Issue link: https://beckershealthcare.uberflip.com/i/1543350
6 ASC MANAGEMENT "Traditional ownership or long-term lease models lock surgeons into high fixed costs, construction expenses and ongoing administrative burdens," he said. "Our membership model flips that equation, giving surgeons access to fully equipped ORs, concierge-level staff, and patient amenities, with the flexibility to scale their usage up or down as their practice evolves. e main tradeoff is that members don't "own" the space, but for most, the benefits of flexibility, lower risk, and operational support far outweigh the limitations of ownership." 4. A renewed push for independence is shaping new MSO and development models Consolidation by hospitals, health systems and private equity continues, but some ASC leaders are seeing renewed interest in independence as physicians look to preserve autonomy and ownership. Newer MSOs and development groups are positioning independence as the value proposition. Pelto Health Partners, for example, was created through a collaboration among Durham, N.C.-based Emerge Ortho, Indianapolis-based OrthoIndy and Seattle-based Proliance Surgeons to support private practice sustainability, particularly around contracting leverage, infrastructure and nonclinical operations. Another new entrant, ASCend (Gillette, Wyo.), is focused on keeping rural ASCs locally owned and supporting physician-led centers in underserved regions, according to its leadership. 5. EP ablation is a major new frontier for ASC cardiology CMS' decision to approve electrophysiology ablation procedures in ASCs marks a significant step for outpatient cardiology and could accelerate the development of specialized cardiac ASCs. Medicare historically restricted EP ablation coverage to hospital outpatient departments due to concerns about supporting higher-acuity cardiac care outside the hospital. "e addition of EP ablation is a big win for cardiology," Tracy Helmer, administrator of Mesa, Ariz.-based Tri-City Surgical Centers, told Becker's. "ere's been a lot of work with that over the last number of years to show the efficacy and safety profile for those particular procedures." A scientific statement published by the Journal of the American College of Cardiology in November describes electrophysiology as the next specialty poised for site-of-care migration, similar to interventional cardiology's path before CMS expanded ASC coverage for cardiac catheterization and percutaneous coronary intervention in 2020. Cardiology's outpatient expansion is accelerating. In 2024 alone, 26 cardiology-focused ASCs were opened or announced, reflecting rapid growth in outpatient cath and EP capacity. 6. Sale-leasebacks are gaining appeal as a liquidity and valuation strategy As ASCs look to improve liquidity, simplify ownership and strengthen valuation, sale-leaseback arrangements are drawing more interest. In a sale-leaseback, an ASC sells its real estate to an investor and signs a long-term lease, oen 10 to 12 years, while retaining operational control of the surgery business, said Jon Vick, founding partner of Vick & Co. Leases are commonly structured as triple net. For physician owners, the strategy can convert real estate equity into cash for debt payoff, partner buyouts, expansion or technology upgrades. Vick said sale-leasebacks can also improve cash flow in a high-rate environment when long-term rent is lower than short-term debt service, potentially boosting EBITDA and enterprise value ahead of a strategic transaction. He added that timing matters: if physicians are considering selling a controlling stake in the ASC, completing the real estate transaction first can preserve control over lease terms. Owners also need to evaluate tax implications, including capital gains and options such as 1031 exchanges, depending on their goals. n Sale-leasebacks Convert Equity into Cash Find Out What Your Building Is Really Worth Physician-Owners: Get a Free, no-obligation lease review and real estate valuation Scan or call (760) 291-7745 ASC Realty Advisors | ascrealtyadvisors.com Physician-owners can unlock the equity in your ASC real estate without giving up control of the property. ✓ Simplify partnership transitions and buy-ins ✓ Free up cash to renovate, expand, or pay off debt ✓ Keep full control of your property with a long-term lease ✓ Convert your building's equity into cash you can use today The ASC real estate sale-leaseback experts! ascrealt yadvisors .com