The 5 ASC powerhouses: 35 things to know about the largest surgery center chains

The following five major companies have made a name for themselves in the ASC business, providing management expertise to centers spanning the nation.

Here are 35 things to know about the five largest ASC chains:

Tenet Healthcare/United Surgical Partners International (Dallas)
1. In 2015, Tenet Healthcare penned a deal with Welsh, Carson, Anderson & Stowe to purchase 50.1 percent of United Surgical Partners International with the intent of eventually acquiring the entire company. The combined company jointly owns ASCs as well as imaging centers.

2. Tenet/USPI has 470 surgery centers spanning the United States. The company also owns and operates 79 hospitals, 20 short-stay surgical hospitals and employs nearly 130,000 individuals.

3. Trevor Fetter became Tenet's president in November 2002 and CEO in September 2003. He was appointed the company's chairman in May 2015. Mr. Fetter earned a master of business administration from Boston-based Harvard Business School.

4. Since 2004, Mr. Wilcox has served at USPI's helm as CEO. He serves on the company's board and is a board member of European Surgical Partners, which owns and operates Aspen Healthcare in the United Kingdom. Mr. Wilcox holds a master's degree in health systems management from Tulane University in New Orleans. Brett Brodnax is the president and chief development officer of USPI.

5. During the third quarter of fiscal year 2016, Tenet had:

•    Adjusted EBITDA hitting $570 million
•    Ambulatory care adjusted EBITDA totaling $157 million
•    Cash flow hitting $237 million in the first nine months of FY 2016

6. In October 2016, Tenet agreed to pay the federal government, Georgia and South Carolina $514 million to settle kickback allegations, which claimed Tenet hospitals paid kickbacks for obstetric referrals in Georgia and South Carolina.

7. In 2015, Tenet looked at eight quality measures on their Balance Scorecard and improved upon seven of those measures. Compared to 2014, Tenet's readmission rate dropped 13.6 percent.

AmSurg (Nashville, Tenn.)
1. AmSurg and Colorado-based Envision Healthcare Holdings signed a definitive merger agreement in June 2016, with the combined company having a pro forma market cap of nearly $10 billion. Per the merger agreement, Envision shareholders will hold a nearly 53 percent stake in the company, with AmSurg shareholders having a 47 percent stake.

In September 2016, the waiting period under the Hart-Scott-Rodino Antitrust Improvements Act of 1976 expired for the Envision Healthcare/AmSurg merger. Waiting for the expiration period to end satisfies one of the conditions of the merger's closing. The merger is subject to other closing conditions, including shareholder approval from both Envision and AmSurg.

2. AmSurg operated 260 ASCs and one surgical hospital at the end of Q3 FY 2016, slightly more than 253 ASCs during Q3 FY 2015. The company acquired three ASCs during Q3 FY 2016 and disposed of one ASC. At the end of the quarter, AmSurg had two ASCs under letter of intent and one under development.

3. During Q3 FY 2016, AmSurg had:

•    Net revenue reaching $822.2 million
•    Ambulatory net revenues totaling $314.6 million
•    Adjusted EBITDA for ambulatory surgery jumping to $61.1 million

4. Sheridan, AmSurg's physician services divisions, acquired a series of practices this year. In April 2016, Sheridan acquired North Florida Anesthesia Consultants, which is comprised of more than 70 physicians, certified registered nurse anesthetists and anesthesiologist assistants spanning 18 facilities in Florida. Sheridan also acquired Jandee Anesthesiology Partners and Karadan Anesthesiology and Pain Management, both based in Ramsey, N.J., in May 2016.

5. Sheridan acquired AllegiantMD in July 2016. AllegiantMD provides radiology services to Tampa residents. Within July 2016, Sheridan also purchased Boca Raton, Fla.-based Resolute Anesthesia and Pain Solutions as well as Clermont, Fla.-based South Lake Anesthesia Services. During the latter half of this year, Sheridan expanded its anesthesiology business in Southern California through acquiring Ambulatory Anesthesia Associates and Genesis Anesthesia Services in September. Sheridan also acquired California-based Fidere Anesthesia Consultants in October 2016.

6. Christopher A. Holden is AmSurg's president, CEO and director. Seasoned with more than two decades of healthcare experience, Mr. Holden joined the company in 2007. Phillip A. Clendenin is the company's president of ambulatory services. Claire Gulmi is AmSurg's executive vice president, CFO, secretary and director, and Kevin Eastridge served as AmSurg senior vice president of finance and chief accounting officer.  Robert Coward joined AmSurg in 1994, and currently serves as the president of Sheridan Healthcare.

7. In March 2016, AmSurg launched a program focused on improving patient safety during scope reprocessing. The program requires staff that reprocesses endoscopes between gastroenterology procedures to complete rigorous training and demonstrate a detailed understanding of the highly technical steps associated with the process. Since its launch, more than 1,000 healthcare professionals have enrolled in the program.

Surgical Care Affiliates (Deerfield, Ill.)
1. SCA had a total of 205 ASCs as of Nov. 1, 2016.  SCA acquired six new facilities in Q3, four of which are consolidated and two of which are nonconsolidated. SCA also closed one consolidated facility and sold one equity method facility. Of SCA's existing facilities, seven converted from nonconsolidated to consolidated. The conversions did not impact SCA's total facility count for the third quarter.

