With health systems, private equity firms and management companies all buying, ASCs that look “best in class” get the best deals, panelists said Oct. 29 at Becker’s 32nd Annual Business and Operations of ASCs in Chicago.
“You want to buy one that’s profitable, that is making distributions, that has great payer contracts,” said Geri Eaves, vice president of ambulatory services at Azana + MedHQ.
Ms. Eaves called payer contracts “one of the foundations” of a facility. Buyers also want strong utilization and case mix. She named orthopedics, spine, gastroenterology and ophthalmology as attractive specialties.
Specialty choice shapes the kind of profit a center earns. Established specialties such as ophthalmology, GI, pain management and podiatry deliver “steady revenue growth through high-volume, lower-margin case returns,” Joe Peluso, administrator at Aestique Surgical Center in Greensburg, Pa., told Becker’s in 2025.
Orthopedics, neurosurgery and cardiac catheterization offer “higher per-case returns and lower volumes with significantly higher margins,” he said. Total joints carry the highest revenue margin of any current specialty, he added.
Multispecialty mix also varies by ownership. A JAMA Health Forum study of 257 Pennsylvania ASCs found 62.3% of nonprofit centers offered multiple specialties, compared with 29.9% of for-profit centers. The most common specialties at nonprofit centers were GI (73.6%), orthopedics (58.5%) and ophthalmology (50.9%).
Single-specialty ASCs typically trade at 5x-8x EBITDA, while larger multispecialty centers can command 6x-10x EBITDA, according to Scope Research, a company that specializes in appraising healthcare businesses and services arrangements. Regional and national operators with multiple centers and demonstrated growth capability can reach 11x-17x EBITDA.
According to VMG Health’s 2026 Healthcare M&A Report, the median total invested capital-to-EBITDA multiple for ASC transactions rose to 7.9x in 2025 from 7.6x in 2024, the highest level since at least 2017.
Ms. Eaves said gaps in compliance or life safety drive valuations down. Red flags include a poor last survey, surveyors having to come back, anything that will need capital and weak payer contracts.
“I think you should do a really, really good due diligence,” she said.
Adam Schurz, administrator of Riverwoods Surgery Center in Provo, Utah, said the highest offer isn’t always the best one.
“I’ve seen some 11, 12x multipliers. Well, sometimes that’s not always the best deal,” he said. A partner offering 6x or 7x may deliver more growth, he said. “You might have to take a little haircut somewhere to go with the right partner.”
Mr. Schurz said sellers should make sure a health system partner is actively recruiting physicians so referrals keep coming.
Ms. Eaves said sellers should pin down governance before signing:
- Who controls the block schedule, the board or the hospital?
- Who handles distributions?
- How is capital spending approved?
- Who approves utilization and credentialing?
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.
