Thursday, August 28th, 2025:
As outpatient care accelerates across the U.S., real estate has become a powerful lever for ASCs and health systems alike.
Jon Vick, founding partner of ASCs Inc. and ASC Realty Advisors, joined Becker’s to discuss the overlooked financial potential of ambulatory surgery center real estate, and why many physicians miss their window to fully capitalize on it.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How have you seen the healthcare real estate market evolve in recent years, particularly around ASCs and outpatient facilities?
ASC Realty Advisors: The healthcare real estate market has pivoted decisively toward outpatient facilities, especially ASCs. Many national institutional and private buyers are actively pursuing investments in both new and existing outpatient properties. This high demand has created a competitive pricing environment, with more buyers than sellers.
Q: When it comes to strategic transactions in healthcare, what factors should physician groups prioritize when evaluating opportunities?
ASCRA: Physician groups evaluating mergers, acquisitions, partnerships or joint ventures should consider financial, operational, clinical and cultural factors. The goal isn’t just growth, it’s sustainable alignment that improves care quality, strengthens market position and enhances long-term value.
Q: What kinds of partnership structures between health systems, physicians and investors are becoming most common in ASC and outpatient facility transactions?
ASCRA: Each structure involves trade-offs in autonomy, capital access, clinical control and long-term value. The most common partnership models include
Physician–hospital joint ventures: Hospitals typically hold a majority stake (often 51% or more), while physicians retain minority ownership and clinical input. This structure aligns hospital resources and payer leverage with clinical care.
Three-way joint ventures: These involve hospitals, physicians and ASC management firms (such as USPI or SCA). The model integrates clinical, financial and operational strengths for long-term scalability.
Corporate/investor models: Private equity or management companies acquire majority or minority stakes. Physicians may receive upfront cash or rollover equity. While these models can accelerate growth and provide liquidity, they often reduce physician control.
Hospital-owned conversions (HOPDs): Hospitals acquire ASCs and convert them into hospital outpatient departments. This often eliminates physician ownership and increases reimbursement.
Q: How do real estate transactions around ASCs fit into broader financial and operational strategies for health systems, especially given current capital pressures?
ASCRA: Real estate transactions, especially sale-leasebacks and property-related joint ventures, have become critical strategic tools for health systems navigating capital constraints and shifting toward outpatient care.
Q: As demand for outpatient care continues to grow, what role do you see strategic real estate transactions playing in shaping the future of healthcare delivery?
ASCRA: Strategic real estate transactions are increasingly foundational to healthcare delivery transformation. Investments in ASCs, medical office buildings and outpatient clinics support the industry’s shift toward lower-cost, decentralized and more accessible care.
Q: How does ASC Realty Advisors help healthcare organizations maximize the value of their real estate while also aligning with long-term strategic goals?
ASCRA: Our work goes beyond handling property sales. ASC Realty Advisors integrates real estate strategy with healthcare organizations’ broader operational and strategic goals.
We coordinate the timing and structure of real estate deals with overall strategic transactions—ensuring both financial benefit and alignment with long-term growth. Our goal is to help owners maximize the value of both the ASC business and the underlying real estate.