8 executive insights from USPI, Surgery Partners, HCA 

United Surgical Partners International, Surgery Partners and HCA Healthcare are three of the largest ASC chains in the U.S. 

Here are insights from their top executives on their strategies for 2021 and beyond:

United Surgical Partners International

Transactions: Dallas-based USPI is ending the year strong. The company completed a large acquisition of SurgCenter Development and its more than 90 ASCs for about $1.2 billion and acquired ownership and management interests in nine ASCs from Compass Surgical Partners.

In an Oct. 21 third quarter earnings call transcribed by The Motley Fool, Saum Sutaria, MD, CEO of parent company Tenet Healthcare, attributed much of USPI's success to its ownership model. 

The model allows the company to "deploy capital on both mature centers and centers that are still developing, but actually generate returns faster as a better natural owner that is going to expand the set of opportunities for us at USPI," he said. 

Higher-acuity procedures: The company sharpened its focus on higher-acuity cases, both in its ASCs and hospitals. Tenet's orthopedic services saw growth rates up 22 percent in the third quarter, compared to the same period last year, Ronald Rittenmeyer, executive chairman, said in the call.

Additionally, USPI has completed more than 535,000 musculoskeletal procedures to date, and joint replacement surgeries have more than doubled from the year prior.

"We remain focused on executing our strategy of delivering high-acuity services for both emergent and elective basis," Mr. Rittenmeyer said in the call. 

Physician growth: USPI has also added a total of 1,700 physicians to date, including 580 in the third quarter. 

"It's important to note that these are independent physicians choosing to come and work at our facilities," Mr. Rittenmeyer said. "Our acquisition pipeline remains active as we partner with physicians and health systems in attractive markets."

Surgery Partners

Brentwood, Tenn.-based Surgery Partners grossed $320.9 million in closing its underwritten public offering of 6.9 million shares, beating its projection. 

Physician growth: Surgery Partners is remaining focused on physician growth, adding 10 percent new physicians to its facilities this year, executive chairman Wayne DeVeydt said in a Nov. 2 third quarter earning call transcribed by The Motley Fool

"We continue to see new and increased physician demand for our short-stay surgical facilities, and our targeted recruitment approach remains focused on attracting the highest quality physicians," CEO Eric Evans said in the call. 

Total joint replacements: Surgery Partner's total ASC joint replacements increased about 108 percent on a year-to-date basis compared to the prior year, Mr. Evans said. This growth is led by CMS total joint procedures, which grew by about 300 percent year-to-date.

Robotics cases are also up 62 percent year to date at 14 of the company's ASCs with 34 total robots deployed across its facilities. 

"We've made it to become a national leader in outpatient total joint procedures in our ambulatory surgery centers," Mr. Evans said. "While ASC total joint procedures still represent a small portion of our overall case mix, they are an important and fast-growing part of our value proposition to consumers, providers and payers." 

Cardiology: The company is also focusing on a longer-term opportunity in cardiology, considered one of the biggest opportunities for growth in the ASC industry. 

In 2021, Surgery Partners revitalized cardiology programs at four ASCs and one surgical hospital, with plans to expand to another six locations in 2022, Mr. Evans said. 

"Our ASC focus to date is in cardiac rhythm management procedures, including pacemakers, [implantable cardioverter defibrillator] implants and replacements and loop recorder implants," Mr. Evans said. "But we're also looking at expansions into higher-acuity interventions to include [percutaneous coronary intervention], as those procedures were approved by CMS for ASCs last year." 

HCA Healthcare:

Nashville, Tenn.-based HCA Healthcare reported strong growth in outpatient revenue and profit in the third quarter of 2021. 

Outpatient investment: Outpatient revenue was 34.1 percent of all patient revenue for the quarter. The company reported a 7.2 percent increase in outpatient surgery cases in the third quarter from the same period last year. 

"Our development pipeline of new outpatient facilities is robust, and we fueled that with investment," HCA CEO Sam Hazen said in an Oct. 22 third quarter earnings call transcribed by The Motley Fool. "We have a strong pipeline of projects that will come online in 2022 and 2023 that are connected to both our hospital platform as well as our outpatient platform."

Physician platform growth: The company has also added to its physician platform over the past 18 months, through both the development of existing practices and new acquisitions.

"Inside of our physician platform, we do see opportunities to continue to push further into value-based care," Mr. Hazen said. "In that particular platform in our company, we have aspects of value-based care. They vary a little bit from one market to the other depending on the circumstances and the demographics and payer dynamics in those markets."

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