WHO’S WHO
THE COMPANIES

By John Roark and Tina Brooks

We present a compendium of companies that are making a difference in the ASC arena, a roster of those responsible for driving the industry forward, for raising the standards, and for challenging the system. These companies stand out by anticipating, meeting — and exceeding the needs of the market.

Ambulatory Surgery Centers of America (ASCOA) challenges the surgical center industry to think better, to create centers of quality and profitability. “We provide total management, says Brent Lambert, MD, FACS, director of business development and operation. “Where we differ from consulting companies is we don’t manage anything we don’t own. We have 30 percent ownership in our surgical centers, and the physicians own 70 percent. Whereas other companies may be managing just for the management fees, we don’t do that.”

Founded in 1997, all principals of the ASCOA team are physicians with experience in ambulatory surgery centers. “We partner with physicians. We know what their needs are because we are physicians ourselves. I think that gives us a leg up in terms of meeting their needs,” says Lambert. “The reason we are successful is because we are very, very efficient. We know what it costs to do every case. We have benchmarks for everything, so if someone is out of line in terms of costs of doing a case, we can point out where there may be some waste. Not necessarily the surgeon, but maybe the ancillary people he is working with are not as efficient as they should.”

“We feel that our physician partners will do the right thing for themselves and for everybody without us having to control them by saying, ‘We own more than you, so we’re going to make it happen.’We think that if we are running this right and we’re doing right by our partners, they’ll make the right decisions. Even though we don’t have ownership, our experience is that they continue to do the right thing.”

Lambert is bullish on the industry. “I think that physicianowned freestanding ASCs are a fixture in our healthcare system,” he says. “We are the low cost providers. The whole healthcare industry is the beneficiary of that. I know there’s talk, there have been several legislative initiatives to try to what in effect would do away with freestanding ASCs that are physician-owned. That would throw our healthcare system into bankruptcy, I believe, and chaos. We’re doing such a huge volume of cases — are they all going to go back in the hospital? I think that ASCs are going to continue to prosper.”

AmSurg Corp. develops and manages single specialty ambulatory surgery centers in partnership with physicians across the country. “The business of delivering medicine today is harder than delivering the medical side of medicine,” says Ken McDonald, president, CEO and director of AmSurg.

With business issues being extremely important for surgery centers, the corporate partner becomes a crucial element, says McDonald. AmSurg oversees the clinical services, business office, marketing, financial reporting, accreditation and administrative operations of its surgery centers, while physician partners focus on providing patient care. “We let doctors be doctors,” McDonald says.

“What we try to do is make a difference in the doctors’ lives by making them more effective and efficient, locating the surgery center right where their practices are located, improving the outcomes they can deliver by working in a single specialty center with dedicated and consistent staff, and helping them differentiate their practice from competing practices in the same specialty,” McDonald says.

McDonald believes that this segment of the healthcare industry is one of the best there is. “There are so many things that are leading this business into the future. Technology marches on and as it does, there are more and more things that can be done or done even more efficiently tomorrow than today in the outpatient arena. Those technological changes are just working to the advantage of this entire sector.”

Founded in 1998, ASCs, Inc. specializes in strategic partnering for new and existing ambulatory surgery centers. “We help doctors who either have or want to have a surgery center find the right partner and obtain the highest value for their center,” says founder and president Jonathan Vick. In addition to helping physicians identify potential corporate partners, ASCs Inc. also has expertise in the areas of sales, purchases, valuations, mergers and acquisitions.

“All of the centers that we’ve helped find partners for are doing better than the centers that are trying to do it on their own,” says Vick. “We’ve helped doctors get as much as 50 percent more for their center than they have gotten on their own. It’s hard for the doctors to sort out who’s the best partner for them, and then structure the deal in such a way that they get the best value from it. We act as representatives for the doctors. We know who all the companies are, and we know which ones have the capital and good management systems. We can advise them as to who are the good partners for them, and how to get the maximum value for what they have to offer.”

Vick sees independent centers affiliating with corporate partners because of the increased complexity of contracting and managing to increase revenues at a time when payers are trying to cut their payments.

