Healthcare in the U.S. is evolving rapidly. Patients want more choice; providers want more control. Across the country, Ambulatory Surgery Centers (ASCs) are stepping into that gap, offering a streamlined, efficient, and increasingly popular alternative to hospital-based care.
But it’s not just the ASC model that’s growing — it’s where these centers are opening that signals a deeper shift. Suburban markets are emerging as the hotbed of ASC development, driven by shifting demographics, real estate opportunity, and changes in how care is delivered.
What is an ASC?
An Ambulatory Surgery Center (ASC) is a healthcare facility that offers same-day surgical care, including diagnostic, preventive, and minimally invasive procedures. ASCs provide a safe, efficient alternative to hospital-based surgery, allowing patients to undergo treatment and return home the same day. They offer lower costs, reduced wait times, and greater physician autonomy.
For healthcare groups, investors, and landlords, understanding this trend is critical. Because suburban ASC growth isn’t just a short-term wave, it’s a long-term repositioning of outpatient care.
What’s Driving the Growth of ASCs?
With this mix of clinical efficiency and operational independence, the ASC model isn’t just thriving, it’s redefining what outpatient care looks like, and they’re booming across the U.S. for several reasons:
- Lower costs: Significantly lower procedure costs compared to hospitals, benefiting patients, insurers, and providers.
- Faster throughput: Shorter wait times, faster patient turnover, and simpler scheduling make ASCs attractive to surgeons and administrators.
- Favorable reimbursement: CMS and private clients continue to expand the number of approved ASC procedures, with reimbursements that can exceed hospital outpatient rates.
- Physician ownership: Many ASCs are partially or fully owned by surgeons or provider groups, giving them greater operational control and financial upside.
- Post-pandemic decentralization: COVID-19 amplified the need for care outside the hospital, and ASCs delivered.
Why Suburban Markets Are Leading the Way
While urban ASCs continue to grow, suburban locations are seeing the fastest and most strategic expansion. And because the suburbs have become the new frontline for delivering accessible, same-day care, smart real estate investments should follow the patient’s lead.
Here’s why:
- Affordable square footage: ASCs typically require 10,000–15,000 sq ft and are easier to acquire or develop in suburban areas with lower land and build-out costs.
- Better demographics: Suburban populations often include aging adults, growing families, and insured residents, which is ideal for elective outpatient procedures
- Easier zoning and approvals: Compared to downtown or urban medical corridors, suburban municipalities often provide more flexibility for healthcare uses.
- Accessibility and parking: Suburban sites offer large surface lots, easier drive-up access, and less congestion — all critical for patient convenience.
What ASC Real Estate Demands That Other Clinics Don’t
Developing or leasing a suburban ASC involves a more complex, regulated process than a typical clinic or urgent care facility. This is where many developers, and even experienced healthcare operator, get stuck. It’s not just about finding a space, it’s about making sure the space actually works.
Assessing an investment should consider:
- Site selection and zoning: Not all medical office properties are zoned or permitted for surgical use. Early due diligence is key to avoiding expensive delays down the line.
- Specialized build-out: ASCs require sterile corridors, dedicated operating rooms, PACU/recovery bays, and high-grade HVAC — often at a much higher spec than general medical offices.
- Ground floor location: For safety, accessibility, and code compliance, most ASCs must be located on the ground floor with direct exterior access.
- Enhanced parking: With rotating procedures, family drop-offs, and staff turnover, ASC sites need ample, accessible parking on-site.
- Infrastructure requirements: Medical gases, redundant power, digital integration, and compliant waste disposal systems must be planned from day one.
- Timeline and cost management: ASC development can take 9–18 months and requires close coordination across leasing, design, engineering, and compliance teams.
Strategic Implications for Investors, Landlords, and Operators
Suburban ASCs aren’t just filling a care gap, they’re creating new financial opportunities across the real estate value chain. In a competitive market, buildings that can accommodate surgical use stand out and lease faster:
- For operators: A suburban ASC can boost patient acquisition, increase reimbursement rates, and offer scalable growth without hospital constraints.
- For investors: Healthcare REITs, private equity groups, and family offices are actively acquiring purpose-built ASC assets in suburban corridors — often at cap rates that reflect stability and institutional credit.
- For landlords: If you own suburban medical real estate, preparing your site to meet ASC standards (or retrofit for surgical use) can position your asset for premium tenants and long-term leases.
Conclusion
This growth trend isn’t slowing. Nearly 70% of surgical procedures in the U.S. are now performed in outpatient settings — a figure projected to keep climbing.
Healthcare is shifting from centralized to distributed, from inpatient to outpatient, from the hospital tower to the suburban center. That’s a shift in care, but it’s also a shift in real estate.
If you’re planning your next move, whether building an ASC from the ground up, converting an existing site, or exploring suburban expansion, Gittleson Zuppas can help.