Blueprint to Buyout—A Strategic Guide to ASC Success
November 19, 2025
Discover the strategies, pitfalls, and growth opportunities shaping today’s ASC market—and how to position your center for long‑term success.
Transaction Advisory
News & Trends
Ambulatory surgery centers (ASCs) continue to play a central role in the shift toward outpatient care—and with this shift come new opportunities, complex decisions, and heightened interest from private equity firms, hospitals, and independent medical groups. In our recent webinar, Blueprint to Buyout: A Strategic Guide to ASC Success, Mark Reiboldt moderated a panel discussion with Andrew Hranka, Richard Romero, and Wendy Bruno Thomson, exploring market forces, valuation drivers, and practical steps for building, optimizing, or preparing to sell an ASC.
The conversation centered on the growing demand for ASC services and the realities needed to support long-term success—whether developing a new center, restructuring an existing one, or weighing a potential partnership or transaction.
ASC Market Outlook: High Demand, New Challenges
Wendy Bruno Thomson opened by highlighting sustained growth in the ASC market, with more than 10,000 ASCs nationwide and continued payer support for shifting surgeries out of the hospital setting. But growth does not guarantee profitability. Many ASCs are struggling due to operational inefficiencies, shifting ownership dynamics, or a lack of strategic planning.
Key themes included:
- Strengthened payer support for ASC rates
- Greater demand among physicians for ownership opportunities
- Heightened attention on optimizing operations early—not only when preparing to sell
- A rising need for thoughtful long-term partnership structures
ASCs remain a powerful engine for physician productivity and financial performance—if they are built and managed with intention.
Build vs. Buy: Planning for the Long Game
Much of the webinar focused on the importance of long-range planning from day one. Owners often default to short-term thinking—such as quick revenue wins or basic operational setup—but overlooking structure, governance, and exit pathways can derail future opportunities.
Key planning considerations:
- Ownership structure and partnership alignment
- Long-term sustainability of the service mix
- Governance and restrictive covenants that won’t block future deals
- Capacity and OR utilization strategies to maximize throughput
Groups must design today’s ASC with tomorrow’s goals in mind.
Why Private Equity Is Interested—and What They’re Looking For
Andrew Hranka discussed the private equity perspective, noting that PE activity in ASCs continues to rise because ASCs:
- Enable lower-cost, higher-quality care
- Offer strong ancillary revenue streams
- Provide alignment opportunities through rolled equity
- Allow investors to build multi-site platforms with scalable growth
PE sponsors typically evaluate:
- Market-leading margins
- Strong referral alignment
- Demonstrated outcomes improvements
- Growth opportunities across ancillaries
- Clean, rational ownership structures
Private equity wants stability, scalability, and a clear pathway to expansion—not just strong current-state financials.
Valuation: Telling a Clear, Consistent Story
Richard Romero emphasized that ASC valuation is fundamentally the story of benefit versus risk, shaped primarily by:
- Reliable cash flow
- Reimbursement stability
- Capacity for growth
- Clear, auditable financials
- Operational efficiency
- Market comparables and regulatory context
Most overlooked valuation drag? Capacity constraints. OR availability, staffing shortages, and operational bottlenecks often undermine otherwise strong financial performance.
Other valuation must-haves:
- Clean, accurate financial statements
- Properly separated implant costs, anesthesia, and revenue streams
- RCM performance that reflects true collectible revenue
- Projections that match historical realities
A valuation without a clear operating story creates uncertainty—and uncertainty suppresses value.
Preparing for Growth or a Future Transaction
The most successful ASC transactions begin 12–18 months before going to market.
Preparation steps include:
- Standardizing financial reporting
- Optimizing revenue cycle operations
- Increasing OR utilization and efficiency
- Reassessing staffing and overhead needs
- Resolving governance issues early
- Documenting quality and outcomes data
These steps not only improve performance but also increase future deal value.
Key Takeaways for ASC Leaders
- Start early. Preparing your ASC for growth or a sale takes time.
- Optimize operations now. Underutilized ORs and weak RCM directly reduce value.
- Fix ownership structure issues before they block deals.
- Collect and leverage data to strengthen payer and investor confidence.
- Tell a clean, consistent financial story to reduce perceived risk.
Whether launching a new ASC, expanding capacity, or preparing for a sale, today’s leaders must think beyond daily operations and plan for the long-term vision that determines lasting success.
