Becker's ASC Review

19 TRANSACTIONS What's shaping ASC mergers and acquisitions in 2025? By Francesca Mathewes A s hospital and health systems become increasingly interested in partnerships and acquisitions with ASCs, several trends have emerged as guiding forces within these deals. Physician engagement and leadership ASC leaders and physicians have said that the future success of ASC- hospital partnerships lies in physician buy-in and leadership. "e days of physicians being seen as widgets to be monetized are over, and hospitals and health systems know this. In addition, regulatory capture can no longer be relied upon to deny physicians' participation [in] their true value-proposition," Peter Doble, MD, and Heath Veuleman, formerly of Sawtooth Surgery Center in Twin Falls, Idaho, told Becker's. "As care becomes consumer-centric and ambulatory-centric, hospitals and health systems must become shareholders in physician- led enterprises to still maintain market share," they continued. "is allows for the recruitment and retention of new physicians as well as retirement solutions for aging physicians, while still driving downstream revenue to hospitals and health systems." About 75% of hospitals are structuring ASCs as joint ventures with physicians, according to Avanza's Intelligence Hospital Leadership ASC Survey. Physician buy-in promotes engagement and cost- awareness. Even minority-ownership models remain attractive to physicians, especially when hospital-led deals offer access to better payer contracts and purchasing agreements, according to the survey. Cultural alignment and unity ASCs are increasingly focused on ensuring that their potential partners are aligned with their missions, values and goals as the market matures. "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 supermajority 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," Benjamin Stein, MD, an independent orthopedic surgeon and co-founder and chairman of Gaithersburg, Md.-based Capital Surgical Solutions, told Becker's. "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," he continued. "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 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." Increased payer pressure toward ASCs More than 60% of hospitals and health systems in the survey report that payers are pressuring them toward ASC options for appropriate cases, according to the Avanza report. Twenty-five percent of surveyed hospitals and health systems said they are expanding their ASC footprint specifically due to payer pressure. "Over the past year, the biggest shi in our payer relationships has been a more aggressive push toward bundled payments and site-of- service steering, particularly for high-volume orthopedic procedures like total joints and spine cases. Payers are increasingly focused on shiing these procedures to lower-cost settings like ASCs, which creates opportunities — but also new pressures," Lori Callahan, executive director of Algonquin Road Surgery Center in Lake in the Hills, Ill., told Becker's. "Looking ahead, we're preparing by deepening our investment in clinical and financial analytics, so we can clearly track and report on patient outcomes, complication rates and cost savings," she continued. "We're also staying close to evolving payer policies around prior auth[orization] reform and coverage changes for outpatient orthopedic procedures, particularly in total joint replacements. As the landscape continues to evolve, our strategy is to stay nimble, data- driven and proactive in demonstrating the value orthopedic ASCs bring to both patients and payers." n Private equity group expands into Georgia with 9-center acquisition By Francesca Mathewes P rivate equity-backed Capitol Imaging expanded into Georgia with the acquisition of nine outpatient imaging centers. According to a June 3 news release, the nine centers were owned and operated by Peachtree City, Ga.-based Outpatient Imaging. OPI's centers provide diagnostic services, including MRI, CT, ultrasound, mammography and X-ray. Capitol Imaging, backed by Clearview Capital Fund, offers outpatient imaging services in Texas, Louisiana, Alabama, Mississippi, Florida and now Georgia through a total of 57 locations. The nine recently acquired centers are located in Statesboro, Ga., and the greater Atlanta area. n

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