ASC leaders are watching ownership structures evolve quickly as private equity, hospitals and MSOs continue to expand their footprint
Tina DiMarino, CEO of ASC management company Custom Surgical Partners, joined Becker’s to discuss the rise of joint ventures and the risks of misaligned expectations among new owners.
Editor’s note: This interview was edited lightly for clarity and length.
Question: Have you seen changes in ownership structures over the past year?
Tina DiMarino: We’re seeing more joint ventures, as well as increased private equity and MSO involvement. If a PE group owns two ASCs, they’re often acquiring a third.
Hospitals, PE firms and MSOs are all entering the ASC space — sometimes without fully understanding it. We’re also seeing specialty-specific rollups, including podiatry and others, where practices and their ASCs are acquired together.
Q: With all these new players, is there anything that is concerning you? What’s exciting you?
TD: The concern is misalignment. When new owners don’t understand ASC operations, expectations can be unrealistic, and resources may not be allocated appropriately.
Administrators need to advocate strongly for what the ASC actually needs. That said, the exciting part is access to resources — new equipment, staffing support and capital investments — especially when working with experienced partners who understand the ASC space.
Q: What’s most different about opening an ASC today compared to 10 years ago?
TD: It’s far more expensive and far more regulated. Another major difference is staffing availability. In certain markets, especially rural or highly competitive areas, centers struggle to recruit experienced staff.
Ten years ago, you could post a job and get responses. Today, even when you hire RNs, they often lack perioperative experience, requiring more training and mentorship.
