15 things to know about ASC valuation from HealthCare Appraisers' 2016 survey

HealthCare Appraisers released the 2016 "ASC Valuation Survey: How do the ASC companies assess value?"

The survey includes 20 respondents representing more than 700 surgery centers across the United States.

Here are 15 things to know about ASC valuation based on the HealthCare Appraisers survey:

1. Most ASC company respondents are willing to pay a premium for ASCs in certificate-of-need states, with 56 percent reporting they would pay a premium of 0.51 to +1.0 to the typical multiple.

2. More than half — 53 percent — of the respondents said out-of-network revenue at 20 percent of the ASC's total revenue would exceed the risk tolerance as a viable investment. But, 21 percent of respondents reported no risk threshold for out-of-network ASCs.

3. Around 70 percent of respondents said out-of-network ASCs would reduce the typical multiple by more than 2.0.

4. For out-of-network centers, 63 percent of the management companies convert revenue to reflect in-network rates and then model the ASC's adjusted EBTIDA multiplied by unadjusted market multiples.

5. When purchasing minority interest in a single-specialty ASC, 50 percent of the respondents reported prevailing multiples of 3.0 to 3.9 times EBITDA. When purchasing a controlling interest in a single-specialty ASC, 73 percent of the respondents reported prevailing valuation multiples of 6.0 to 7.9 times EBITDA. The valuation for controlling interests in single-specialty ASCs was consistent with previous years.

6. When purchasing a minority interest in a multispecialty ASC, 65 percent of the respondents reported prevailing valuation multiples of 4.0 to 5.9 times EBITDA. When purchasing a controlling interest in a multispecialty ASC, 78 percent of the respondents reported prevailing valuation multiples of 7.0 to +8.0 times EBITDA. The valuation multiples for respondents purchasing controlling interests were consistent with previous years.

7. The typical management fee ranged from 5 percent to 6 percent of net revenue for 61 percent of the management company respondents. Twenty-eight percent reported management fees of 3 percent to 4 percent of net revenue.

8. Comparatively, the management company fees reported were lower than in the previous HealthCare Appraisers survey. Sixty-nine percent of respondents charged between 5 percent and 6 percent of net revenue last year and 11 percent charged 7 percent of net revenue last year; in 2015 only 5 percent charged 7 percent of net revenue.

9. There are 35 percent of the respondents who charge a minimum management fee and 50 percent of those companies report a typical management fee from $100,000 to $199,999 per year.

10. There were 12 percent of the respondents with management fee arrangements putting their fee "at risk" for performance metrics — lower than last year; 88 percent have no "at risk" management fee arrangements.

11. At single specialty centers, 78 percent of management companies prefer six to 10 physician owners.

12. For multispecialty ASCs, 33 percent of management companies prefer 11 to 15 physician owners.

13. The management company's preferred ASC ownership structure reported in the HealthCare Appraisers survey is:

• Less than 10 percent ownership: 18 percent of management companies
• 11 percent to 29 percent ownership: 18 percent of management companies
• 30 percent to 50 percent ownership: 29 percent of management companies
• 51 percent to 75 percent ownership: 35 percent of management companies

14. Fifty-eight percent of management companies say their competition for acquisitions is increasing — more than last year; 37 percent said there was no change from the previous year.

15. According to HealthCare Appraisers, 61 percent of ASC management companies plan to purchase one to five ASCs in the next 12 months. Another 22 percent plan to purchase six to 10 centers.

More articles on surgery centers:
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60 spine-driven ASCs to know
Northern Wyoming Surgical Center, West Park Hospital debate future recruitment

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