Hospitals double down on ambulatory care expansion with major investments

Editor's Note

Health systems across the US are making major investments in ambulatory care, responding to increasing patient demand for lower-cost, community-based healthcare, Modern Healthcare February 4 reports. From debt financing to philanthropic campaigns, hospitals are leveraging diverse funding strategies and shifting capital investments to build and expand outpatient facilities.

This trend aligns with more patients seeking convenient, cost-effective care closer to home; aging population needs; and the financial sustainability of outpatient services. For funding, providers are tapping into cash reserves, debt financing, and philanthropic donations, the article noted. Here’s how five health systems are leading the charge:

Sutter Health. Sacramento-based Sutter Health is aggressively expanding its outpatient footprint, utilizing a mix of cash flow and debt financing. In 2023, the system issued $750 million in bonds and plans another round of bond funding this year.

• Flagship project: $800 million Santa Clara ambulatory care hub, with two campuses totaling 1 million square feet
• Opening timeline: East Santa Clara Campus (300,000 sq ft) by late 2025; West Santa Clara Campus by 2027
• Additional expansion: $1 billion earmarked for 25 ambulatory sites in Northern California, with 15 sites launching this year
• Urgent care growth: 27 new sites over the next 3 years.

Advocate Health. Charlotte-based Advocate Health (a $32 billion system) is committing $700 million to ambulatory expansion in South Side Chicago over the next decade, with funding from reserves, bonds, and possible philanthropy.

• New facilities: 10 neighborhood care sites, with the first opening in 2024 at South Side YMCA
• Women’s health, chronic care: $200 million to expand OB-GYN services, adding 5,000 annual visits and increasing access to pre- and post-natal care
• Additional initiative: “Mobile Medicine Expansion” for primary care outreach.

Children’s Health. Dallas-based Children’s Health is investing in two specialty centers using cash reserves.

• Fairview Specialty Center: $33 million, 28,000 sq ft, 19 providers across 11 specialties (opening in 2024)
• RedBird Specialty Center: $37 million, located in UT Southwestern Medical Center, expected to open in 2027.

UC Davis Health. Sacramento’s UC Davis Health is set to open a 268,000-sq-ft ambulatory surgery center (ASC) in July as part of its $589 million 48X Complex.

• Strategic goal: Shift outpatient surgical procedures away from UC Davis Medical Center, which performs 50% of its surgeries as outpatient cases
• Projected volume: Up to 15,000 patients per year at full capacity
• Funding: Debt financing.

Harris Health. Texas-based Harris Health is utilizing a $2.5 billion voter-approved bond package to fund strategic facility expansions, including $500 million for outpatient care.

• Primary focus: Adding three new community clinics and upgrading existing facilities
• Funding mechanism: Bond-funded tax increase in Harris County
• Projected timeline: Clinic design phase to begin in 2026 or 2027

The expansion of ambulatory facilities will significantly impact surgical nursing leadership. With the shift of outpatient procedures from hospitals to standalone surgery centers, perioperative teams must adapt to new workflows, staffing models, and patient throughput expectations. Perioperative leadership should prepare for:

• Greater reliance on ASCs for lower-acuity procedures
• Emphasis on efficiency and patient turnaround times in outpatient settings
• New opportunities for leadership in ASC management and clinical innovation.

Bottom line, the ambulatory care boom is reshaping hospital investment strategies, signaling a clear shift in healthcare delivery models. As hospitals reallocate billions to expand outpatient services, these investments point to a broader trend in healthcare: the shift toward ambulatory care as a cornerstone of patient access and cost efficiency.