Becker's ASC Review

9 ASC MANAGEMENT The crossroads of ASC growth By Patsy Newitt O nce viewed as niche facilities for low-acuity, outpatient procedures, ASCs are poised to expand into new specialties, adopt higher-acuity surgeries and redefine patient and physician expectations for surgical care. Here are five recent changes for the ASC industry: 1. New clinical frontiers e next era of ASC growth will be defined by procedures once considered exclusive to hospitals. Michael Cournyea, CEO of University at Buffalo (N.Y.) Neurosurgery, told Becker's he is most excited about "the potential cases that will be moved to ASCs within the next five years or so." ese include endovascular procedures for stroke, craniotomies for tumor removal, radiosurgery for cancer and interventional cardiology. Orthopedic and spine specialists echoed that optimism. Vadim Coz, MD, spine surgeon at Reno (Nev.) Orthopedic Clinic, told Becker's that advances in minimally invasive techniques now allow many patients to undergo lumbar fusions with same-day discharge. "e combination of these trends — the evolution of minimally invasive spine procedures and the financial implications of programs like Medicare's TEAM pilot — will inevitably drive a greater volume of spine surgeries from traditional hospital settings to ASCs," he said. 2. ASCs' unique, efficient model Beyond clinical expansion, leaders emphasized the environment ASCs foster: streamlined operations, cutting-edge technology and a relentless focus on patient comfort. "ASCs find themselves at a crossroads so commonly because they are blazing new pathways for patient care that radiates efficiency, innovation and forward thinking," said Tracy Helmer, BSN, RN, administrator of Mesa, Ariz.-based Tri City Cardiology Surgical Center. For patients, this oen translates into less stress and a smoother experience. "e patient experience is improved due to the ease of navigation and the perception of a more relaxed surgical encounter," said Josh Troast, MSN, director of ambulatory surgical services at Muskegon (Mich.) Surgical Associates. 3. Physician engagement and ownership ASCs also remain vital to physician independence and engagement. Mr. Troast pointed out that in physician-owned centers, surgeons have "a chance to engage in the operations of the surgical environment that they and their patients access," while also supplementing compensation with ownership revenue, a factor that can help sustain private practice viability. 4. Lower costs Cost remains one of the ASC model's strongest selling points. "As technology advances and healthcare delivery shis toward value and convenience, ASCs are uniquely positioned to lead the way — offering high quality outcomes, lower costs and a better experience for both patients and providers," said Bonnie Greenblatt, director of ambulatory surgical services at the Utica-based Michigan Institute of Urology. Mr. Troast added that financial relief is critical in today's environment of rising patient responsibility. "With the lower-cost option of an ASC, the financial strains can be reduced," he said. n ASC consolidation by the numbers By Sophie Eydis T he ASC sector is rapidly consolidating. National operators, health systems and private equity firms are accelerating acquisitions, reshaping market dynamics and changing what it means to be an independent ASC. Nearly 2,000 ASCs are now affiliated with a national chain — a sign of how much of the market has shifted away from physician-owned independence. Chain operators now control about 33.5% of freestanding ASCs, with the remaining 66.5% still held by independents. The leaders in market share are familiar names: Dallas- based United Surgical Partners International holds 8.1% of the ASC market, Deerfield, Ill.-based SCA Health 5%, Nashville, Tenn.-based AmSurg 3.9%, Nashville, Tenn.- based HCA Healthcare 2.3%, and Brentwood, Tenn.- based Surgery Partners 2%. While each operator's strategy differs — from USPI doubling down on orthopedics to SCA expanding its gastroenterology platform through its acquisition of Exton, Pa.-based U.S. Digestive Health, the cumulative effect is clear: independent ASCs are becoming rarer. The shift is also influencing the financial landscape. Multiples for ASC acquisitions are stabilizing at around 8× EBITDA, a signal that valuations are becoming more standardized as competition for deals heats up. But the rush to consolidate raises questions. Physician leaders have pointed to trade-offs in autonomy, pricing and patient choice as facilities join larger platforms. Others are asking what happens when the supply of independent ASCs runs thin. Some suggest the "endgame" could involve mega platforms or even REIT- style investors stepping in as the next wave of buyers. Industry executives widely expect the consolidation curve to continue, with both large strategic acquisitions and smaller roll-ups of underperforming centers likely through 2025 and beyond. For independent centers, the question is no longer whether consolidation is coming — but how soon they may be next. n

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