As healthcare delivery continues to move toward lower-cost settings, ambulatory surgery centers are an increasingly attractive investment. Recently, along with investors and providers, insurers entered the picture as owners of large ASCs – continuing to blur the lines between providers and payers. This trend is likely to have a significant impact on the competitive and reimbursement landscape. Private equity investment in physician practices has been a key catalyst for consolidation in some specialties. Dermatology and ophthalmology led private equity investment in the space, with continued trends toward consolidation in these specialties.