This paper addresses how owners of ambulatory surgery centers (ASCs) should think about the value of their facility — both the operations and the real estate — particularly as interest in ASC transactions grows. Some of the major points:
1. Market interest in ASCs is strong
Many owners should not be surprised if you hear from any number of organizations asking if you will engage in a conversation about the future of your center.
The implication: owning an ASC means you may already be in the cross-hairs of potential buyers, joint-venture partners or real-estate investors.
2. The importance of due diligence & data packaging
Once an ASC owner engages an advisor, such as ASC Realty Advisors, the process involves collecting significant due diligence material and developing an Offering Memorandum (OM).
This document shares financial and operational information about the ASC that is critically important to prospective buyers. It also helps interested buyers determine what they will offer for the center.
Valuation is not a casual thing — having clean, well-prepared documentation increases credibility and helps a seller command value.
3. Value drivers for an ASC
Several factors drive value, including:
Strong case volume, payer mix, efficiency of operations
Physician alignment / ownership structure
Real estate ownership or lease terms
Market demand, scarcity of similar facilities, and investor interest
For real estate, location, operating room count, condition of facility, lease stability
4. Real estate component often overlooked
ASC real estate has increased in value tremendously, and a lot of times the owners don’t understand how much value they have there. The physician-owners may pay themselves “market-rate rent … so they’ve greatly increased the value of the property.” Becker’s ASC. Hence: when valuing “your ASC,” you must separately consider the surgical operations business and the real-estate asset if owned.
5. Strategic timing & planning
Knowing your ASC’s value is helpful for both short- and long-term planning.
For an owner who might be planning to sell, partner, or roll up into a larger platform, being proactive (rather than reactive) is beneficial.
Having the right data, perhaps tidying up operations, clarifying physician ownership, real estate arrangements, etc., will support a better outcome.
Important considerations for maximizing value:
Make sure you have a well-prepared OM or equivalent package: operating metrics, financials, payer mix, surgeon alignment, facility assets, growth potential.
Recognize that your real-estate asset (if you own it) may be a major part of value — sometimes even more than the operations business itself.
Consider timing: the market is interested, but a clean story (good metrics, stable physicians, scalable opportunity) will help you capture a premium.
Begin the internal (short-term) work now: tighten up operations, verify ownership structures, clarify lease or real-estate terms, ensure proper documentation.
Understand that valuation isn’t just based on volume today, but also perceived growth potential and risk mitigation — buyers pay more for predictable, scalable, well-governed assets.
The right guidance can help you unlock capital while ensuring your control of your ASC business and property. Physicians can obtain more information about valuation and sales of ASC businesses and real estate by contacting Jon Vick (jv***@*******ty.com) at 760-291-7745 or Jason Winokur (jw******@*******ty.com).
Since 1984 we have advised ASC physician-owners on business matters relating to physician-owned ASCs, endoscopy centers (ECs) and surgical hospitals. ASC/MOB real estate expert and broker JH Winokur, Inc. specializes in ASC & MOB real estate sales and sale-leasebacks, expansion capital, property valuations and 1031 exchanges.