Ascension Health Alliance Had to Sell Seven Surgery Centers Before Its AmSurg Deal Could Close

Nonprofit health system Ascension Health Alliance will be required to divest seven ambulatory surgery centers to complete its proposed $3.9 billion acquisition of AmSurg LLC, under a consent order aimed at preserving competition for outpatient surgical services in the markets most affected by the deal.DOCUMENTED

Ascension and AmSurg both operate outpatient surgical centers offering procedures ranging from cataract surgeries to colonoscopies — services performed by gastroenterologists, ophthalmologists, and orthopedists that patients often have limited ability to comparison-shop for locally.DOCUMENTED

Why these five markets specifically

According to the order, combining Ascension's outpatient footprint with AmSurg's centers would have significantly reduced competition for certain outpatient surgical procedures across Nashville, Tennessee; Panama City, Florida; Tulsa, Oklahoma; Waco, Texas; and Wichita, Kansas — markets where the two companies' existing centers directly overlapped in the specific surgical specialties at issue.DOCUMENTED "Access to quality surgical care at an affordable price is critically important for millions of Americans across the country," said Daniel Guarnera, Director of the Bureau of Competition, in announcing the order. "The FTC's action ordering divestitures of surgical care centers will help preserve a competitive market that will allow patients to get the care they need at a fair price."DOCUMENTED

Outpatient surgical care occupies a distinct competitive position compared to hospital-based surgery: because ambulatory surgery centers typically offer lower prices than hospital outpatient departments for comparable procedures, a reduction in the number of independent centers competing in a given metro area can push patients back toward higher-cost hospital settings for procedures that would otherwise be available more affordably nearby.REVIEWED

What gets divested and to whom

Under the order, six of the seven centers — Waco Gastroenterology Endoscopy Center, Tulsa Endoscopy Center, Eye Surgery Center of Tulsa, Surgery Center of Kansas, Associated Endoscopy in Hermitage, Tennessee, and two Nashville-area centers — will be sold to SC Affiliates, an operator that already runs ambulatory surgery centers nationwide.DOCUMENTED The seventh, Northwest Florida Gastroenterology Center in Panama City, will go to a separate buyer, identified in the order as Panama City Doctors.DOCUMENTED The order requires the divestitures to be completed no later than ten days after the underlying acquisition closes.DOCUMENTED

Six of the seven divested centers are going to a single existing operator — meaning the fix for one merger's competitive overlap runs through consolidating those specific locations under yet another established surgery-center company.

The scale of the underlying deal

Ascension originally announced its plan to acquire AmSurg, a subsidiary of Ambulatory Topco LLC, in June 2025 as part of a broader strategic shift toward expanding its outpatient care footprint relative to its traditionally hospital-heavy portfolio.REVIEWED If completed, the combined company would operate more than 300 ambulatory surgery centers across 35 states, positioning it among the largest outpatient surgery platforms in the country — a scale that made the deal's competitive overlaps in specific local markets a central focus of the review, even though the transaction as a whole was allowed to proceed.REVIEWED

Why merger remedies target overlap markets specifically

Rather than blocking the transaction outright, the order reflects a standard approach in merger enforcement: identifying the specific local markets where the combination would concentrate market share to a degree likely to raise prices or reduce quality, and requiring divestitures narrowly tailored to restore competition in exactly those markets while allowing the broader transaction to move forward elsewhere.REVIEWED That structure reflects a judgment that most of the combined company's footprint poses no competitive concern, while the five identified metro areas specifically needed a structural fix before the deal could close.REVIEWED

Ascension said it was pleased with the outcome and expects the transaction to close in the near future, framing the divestiture requirement as a compromise that allows the broader acquisition to proceed as planned.REVIEWED

For patients in the five affected metro areas, the practical effect of the order is that the specific surgical centers changing hands will continue operating as independent facilities under new ownership, rather than being absorbed into the combined Ascension-AmSurg network — preserving the number of separately owned options available for the specific procedures at issue, even though the buyer in most cases is itself an established multi-location operator rather than a brand-new market entrant.REVIEWED Whether that structure delivers the same competitive benefit as an entirely new, unaffiliated entrant taking over the divested centers is a question merger economists continue to debate across divestiture remedies generally, since a buyer that already operates dozens of similar facilities nationwide may compete somewhat differently than a truly independent local operator would.REVIEWED

The order's ten-day completion window following the deal's close gives regulators a concrete, verifiable deadline to check compliance against, rather than an open-ended commitment to divest "in due course" — a structural feature that reduces the risk of a divestiture requirement quietly slipping for months while the combined company's day-to-day integration proceeds in the meantime. That short window also limits how long the overlapping markets remain under any degree of shared ownership before the required separation actually takes effect, giving patients in the affected metro areas a clearer, near-term timeline for when the promised competitive structure will actually be in place. Regulators will continue to monitor the divestitures through the transition to confirm the new owners are operating the centers as genuinely independent competitors, rather than simply changing the name on the door while informal coordination with the combined network continues behind the scenes. That kind of post-divestiture monitoring has become a standard feature of merger remedies precisely because a paper transfer of ownership does not, by itself, guarantee the restored competition regulators intended.REVIEWED

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