FTC to Allow Ascension’s $3.9 Billion Acquisition of AmSurg Only After Sale of Seven Surgery Centers

The Federal Trade Commission said Tuesday it will allow Ascension Health Alliance’s proposed $3.9 billion acquisition of AmSurg LLC to move forward only if Ascension sells seven ambulatory surgery centers in five local markets where the agency says the deal would otherwise reduce competition and drive up the cost of outpatient procedures.

The centers are in the metro areas of Nashville, Tennessee; Panama City, Florida; Tulsa, Oklahoma; Waco, Texas; and Wichita, Kansas, according to the FTC’s complaint and proposed consent order announced June 2. Six of the centers would be sold to SC Affiliates, which the FTC described as an experienced ambulatory surgery center operator. The Panama City center would be sold to Florida Gastroenterology Center, a physician group that already owns a minority stake in that facility and would take full ownership.

The FTC alleges that, without those divestitures, the acquisition would reduce competition for certain outpatient surgical services performed by gastroenterologists, ophthalmologists and orthopedists. Ambulatory surgery centers are outpatient facilities where patients receive procedures that do not require an overnight hospital stay, including services such as colonoscopies and cataract surgeries. The agency said fewer local competitors would likely give providers more leverage in negotiations with insurers, leading to higher surgery prices and potentially higher premiums, copays or other out-of-pocket costs for patients. The FTC also said the loss of competition could reduce quality of care and limit innovation.

“Access to quality surgical care at an affordable price is critically important for millions of Americans across the country,” Daniel Guarnera, director of the FTC’s Bureau of Competition, said in a statement. “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.”

The FTC complaint says Ascension, a national nonprofit health system, has about 97,000 employees and more than $28 billion in annual operating revenue. AmSurg operates more than 260 ambulatory surgery centers in 34 states and has annual operating revenue above $1.3 billion, according to the complaint. The FTC said Ascension agreed to acquire AmSurg parent Ambulatory Topco LLC under a purchase agreement dated June 16, 2025, later amended Dec. 5, 2025.

The agency’s complaint alleges the transaction, if completed without remedies, would violate Section 7 of the Clayton Act, which prohibits acquisitions that may substantially lessen competition, and Section 5 of the FTC Act, which bars unfair methods of competition. The FTC said it worked with the attorneys general of Florida, Oklahoma and Tennessee during the investigation.

Under the proposed order, Ascension also must provide transition assistance for up to one year, protect confidential information, maintain the divested assets until they are transferred and avoid interfering with employment relationships at those facilities. A monitor will oversee compliance, and Ascension would have to give prior notice for 10 years before acquiring ambulatory surgery centers in the metro areas around the divested facilities. The commission voted 2-0 to issue the complaint and accept the consent agreement for public comment. The proposal will be open for 30 days before the FTC decides whether to make it final.