A sale-leaseback transaction offers ambulatory surgery center (ASC) owners the opportunity to convert real estate equity into capital while maintaining full control of the facility’s operations. To ensure a successful outcome, ASC physician-owners must approach the process with clear strategy and attention to detail. The following are the core elements that contribute to a well-executed and value-maximizing sale-leaseback.
1. Clear Strategic Objectives
Before entering the market, owners should define their goals: Is the aim to maximize immediate liquidity, reduce real estate risk, fund expansion, or prepare for succession? Having clarity on objectives shapes key decisions throughout the process.
2. Accurate Valuation
Engage an experienced healthcare real estate advisor or appraiser to determine fair market value (FMV) for both the property and the proposed lease rental rates. Accurate valuation helps align expectations and ensures compliance with regulatory requirements.
3. Strong Lease Terms
The lease is central to the sale-leaseback. It should reflect market terms while protecting the ASC’s long-term operational interests. Typical features include a 10–15-year term, triple-net (NNN) structure, annual rent escalations, and renewal options.
4. Institutional-Grade Marketing
Create a professional Marketing Package that highlights the ASC’s operational stability, lease terms, financial performance, and property details. Presentation quality significantly affects buyer interest and perceived value.
5. Competitive Bidding Process
Attract multiple offers by soliciting bids from a targeted list of healthcare-focused buyers. Competition can lead to stronger pricing and more favorable terms.
6. Experienced Deal Team
Work with advisors who specialize in ASC real estate transactions—especially brokers, attorneys, and compliance consultants. Their expertise ensures the process is efficient, compliant, and aligned with the ASC’s unique needs.
Conclusion
A successful ASC sale-leaseback balances immediate financial gain with long-term operational control. By focusing on the right elements—strategic goals, strong lease terms, and experienced advisors—physician-owners can unlock the full value of their real estate while securing the future of their surgical practice. A well-executed sale-leaseback can provide physician-owners with liquidity, strategic flexibility, and long-term facility control. By following a disciplined process and partnering with experienced advisors, ASC owners can achieve a successful outcome that supports both their financial and operational goals.