A sale-leaseback of ambulatory surgery center (ASC) real estate can unlock capital, reduce risk, and provide long-term control for physician-owners. However, to fully realize these benefits, the transaction must be approached with strategy and precision. Below is a recommended process to guide physician-owners through a successful sale-leaseback of their ASC facility real estate.
1. Internal Alignment and Goal Setting
Before entering the market, physician-owners should align on key objectives: Is the goal to maximize value, recapitalize the business, or ensure operational control? Clear goals help shape lease terms, pricing expectations, and timing.
2. Engage Experienced Advisors
Work with advisors who specialize in ASC real estate, including a broker, legal counsel, and valuation expert. Healthcare-specific experience is critical for navigating lease structures, compliance, and buyer expectations.
3. Optimize Lease Terms
Structure a lease that is market-rate rent, operationally sound, and investor-friendly. Key elements include term length (typically 10-15 years), triple-net structure, rent escalators, and renewal options.
4. Prepare a Professional Marketing Package
Your broker should develop a professional marketing package detailing the property, lease terms, ASC performance, and investment highlights. This ensures potential buyers fully understand the opportunity.
5. Run a Competitive Bidding Process
Solicit offers from a targeted list of healthcare real estate investors, including REITs and private equity-backed platforms. Competition drives higher values and stronger terms.
6. Select the Right Buyer
Choose a buyer not only based on price, but on their ability to close, flexibility in negotiations, and reputation for fair dealing. Your advisor will guide you through offer analysis and negotiation.
7. Due Diligence and Closing
Work with your legal and advisory team to provide documents, respond to buyer inquiries, and finalize the transaction. A strong lease agreement will protect your interests post-closing.
Conclusion
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.