthcare environment that is becoming more distributed, specialised and connected.
The ASC is therefore becoming more than a destination for surgery. It is becoming part of a fundamental redesign of how healthcare capacity is organised.
This article is the second instalment in a three-part Frost & Sullivan blog series examining the evolving ASC landscape.
Part 1: Reimagining Healthcare Infrastructure: Why ASCs Are Becoming the New Centre of Care explores the structural shift towards outpatient surgical care and why ASCs are becoming an increasingly important component of healthcare infrastructure.
Part 2: From Hospital to Hub: The Policy and Structural Shifts Accelerating ASC Growth examines how reimbursement reform, healthcare infrastructure investment, regulatory change, and consolidation are creating the conditions for continued ASC expansion.
Part 3: The Monitoring Imperative examines how rising patient acuity and procedural complexity are reshaping patient monitoring requirements within ASC environments.
