Bon Secours Mercy Health’s planned $5.7 billion acquisition of Surgery Partners would put a national outpatient surgery operator with a growing orthopedic business under hospital system ownership.
Cincinnati-based Bon Secours Mercy Health agreed Oct. 26 to take Brentwood, Tenn.-based Surgery Partners private through HealthSpan Partners, a contractual affiliate of the system, in an all-cash deal valued at about $5.7 billion including debt. Shareholders other than Bain Capital will receive $23.50 per share, a 49% premium to the stock’s prior close. Bain, which holds about 39% of outstanding shares, will roll its stake into the acquiring entity and remain a partner.
The deal is expected to close in the first quarter of 2027. It adds more than 200 sites across 30 states and about 5,000 affiliated physicians to a system that operates more than 45 hospitals. Surgery Partners will remain a secular organization and will not be characterized as a Catholic ministry entity.
For orthopedic and spine surgeons, the deal raises questions about how Surgery Partners’ musculoskeletal strategy, which has centered on moving joint and spine cases into ASCs, could change under a new owner.
Musculoskeletal is the growth engine
Surgery Partners has spent years positioning orthopedics, total joints and spine as the center of its strategy. Total joint replacements in its ASCs grew 14.6% year over year in the first quarter of 2026, executives said on the company’s May 5 earnings call. About 70% of its facilities are equipped for musculoskeletal procedures, and executives described surgical robotics as the main lever for persuading surgeons to move higher-acuity joint cases out of the hospital.
The company has fed that strategy with recruiting. In 2025, it added about 500 physicians, many of them orthopedic surgeons, supporting growth in total joint and spine volume. The orthopedic focus is not new: musculoskeletal cases made up 44% of procedures at its facilities in 2020, up from 37% the year before.
Systems are buying the outpatient shift instead of fighting it
The deal is the second of its kind in 2026. St. Louis-based Ascension bought AmSurg for $3.9 billion earlier this year. Both transactions put large nonprofit systems in control of national ASC platforms rather than building outpatient capacity market by market.
For orthopedics, the logic is direct. Total joints and a growing list of spine procedures are migrating to ambulatory settings, pulled by CMS payment policy, commercial payer steerage and surgeon preference. A system that owns the ASC platform keeps a share of that volume and margin rather than watching it leave its operating rooms.
Surgery Partners is no stranger to this kind of attention. In June 2025, it rejected a take-private bid from Bain, its largest shareholder, and chose to remain independent. Monday’s agreement keeps Bain in the capital structure while handing control to a hospital system.
The independence question for surgeon partners
Surgery Partners built its physician pitch on independence. For years, executives framed the company as an alternative for surgeons who wanted ownership and autonomy outside hospital employment, and they cited that independence as an advantage in negotiating with payers.
That pitch now has a hospital system behind it. Orthopedic and spine surgeons who hold equity in Surgery Partners facilities will want answers on several fronts: whether syndication and buy-in terms change, whether governance at the center level shifts, and whether there will be any expectation, formal or informal, to align referrals or call coverage with Bon Secours Mercy Health hospitals in shared markets.
The companies have not detailed how physician partnerships will be structured after closing.
Where the footprints meet
Much of Surgery Partners’ footprint lies outside Bon Secours Mercy Health’s hospital markets, which span Ohio, Kentucky, Virginia and South Carolina, among others. A Mizuho analyst told Reuters there is some overlap in Ohio and Kentucky but that the deal mainly broadens the system’s national reach, and the firm does not expect meaningful antitrust risk.
Those overlap markets are where orthopedic groups are most likely to feel a difference. In them, the system will own both the hospital ORs and competing ASCs, and decisions about where total joint and spine cases go become internal ones. Elsewhere, the near-term question is capital. HealthSpan is financing the deal with cash on hand and new debt, so how much a system owner will invest in robotics, de novo centers and spine programs remains to be seen.
What to watch
Nothing changes for surgeons on day one; the deal still needs shareholder approval and regulatory clearance before its expected first-quarter 2027 close. Between now and then, orthopedic and spine leaders can watch for a few signals:
- How Bon Secours Mercy Health describes Surgery Partners’ operating independence and brand after closing
- Whether physician ownership and syndication terms are addressed in proxy filings
- How the combined organization approaches overlap markets in Ohio and Kentucky
- Whether the 2026 pace of total joint and robotics growth holds through the transition
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
