Maximize the Value of Your Ambulatory Surgery Center

ASCs are valued primarily as operating businesses using EBITDA multiples (typically 6-10x), while medical office buildings are valued using cap rates on rental income. ASC valuations consider operational metrics including case volume, payor mix, physician partnerships, specialty focus, and growth potential. The operational complexity and higher returns drive premium valuations compared to passive real estate investments.

Transaction structures vary. In a full sale, physicians receive cash at closing and typically sign employment agreements to continue practicing. In a majority recapitalization, physicians sell 51-80% for immediate liquidity while retaining minority ownership with upside in future growth and ultimate exit. Physicians usually maintain clinical autonomy and control over medical decision-making regardless of structure.

State licensing transfers typically take 60-120 days depending on the state. Medicare change of ownership certification takes 30-45 days after closing. Certificate of Need amendments (in CON states) can take 90-180 days. We coordinate all regulatory approvals in parallel with due diligence to minimize delays. The overall transaction timeline is typically 6-9 months from LOI to closing.

Equipment and inventory are typically included in the purchase price and transferred at closing. Buyers conduct equipment appraisals during due diligence. Any leased equipment requires lease assumption or buyout negotiation. Medical supplies and inventory are usually transferred at cost based on physical count at closing. We coordinate detailed equipment schedules and inventory protocols to ensure smooth transition.

We employ strict confidentiality protocols including comprehensive NDAs before sharing any information, coded marketing materials without identifying details, controlled data room access with audit trails, limited buyer universe of qualified institutions, and carefully staged disclosure. You control the timing of communicating with staff, referring physicians, and hospital partners. Most physician-owners continue normal operations throughout the process without staff awareness until late stages.

This is common. Options include: (1) exiting physicians sell their interests to continuing physicians with financing arranged by us, (2) partial sale where exiting physicians sell while others retain ownership, or (3) full sale where continuing physicians receive employment agreements and new ownership opportunities in buyer's platform. We structure transactions to accommodate different physician goals while maximizing overall value.

Primary buyers include private equity-backed ASC management companies (SCA, Surgery Partners, Envision), public ASC operators (United Surgical Partners, AmSurg), health systems seeking to expand outpatient capabilities, specialty-specific platforms (ophthalmology, orthopedic, GI), and REITs with healthcare operating platforms. Each buyer type has different investment criteria, geographic focus, and transaction preferences. Our network includes all buyer categories to ensure competitive bidding.