Most ASCs are physician-owned, according to the Ambulatory Surgery Center Association's 2017 Salary & Benefits Survey.
A breakdown of ASC ownership:
1. Physician: 64 percent
2. Physician-hospital: 24 percent
3. Physician-corporate: 4 percent
4. Corporate: 4 percent
5. Hospital: 3 percent
6. Physician-hospital-corporate: 1 percent
HealthCare Appraisers surveyed 15 respondents, including representatives of Ambulatory Surgery Centers of America, Birmingham, Ala.-based Surgical Care Affiliates and other ASC organizations, on selling minority and controlling interests in surgery centers. Over 700 surgery centers were represented in the report.
Controlling, minority interests
Length of time it takes to sell minority interests:
7. Less than three months: 27 percent
8. Three to six months: 33 percent
9. Six months to one year: 40 percent
Length of time it took to identify a buyer for a controlling interest:
10. Three to six months: 33 percent
11. Six months to a year: 67 percent
The buyer of a controlling interest:
12. Single outside third party: 57 percent
13. Single existing owner: 7 percent
14. Multiple outside parties: 0 percent
15. Multiple existing owners: 0 percent
16. Hospital or health system: 36 percent
ASC ownership:
17. Eighty percent of respondents preferred between six and 15 physician-owners for a single-specialty ASC, while 60 percent preferred between 11 and 20 physician-owners for a multispecialty ASC.
18. Concerning equity in a center they're acquiring, 13 percent of respondents preferred less than 10 percent ownership; 40 percent preferred between 11 percent and 50 percent ownership; and 47 percent preferred between 51 percent and 75 percent ownership.
19. When buying into centers with a minority stake, 53 percent of respondents said they used a formula to come up with a price, while 47 percent said they used an independent appraisal to determine value.
20. When selling a minority stake to physician investors, 33 percent of respondents said it took on average three to six months to make a sale. Forty percent of respondents said it took an average of six months to a year to make a sale.
21. When selling a controlling interest in a center to physician investors, the average selling period was between six months to a year for 67 percent of respondents.
22. Respondents sold controlling interest in an ASC to a single outside third party 57 percent of the time and to a hospital or health system 36 percent of the time.
ASC valuation multiples:
Minority interest, single-specialty
23. 2 to 2.9 times: 8 percent
24. 3 to 3.4 times: 23 percent
25. 3.5 to 3.9 times: 15 percent
26. 4 to 4.9 times: 38 percent
27. 5 to 5.9 times: 15 percent
Controlling interest, single-specialty
28. 5 to 5.9 times: 23 percent
29. 6 to 6.9 times: 38 percent
30. 7 to 7.9 times: 38 percent
Minority interest, multispecialty
31. 3 to 3.4 times: 14 percent
32. 3.5 to 3.9 times: 21 percent
33. 4 to 4.9 times: 50 percent
34. 5 to 5.9 times: 7 percent
35. 6 to 6.9 times: 7 percent
Controlling interest multispecialty
36. 6 to 6.9 times: 29 percent
37. 7 to 7.9 times: 64 percent
8 times or more: 7 percent