Designing ASC Strategy With the Long View in Mind
Insights From Blueprint to Buyout: A Strategic Guide to ASC Success
Ambulatory surgery centers continue to play a growing role in the healthcare ecosystem—driven by cost efficiency, patient convenience, and expanding payer support. But as interest in ASCs accelerates across operators, health systems, and private equity, the decisions made early in an ASC’s lifecycle are increasingly shaping long-term outcomes.
That theme anchored Coker’s recent webinar, Blueprint to Buyout: A Strategic Guide to ASC Success, a panel discussion focused not only on transactions but on how strategy, structure, and performance alignment influence ASC value over time.
The ASC Market: Momentum Paired With Complexity
Panelists opened the discussion by acknowledging what many leaders are seeing firsthand: ASCs continue to expand in number and scope, with more than 10,000 centers now operating nationwide. Payers are increasingly supportive of outpatient migration, and procedural volume continues to shift away from the inpatient setting.
At the same time, not all ASCs are experiencing the same level of success. Market momentum alone does not guarantee performance or durability.
As the panel emphasized, growth without strategy often exposes structural weaknesses, particularly when ownership transitions, capital partnerships, or expansion opportunities emerge later.
Build, Buy, or Partner: Decisions That Echo Forward
One of the central themes of the webinar was the importance of early clarity around intent—even when long-term outcomes remain flexible.
Whether developing a new ASC, acquiring an existing center, or entering a joint venture, panelists stressed that ownership structure, governance provisions, and operating agreements deserve careful consideration from the outset.
Decisions around:
- Entry and exit rights
- Restrictive covenants
- Capital contributions
- Control and governance
can either preserve flexibility—or quietly constrain future options.
The panel noted that many stalled or challenged transactions trace back not to market conditions, but to misaligned or overly complex ownership frameworks established years earlier.
Why Investors Look Beyond Financial Performance
From an investor perspective, ASCs remain attractive because they sit at the intersection of quality, efficiency, and scalability. But panelists were clear: financial performance alone does not tell the full story.
Private equity groups and strategic partners increasingly evaluate:
- Utilization and capacity constraints
- Referral stability and leakage
- Payer mix and reimbursement sustainability
- Alignment between professional and facility revenue
- Growth pathways within and beyond the current footprint
In other words, value is shaped as much by how an ASC operates and scales as by what it earns today.
The Role of Performance Optimization
Operational discipline emerged as a recurring theme throughout the discussion. Panelists highlighted that many ASCs underperform not because of market limitations but because of avoidable inefficiencies.
Common opportunities include:
- Improving OR utilization
- Addressing revenue cycle leakage
- Aligning case mix with capacity and staffing
- Strengthening financial reporting clarity
These issues often remain manageable—but when left unaddressed, they can materially influence how an ASC is perceived during diligence.
As one panelist noted, performance optimization is no longer a “pre-transaction exercise.” It is increasingly a core component of sustainable ASC strategy.
Valuation: A Story of Benefit and Risk
The conversation around valuation focused less on multiples and more on narrative integrity.
At its core, valuation reflects the balance between expected benefit and perceived risk. Complexity in ownership, unclear financials, capacity constraints, or inconsistent documentation can all introduce uncertainty—regardless of headline profitability.
Panelists emphasized that clean financials, transparent operations, and a coherent growth story help reduce perceived risk and support more confident decision-making on all sides of a transaction.
Preparing for Optionality, Not Just Exit
A key takeaway from the discussion was that ASC leaders do not need to be “for sale” to benefit from transaction-level thinking.
Organizations that plan with optionality in mind—whether for growth, partnership, or eventual liquidity—tend to be better positioned to adapt as market conditions evolve.
That preparation often begins with:
- Honest assessment of current performance
- Alignment between physician owners and operators
- Willingness to address structural complexity early
These steps support flexibility, regardless of whether a transaction ultimately occurs.
Leading With Clarity in a Changing Market
ASCs remain a compelling model for delivering high-quality, efficient care. But long-term success increasingly depends on clarity of strategy, structure, and execution.
As the panel concluded, organizations that invest early in alignment and performance are better equipped to navigate growth opportunities, capital partnerships, and market change—on their own terms.
In a market defined by momentum and competition, the ASCs that perform best over time are those built with clear governance, operational discipline, and informed decision-making—long before a transaction is on the horizon.
