1. Rise in interstate medical tourism. Some large, self-insured employers on the East Coast and in California are sending patients for big-ticket surgeries, such as joint replacement and spinal procedures, to ASCs and surgical hospitals in the Midwest, where prices are considerably lower.
2. Loopholes for physician-owned hospitals. While many physician-investors are racing to beat the Dec. 31 deadline for new physician-owned hospitals, some are exploring potential loopholes in the law. Physicians can always open new hospitals that only serve private payors and self-pay patients, Dr. Curd says, and he thinks this might be viable in some parts of the country.
3. Growth in mergers and acquisitions. There are a lot of potential buyers and sellers. Many physicians are looking to sell their ASCs for various reasons, including cashing in on capital gains before the capital gains tax rises under President Obama.
4. Weak ASC-development activity. “Lending is not super-favorable yet,” Dr. Curd says. Much of that buying comes from private equity and venture capital companies.
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