Becker's ASC Review

23 TRANSACTIONS Inside the new era of ASC ownership By Patsy Newitt B enjamin Stein, MD, an independent orthopedic surgeon and co- founder and chairman of Capital Surgical Solutions, joined Becker's to share his perspective on the evolving ASC landscape. As a leader of a surgeon-majority-owned development group, Dr. Stein shared how a new era of physician ownership is emerging — one that prioritizes alignment, autonomy and collaboration over equity alone amid the rise of health systems and private equity contracts. Editor's note: is interview was edited lightly for clarity and length. Question: How do you currently view the shifting dynamics of surgeon control and ownership in the ASC space, particularly in the context of PE and hospital partnerships? Dr. Benjamin Stein: ere's always going to be different models of ASCs, because it's so regionally based. It depends on the marketplace in that specific community, region or state. So there is always a role and a place for independents that are truly super majority surgeon-owned and controlled — what our entity threads that needle directly in that space compared to private equity-partnered facilities or health system joint venture enterprises. What you're seeing, though, is that all of those can be navigated successfully, but core to success is that you have to have alignment between the surgeons at any facility — whether that be a PE- backed one, health system JV or a company such as my own. ere has to be an alignment so those surgeons feel like they're coming to a venue of surgery where they have real, meaningful input on controlling elements and elements that that are that are related to them — whether that be performing the surgery or managing their patients. It's important they don't feel like they're hitting roadblocks with regards to that. ey can truly be a part of decisions that affect quality and efficiency and all of these things from their lens. ere is, of course, economics as well. When you're a surgeon, and you're sitting in an atmosphere where you're looking at one thing that's predictable in healthcare, there are two things that are very predictable: One is diminishing professional fees rendered. at's dictated by Medicare, and that is on a set clip of decrease. e other thing that's a reliable, concrete reality is the increased cost of operations — in the sense of labor force, adjustment for cost of living, inflation, real estate, right? All of these things are set parameters. And so because of that, as physicians and as surgeons, when we are in that kind of interfacing squeeze, it is incumbent on us to obviously figure out how we can make up for that shortfall economically. And I think the surgery center is one of the ancillaries that allows for that. You really can accomplish that if there's transparency and discussions between surgeons and whomever is managing said facility, whether it's a private equity, whether it's a health system, or a JV health system management company, or just a management company. Q: What advice would you give to surgeons looking to take on more ownership or autonomy — whatever that may look like? BS: I think my advice to other surgeons— like myself, who've experienced some of the pains of their existing surgical center engagement or past ones — is not to be blinded just by the economics. It's easy for that to happen. But instead, think of it as creating a venue where they're happiest taking care of their patients and operating with teams they enjoy working with. If a surgeon looks at it through that lens, and engages in wanting to contribute to the decisions that relate to all of that, they'll succeed and build the best environment. Surgeons shouldn't view a surgery center as just a passive site of care. It's an extension of their practice. e same way they take methodical control over the patient experience in their office. ey need to bring that same mindset to the surgery center. at's at the core. Q: Do you think that mindset shift is underway—across the broader workforce? BS: I think that as market economics shi and more historically hospital- based procedures move to ASCs, there's more opportunity for surgeons to have a meaningful seat at the table and actually control the environment. I think that shi is happening. ere's rising interest. Surgeons entering the workforce — right out of training — are already thinking about that. ey're looking selectively at the right ASC configuration for themselves. n Surgery Partners adds 150 physicians, 5 facilities in Q1 By Patsy Newitt B rentwood, Tenn.-based Surgery Partners added 150 physicians and five surgical facilities in the first quarter of 2025, company executives shared during a May 13 earnings call transcribed by Seeking Alpha. Here are five more notes on the company's growth strategy: 1. Many of the newly added 150 physicians are expected to eventually become partners, according to CEO Eric Evans. The additions span multiple specialties, with a strong emphasis on orthopedics. 2. The latest cohort of physicians is bringing higher- acuity surgical cases compared to the 2024 group. And the company "fully expects 2025 recruits to continue to grow and have a meaningful impact in 2025 and beyond," Mr. Evans said. 3. Surgery Partners has opened eight de novo facilities in 2024, bringing the total to 20 new sites since 2022. The company currently has 10 more under construction, with what Mr. Evans called "a robust pipeline of future de novos." 4. Surgery Partners performed more than 160,000 surgical cases in the first quarter, 4.5% higher than 2024. Mr. Evans attributed this jump to "stronger de novos coming online and [musculoskeletal] growth." 5. So far in 2025, the company has invested $55 million and acquired five surgical facilities at an effective multiple of under 8x adjusted EBITDA, according to Mr. Evans. n

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