De novo ambulatory surgery center (ASC) development is entering a new era driven by population migration, continued shifts of procedures from hospitals to outpatient settings, and the transition toward value-based care. As federal policy expands the list of procedures eligible for outpatient delivery, demand for surgical capacity is growing—particularly in fast-growing markets where existing infrastructure has not kept pace. Rather than replicating legacy models, today’s de novo ASCs are being designed intentionally for efficiency, lower cost, and modern care delivery, incorporating lessons from COVID-era operations such as streamlined footprints and digital-first patient and family engagement. These projects represent an opportunity to build future-ready surgical infrastructure aligned with where healthcare is going, not where it has been.