Basheer Alismail has built partnerships the hard way and learned what breaks them.
As president of Capital Surgical Solutions, he oversees MSO operations, from ASC development to physician practice management.
Mr. Alismail joined Becker’s to discuss why transparency about a physician’s motivations is the first gate, why mid-career “alpha” physicians make the strongest partners, and what a bad fit looks like before the deal is confirmed.
Editor’s note: This interview was edited lightly for clarity and length.
Question: From your vantage point of running the business side, how do you structure the MSO to serve both the independent practice and the ASC without creating competing priorities?
Basheer Alismail: The most important thing we’ve learned — having come from the ASC side first, then moving into practice management, and now doing both — is alignment. And specifically, transparency about where a physician or physician group falls on the spectrum between quality of life and economic interest.
Some physicians just want a better quality of life. They see the ASC as a way to get out of the hospital, gain some latitude, and if distributions come, great. Others — the ones I call the alphas — are focused on how to optimize the financial returns of an ASC strategy. Those are the partners we work hardest to align with. From a business perspective, they’re the ones who drive success. And that transparency also helps us as an operations team actually define what success looks like. The quality-of-life dynamic is harder to quantify.
Our strategy at CSS is largely built around aligning with those alpha physicians in the MSK and ENT space. We’re very upfront about who we are as an organization and what we’re after operationally. If that doesn’t fit, we need to know early.
Q: What are red flags you look out for in partnerships?
BA: Our partnerships take a long time to develop. On the ASC side, it’s typically a three-year runway before we see a first case — coalescing the partnership, finding real estate, breaking ground, building. On the practice side, it’s six to 18 months, but the same principle applies: we don’t go in blind. We spend significant time ensuring aligned interests before anything is formalized.
A lot of it is word of mouth. Having a physician partner who can do peer diligence differently than I can — going to a colleague and asking whether someone has the operational mindset for outpatient surgery — is invaluable.
We’ve learned the hard way what red flags look like. The biggest one is an inability to make decisions. If a physician vacillates constantly or expects us to answer every question, that’s not the right partnership. We need their intangible value — their judgment, their clinical standards, their reputation — to come along with them. If they have great policies and algorithms but a totalitarian mindset about ownership and won’t partner, that’s not our model either. We’ve stubbed our toe on that.
The other two gates are being data-oriented — able to make decisions based on information, not emotion — and, frankly, passing a background check. We run them on everyone now: consulting relationships, MSO partners, ASC partners. Physicians are accomplished people, but they’re still human, and if their risk is tethered to us, we need to know about it upfront.
Q: Which physicians tend to be the best partners?
BA: We tend to look for mid-career physicians — typically in their early 40s. By then, they understand their worth. They know how much revenue they’re generating on the professional side, they have a clear sense of their case volume and reimbursement patterns, and they’re hungry enough to want to build something. Early-career physicians don’t yet have that clarity. Late-career physicians often have an inflated view of what they could still accomplish.
We also look at what we call tethering — how tied is this physician to an existing group or hospital relationship that isn’t serving them well? We don’t want to tortiously interfere, but we need to understand whether they’re capable of taking control of their own destiny and executing on it. The ones who come to us expecting us to extract them from a bad situation aren’t the right fit. The ones who’ve already decided and just need a thoughtful partner to build with — that’s who we’re looking for.
We’re actually in early development right now on an MSK group in the DMV area, targeting a 2029 launch. All employed physicians are starting the groundwork today so that by 2028, location, partners, growth capital, and individual risk appetites are all mapped out. Being able to help shape a practice before it even exists — that’s an exciting part of what we do.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.