September 9, 2026 – Before hospitals emerged in the United States, physician practice and “ambulatory surgery” purchasing was simple and straightforward – doctors either asked aides to order/purchase what they needed from the local mercantile or mail-order retail outlets, or they did it themselves. Back then, however, Pony Express, stagecoaches or trains didn’t deliver as quickly as Amazon and other companies with more vehicles today.
Roughly a half-dozen hospitals debuted in the U.S. in the mid-18th century, concentrated along the East Coast with one in New Orleans, before blossoming in the 19th century and peaking in the 20th, redefining and redirecting the delivery of patient care, particularly in urban and suburban areas.
Through much of the 1990s during President Bill Clinton’s healthcare reform initiative, ambulatory surgery centers (ASCs), physician practices and other nonacute care facilities served a number of roles – from hospital service line extensions to hospital competitors to investment opportunities and consolidation leverage.
One role, however, largely has simmered under the radar: Process incubator for clinical, financial and operational activities, most notably supply chain practices.