HCA, SCA, AmSurg, USPI & Symbion: 5 Key Facts About 5 of the Largest ASC Companies

Here is information on five of the largest ambulatory surgery center management and development companies including leadership, recent financial results and market activity.

1. AmSurg (Nashville, Tenn.). Christopher A. Holden, president, director and CEO of AmSurg, has held all three positions since Oct. 2007. He was previously a founding member, senior vice president and division president of Triad Hospitals based in Plano, Texas. He has more than 21 years of experience with primarily multi-facility and multi-market healthcare management.
AmSurg specializes in the growth and development of single specialty centers between 3,000 and 4,000 square feet without hospital partners. Its typical partnership model includes 51 percent ownership but no management fee. As of December 2013, AmSurg owns and operates 243 centers and partners with more than 1,800 physicians across the U.S.
In its latest financial announcement, fourth quarter 2013, the company announced a 22 percent growth in fourth quarter earnings per diluted share, which Mr. Holden attributed to a 10 percent growth in procedures in the calendar year. AmSurg's fourth quarter revenue was $284.6 million, up 17 percent from fourth quarter 2012. Total revenues for 2013 were $1.08 billion, also up 17 percent from 2012. AmSurg acquired six centers in 2013, which are expected to produce approximately $20 million in annualized operating income.
The company is publicly traded, and its shares trade for $45.04 as of March 10.

2. Hospital Corporation of America (Nashville, Tenn.).
The Hospital Corporation of America's Ambulatory Surgery Division is run by Gregary W. Beasley, CPA, who has served as president of the branch since 2004. He has been with HCA's ambulatory surgery division since 1995 and previously served as the organization's COO.

As of Dec. 31, 2013, HCA operates 115 freestanding surgery centers in 20 states and in England, which, as a standalone company, would make it one of the largest ASC companies in the world.

HCA became a private company for the second time in its history in 2006, acquired by Kohlberg Kravis Roberts, Bain Capital, Merrill Lynch and the Frist family. It returned to being publicly traded on Oct. 3, 2011 with a $3.79 billion IPO.

In the fourth quarter of 2013, HCA Holdings' earnings were up 35 percent per diluted share. Its earnings were $424 million on revenue of $8.84 billion. HCA Holdings finished 2013 with posted earnings of $2.01 billion on $33 billion in revenue.

As of March 10 HCA Holdings shares traded for $49.55 per share.

3. Surgical Care Affiliates (Deerfield, Ill.). Andrew Hayek is the president and CEO of SCA, roles he has held since 2008. In September 2013, SCA filed an initial public offering of up to $100 million in stock. At the close of its IPO on Nov. 4, 2013, the total IPO included 11,244,444 shares.
SCA partners with physicians, health systems and payers to develop and implement surgery strategies across the country. The company operates 185 facilities in 34 states, including ambulatory surgery centers, surgical hospitals and one sleep center, in partnership with more than 2,000 physician partners and in affiliation with 45 leading health systems.

Surgical Care Affiliates is a publicly traded company and its shares traded for $31.14 per share as of March 11.

4. Symbion (Nashville, Tenn.). Richard E. Francis Jr., is the CEO and chairman of the board of Symbion. He has served as CEO since the company's inception in 1999 and assumed the role of chairman of the board in 2002. Cliff C. Adlerz is the president and COO of the company. The company owns and operates 57 facilities, 51 ASCs and six surgical hospitals. It has many multispecialty centers, hospital partnerships and a handful of physician owned hospitals.
Symbion went public in 2004, but returned to being private in 2007 when the company merged with private equity firm Crestview Partners. Crestview Partners is now Symbion's financial partner.

5. United Surgical Partners International (Addison, Texas). William Wilcox is the CEO of USPI, a position he has held since April 2004. Brett Brodnax has served as the company's president since June 2011. He is also chief development officer.

USPI owns and operates 215 facilities, both ASCs and surgical hospitals, 148 of which are joint ventures with not-for-profit health systems. It also has a partnership with Baylor Health System and ownership in some physician owned hospitals. The company has a great reputation and growing interest in orthopedics and musculoskeletal specialties. USPI is a privately held company. Private equity firm Welsh, Carson, Anderson & Stowe has close ties with company.

USPI reported $616.2 million in net revenue for 2013, up 14 percent from $540.2 million at the year-end of 2012. The company's operating income increased 8 percent to $263.8 million, compared to $245.2 million in 2012. Cash flow from operating activities was $159.9 million, compared to $180.3 million in 2012. USPI and its consolidated subsidiaries invested $11.3 million in maintenance capital expenditures and $11.1 million to develop new facilities and expend or invest in existing facilities.

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