Becker's ASC Review

4 ASC MANAGEMENT 10 key consolidation trends for ASC leaders to know By Ariana Portalatin H ealthcare mergers and acquisitions are becoming more prevalent as organizations face increased competition, staffing challenges and financial hurdles. Here are 10 notable trends for ASC leaders to know: 1. Despite a "significant decrease" in the clinical risk of heart failure patients admitted to hospitals acquired by private equity firms, clinical outcomes did not improve, according to a study published June 9 in JACC. 2. Health insurers are facing increased scrutiny from legislators, physicians and other stakeholders over industry consolidation. Lawmakers recently zeroed in on the growth of vertically integrated health conglomerates that own insurance companies, pharmacy benefit managers, physician practices and pharmacies under one umbrella. Congressional hearings were held with insurance CEOs Jan. 22 over industry consolidation, prior authorization practices and executive pay, with Congress members pressing executives to explain how vertical integration benefits consumers as insurance premiums continue to climb. Several lawmakers criticized vertical integration, with one saying, "Vertical integration is destroying people's ability to access care." 3. ere were 963 closed healthcare M&A transactions in fiscal 2025, down from 1,163 in 2024, a continued "normalization" from post-pandemic peaks, according to a Jan. 14 report from PCE Investment Bankers. 4. Physician groups remain a popular target of investment within healthcare as their "value-creation playbook" continues to adapt with new technology and industry demands, Bain & Company reported Jan. 8. While physician group transactions have declined as a share of all global provider transactions, they remain a major part of many private equity portfolios. 5. Many physician practices may involve firms that compete closely enough to raise antitrust concerns, according to a 2025 analysis of claims data covering more than 60 million insured members a year. 6. Merger enforcement in deals involving hospitals and ASCs is below average, according to a report released by the Progressive Policy Institute in December 2025. 7. Acquisitions of physician practices by hospitals and health systems are occurring the most frequently in the Midwest, according to a report released by the Progressive Policy Institute in December 2025. 8. Independent practice is in decline across at least nine medical specialties due to hospital acquisitions, according to a report released by the Progressive Policy Institute in December 2025. 9. Private equity-backed "roll-up" strategies in ASCs have helped create some of the country's largest platforms, oen through a series of smaller acquisitions that may not individually trigger federal antitrust reporting requirements, according to a report from the Private Equity Stakeholder Project. 10 e last several years have seen a significant expansion of private equity activity in healthcare, and with that, a new wave of state-level legislation aimed at placing more scrutiny on PE deals. n Outpatient cardiology's CMS whiplash By Francesca Mathewes F or some independent cardiology practices, fi- nancial and operational stability may feel like a moving target as reimbursement policies and reporting requirements continue to shift. Larry Sobal, CEO of Heart and Vascular Institute of Wisconsin in Appleton joined Becker's to discuss the administrative and financial complications he is identifying and navigating within his independent cardiology practice in 2026. Editor's note: This response has been lightly edited for clarity and length: Q: What area of your practice's financial manage- ment do you feel you have the least visibility on? What sort of tools, regulatory changes or processes do you believe might improve that visibility? LS: As an independent cardiology practice, we have a high percentage of Medicare, Medicare Advan- tage and Medicare Supplemental patients, we suffer the whims of CMS every year in terms of [work rela- tive value unit] adjustments, [Center for Medicare and Medicaid Innovation] programs and overall physician fee schedule changes. The overall strat- egy of CMS is not clear, other than to systematically drive independent physicians into employment by hospitals or private equity. Q: What specific administrative processes are slow- ing you or your team down the most right now? How are you addressing those concerns? LS: Prior authorizations have become a barrier to timely care. We are never quite sure how long the prior auth will take and whether, despite a prior auth, or if a peer-to-peer will be necessary. We are constantly adjusting our processes to be sure that we stay on top of each patient's prior-auth status and whether a test or procedure can proceed. Q: What's the best thing you've done to streamline operations at your practice in the last year? LS: It's currently a work in process, but we are replac- ing our stand-alone EHR with Epic from one of the local health systems. Almost all of the local medical community is on some form of Epic and the chal- lenges of being on a separate system creates a lot of extra work in terms of communication, chart prep, etc. After a few cancelled go-live dates when the health system wasn't ready, we seem to be heading toward a go-live next month. n

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