2.  During Q3 FY 2016, SCA had:

•    Net operating revenue hitting $322.8 million
•    Net income hitting $13.3 million
•    Adjusted EBITDA less non-controlling interest increased to $47.9 million this quarter, up 13.4 percent from the same period during FY 2015

3. Compared to the first nine months of FY 2015, SCA's total joint replacements have more than doubled. Thirty-seven of SCA's facilities are currently performing total joint replacements.

4. Joel Gordon, Andrew Miller and Jack Massey founded SCA in 1982. Andrew Hayek is the current chairman and CEO of SCA, beginning his tenure with the company in 2008.

5. SCA has partnered with a handful of practices in the last couple months. In November 2016, Deerfield, Ill.-based Surgical Care Affiliates partnered with Norwich, Conn.-based River Valley Ambulatory Surgery Center and Surgical Center of Connecticut in Bridgeport. SCA's partnership with Surgical Center of Connecticut and River Valley Ambulatory Surgery Center expands its presence in the state to six locations. SCA also partnered with Executive Surgery Center in Tomball, Texas, in September 2016.

New Jersey-based health system Virtua Health and Surgical Care Affiliates partnered with Bergen-Passaic Cataract Laser and Surgery Center in Fair Lawn, N.J.  Through the partnership, the surgery center is jointly owned by SCA, Virtua and the center's physician partners.

6. In June 2016, SCA established its inaugural Physician Advisory Board, composed of six board members. The board members will offer guidance and industry expertise to enhance patient care and serve SCA's physicians. The members include Bart Asner, MD; Robert S. Bray, MD; Norman H. Chenven, MD; Thomas M. Deas, Jr., MD; Stefan W. Kreuzer, MD; and Daniel Murrey, MD.

7. SCA is affiliated with SCA Medical Missions, which offers medical care to those in need. SCA Medical Mission initially opened a surgery center in Honduras in 2014, Holy Family Surgery Center, as its initial site for medical mission trips. In 2016, SCA Medical Missions completed 11 medical bridges in Honduras, with 462 participants volunteering more than 23,100 hours.

Hospital Corporation of America (Nashville, Tenn.)
1. As of Sept. 30, 2016, HCA operated 117 ASCs spanning the United States and the United Kingdom. Comparatively, the company operated 114 ASCs at the end of Q3 FY 2015.

2. In addition to its 117 ASCs, HCA also operates 169 hospitals. HCA is one of the largest healthcare companies in the United States, with R. Milton Johnson leading the company as HCA's chairman and CEO.

3. HCA named Gregary W. Beasley president of the company's ambulatory surgery division in 2004, a position he continues to hold. He previously was COO of ASD Management, which has offices in Nevada, California, Texas and Florida.

4. During the Q3 of FY 2016, HCA had:

•    Revenue rallying 4.2 percent, hitting $10.27 billion
•    Net income attributable to HCA totaling $618 million
•    Adjusted EBITDA reaching nearly $1.96 billion

5. In 1968, Thomas Frist Sr., MD, Thomas Frist Jr., MD, and Jack Massey founded HCA, forming one of the first hospital companies in the nation.

6. In March 2016, HCA announced that the Ethisphere Institute, a global leader in defining and advancing the standards of ethical business practices, named HCA to its list of 2016 World's Most Ethical Companies. The award marked the seven consecutive year that the Ethisphere Institute has provided HCA with this award.

7. HCA donated $21 million in cash to charitable organizations last year, with the company making community outreach and service a priority. Last year, HCA staff members pledged nearly $8.3 million to community agencies and volunteered more than 36,000 hours.

Surgery Partners (Nashville, Tenn.)
1. Founded in 2004, Surgery Partners has expanded to owning and operating 96 ASCs throughout the United States.

2. Surgery Partners reported the following results for Q3 FY 2016:

•    The company had 18 percent year-over-year revenue growth to $282.7 million
•    Same-facility revenue was up 10.3 percent to $281.2 million. Same facility cases increased 4.3 percent
•    Adjusted EBITDA increased 12.3 percent to $44.7 million

3. During Q3 FY 2016, Surgery Partners closed transactions on a Louisiana surgery center, two physician practices and an anesthesia practice. The company also entered into a relationship with a Florida health system to improve their outpatient strategy.

4. Michael Doyle is the CEO of Surgery Partners. He has more than 20 years of experience in outpatient leadership roles. Before joining Surgery Partners' team in 2004, Mr. Doyle was the senior vice president for Birmingham, Ala.-based HealthSouth, one of the nation's leading owners and operators of inpatient rehabilitative hospitals.

5. In October 2016, Surgery Partners named Teresa DeLuca, MD, to its board of directors. Dr. DeLuca was a senior director of global product development services at PRA International and a senior medical scientist at GlaxoSmithKline.

6. Over the past few years, Surgery Partners has significantly expanded through major acquisitions. In June 2014, Surgery Partners acquired the Green Hills, Tenn.-based ASC company Symbion in a $792 million transaction.

7. The company also merged with Novamed, an ASC operating company, in 2011. Through the deal, Novamed is a wholly-owned subsidiary of Surgery Partners.

More articles on surgery centers:
Tenet bond drops 0.3% — 5 facts
Perimeter Center for Outpatient Surgery submits form D for $206k — 4 takeaways
AmSurg's Q3 ambulatory services adjusted EBITDA surges to $61.1M; Surgery Partners, Florida health system team up to bolster outpatient strategy & more — 5 key notes

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