Ascension’s $3.9 billion acquisition of Amsurg is cleared to close, but only after the St. Louis-based health system parts ways with seven ASCs the Federal Trade Commission says would otherwise leave patients in five markets with less competition and higher prices.
The FTC’s proposed consent order, issued June 2, identifies five metro areas where the combination of Ascension’s existing outpatient footprint and Amsurg’s surgery centers would substantially reduce competition: Nashville, Tenn.; Panama City, Fla.; Tulsa, Okla.; Waco, Texas; and Wichita, Kan. Across those markets, the commission alleges the deal would have given the combined entity outsized leverage over gastroenterologists, ophthalmologists and orthopedists and the insurers who pay for their procedures.
Six of the seven centers will be transferred to SC Affiliates, an affiliate of Optum’s SCA Health. The seventh, in Panama City, will go to a local physician group that already holds a minority stake in the facility. All divestitures must be completed at or before closing.
Once complete, the deal will add more than 250 Amsurg centers to Ascension’s portfolio, making it the country’s third-largest ASC platform with more than 300 locations across 34 states.
The consent order requires transition assistance from AmSurg and Ascension for up to one year post-divestiture, covering everything from billing and credentialing to payor contract transitions. A compliance monitor will oversee all divestiture obligations. If either acquirer is deemed unsuitable or divestitures aren’t completed on time, the order allows the FTC to appoint a trustee to complete the process. The order’s term runs 10 years.
Here are the seven centers at the center of the deal.
1. Waco (Texas) Gastroenterology Endoscopy Center
Acquirer: SC Affiliates
The FTC flagged Waco for outpatient gastroenterology, where the commission said Ascension and Amsurg compete directly. The center operates weekdays and focuses on colonoscopy, upper endoscopy, and related GI procedures. Physician partners include board-certified gastroenterologists from Waco Gastroenterology Associates, a longstanding independent practice in the market.
2. Tulsa (Okla.) Endoscopy Center
Acquirer: SC Affiliates
One of two Tulsa-area Amsurg centers named in the order. The FTC identified Tulsa for both gastroenterology and ophthalmology, making it one of the more complex markets in the consent order.
3. Eye Surgery Center of Tulsa
Acquirer: SC Affiliates
The second Tulsa center in the order, and the only ophthalmology ASC among the seven. The FTC cited the combined entity’s presence in outpatient eye surgery as a competitive concern, specifically for cataract and refractive procedures.
4. Surgery Center of Kansas (Wichita)
Acquirer: SC Affiliates
The lone orthopedic ASC in the divestiture package. The FTC identified Wichita as a market where the deal would have reduced competition for outpatient orthopedic, spine and podiatry procedures.
5. Associated Endoscopy (Hermitage, Tenn.)
Acquirer: SC Affiliates
One of three Nashville-area centers in the order. The FTC flagged the broader Nashville market, defined as Davidson, Sumner, Williamson and Wilson counties, for outpatient gastroenterology.
6. St. Thomas Medical Group Endoscopy Center (Nashville)
Acquirer: SC Affiliates
The second Nashville center, and one of two units operating under The Endoscopy Center of St. Thomas. The FTC’s consent order lists both Suite 400 (St. Thomas Medical Group Endoscopy Center) and Suite 309B (NGS Endoscopy Center) as separate divestiture locations under the same legal entity.
NGS Endoscopy Center (Nashville)
Acquirer: SC Affiliates
The third Nashville location and the second unit under The Endoscopy Center of St. Thomas. NGS Endoscopy operates out of the same building as the St. Thomas Medical Group center but under a separate NPI and suite. Together, the two Nashville units represent the largest single-market divestiture in the consent order.
7. Northwest Florida Gastroenterology Center (Panama City)
Acquirer: Florida Gastroenterology Center
The only center not headed to SC Affiliates. The Panama City ASC — the only freestanding GI endoscopy center in that market, according to the center’s website — will be acquired by its own physician group, which already holds a minority stake. The deal effectively returns the center to full physician ownership.
Becker’s reached out to administrators and leadership at the seven ASCs for comment. This story will be updated if more information becomes available.
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