Are ASC Values Going Up or Down? (Nap Gary, Regent Surgical Health)

Nap Gary, President, Eastern Region of Regent Surgical Health: If I had to guess, I would expect that we’ll see increasing stratification in values, with overall trends being slightly downward. Some centers — for example, those with favorable specialty reimbursement, in larger population areas, with limited out-of-network exposure — will likely see multiples rise, but on the whole, I think there are more negative factors at play than positive ones.

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Some of the positive factors include increased cost pressure on payors, improved Medicare reimbursement for certain specialties, negotiating leverage resulting from having multiple facilities in the same metropolitan market and the related opportunities that may arise to participate in accountable care organizations under the new [healthcare reform] legislation. Additionally, I expect that as some of the private equity-backed surgery center companies seek to return to the public equity markets in the next few years, there will be an increase in demand for strategically positioned centers as acquisition candidates.

Negatives include the increased difficulty of maintaining a meaningful out-of-network strategy, the uncertain political environment (including possible threats to physician ownership), the regulatory environment (particularly the impact of the Independent Payment Advisory Board, from whose clutches hospitals are safe until 2019), the challenge of getting government to look at outpatient surgery reimbursement as a whole (which would allow it to recognize the enormous savings generated by increased migration to ASCs, rather than looking at separate hospital and ASC boxes and trying to cut reimbursement to both), payor consolidation and greater hospital control of surgeons (through employment and bundled reimbursement programs). Furthermore, if any of the private equity-backed companies should stumble, that could affect the appetite for acquisition and consequently, the values as well.

As a final note, if the industry is successful in its efforts to enhance lobbying effectiveness through its new Advocacy Committee, it may be able to lessen the effect of some of these negatives.

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