There’s a strong rationale for having a corporate partner versus trying to go it alone. “The industry is growing at probably a 5 percent rate, as far as number of facilities, but at a 10 percent or higher rate as far as number of procedures performed,” says Vick. “That means that the utilization of the centers should increase from where it is now. The biggest pressures are on reimbursements.

One of the best reasons for having a corporate partner is that the partners can concentrate on helping the centers improve their contracts, so their revenue per case increases, and their cost per case decreases. What we’ve seen is that a setup with a corporate partner can produce revenues that are 30 percent or higher than centers that don’t have corporate partners. And almost all of that 30 percent falls through to the bottom line, so they’re far more profitable.”

The successful centers of the future will have the strongest ability to contract with payers, says Vick. “Whether they’re independent or affiliated — contracting is really going to be the key to success. In my opinion, since contracting is not something that doctors have ever shown that they can do well on their own, they really should be considering a partner to do the contracting for them.”

HCA, Inc. owns and operates approximately 190 hospitals and other healthcare facilities in 23 states. The company strives to deliver high-quality, cost-effective healthcare in the communities it serves since its founding in 1968.

By being part of a publicly traded company, HCA’s healthcare facilities have access to a pool of approximately $2 billion in capital annually. “Our main role is to serve as a kind of guiding business engine for those various hospitals and surgery centers; to help them have access to the best facilities, best equipment and best business practices available today,” says Jeff Prescott, spokesperson for HCA. In order to allow its facilities to focus on patient care, HCA has combined several back-office functions into different centers, which serve from 11 to 15 facilities in a geographic region.

For Prescott, the outlook for healthcare is good in terms of demographic trends but uncertain in the legislative arena, which is usually the case. “Right now it’s a larger uncertainty than it has been in the past,” Prescott says. “The presidential election is coming and healthcare is a huge topic. There will be something in that arena that healthcare will have to react to.”

Many healthcare providers, including HCA, have begun anticipating the needs of one aging population, the baby boomers. “What we see in the next 10 to 15 years is a large group of people who are hitting that time of their life where there will be an increased use of healthcare in general,” Prescott says.

Prescott adds, “There was a time not too long ago in the mid and early ’90s when virtually every community in the country had too many hospital beds. Hospitals were being built like crazy and everybody was over-bedded. That trend has reversed itself. We are now spending in the neighborhood of $1.8 billion to $2 billion a year in capital spending, primarily bricks, mortar and equipment in our hospitals and surgery centers to keep up with that coming trend line of use.”

Through the integration of physician owned facilities, networks and centralized administrative support services, IMD provides physicians with business solutions for today, and long-term organizational structure and strategy to maintain and develop the health care services of tomorrow.

IMD integrates the disciplines necessary for successful healthcare facility development, implementation of information systems and administrative support services. Expertise in the areas of group health, workers’ compensation and cost containment further complement IMD’s ability to negotiate and build payer and provider relationships.

“The essence of the company really came from the first imaging center that was opened in Oklahoma in the early ’80s,” says IMD president and CEO, John Perri. “By the late ’80s, it quickly became apparent that a single modality couldn’t compete. And parallel to that, physicians were beginning to open surgery centers and other imaging centers, so the concept was: let’s provide a vehicle in which they can do that. Let’s start a company that can help physicians own these various facilities.”

“We’re one of the few companies in this industry that centralizes all our services,” continues Perri. “What separates us from others is that we bifurcated what goes on at the facility — all the clinical and administrative aspects of the operation are separated. What that does is it allows the physicians to focus on the clinical operations, and that’s what provides the success for these facilities. We don’t manage the facilities. We truly believe that the physicians who own the facility manage the facility; we’re providing them with a vehicle by which they can do that effectively. They can concentrate on patient care and clinical operations without having to worry about hiring CFOs, controllers, billers and coders — we provide those and other services, freeing them to do the things they are trained to do. In our minds, it’s a much more efficient approach to the delivery of healthcare.”

Perri sees government regulation of physician- owned facilities as impractical. “Long-term, what’s driving these changes is technology. Technology today is allowing surgeons to do procedures that even 10 years ago would require multiple days’ stay in hospitals. Now they’re taking one and two days. Government can’t legislate technology. Technology is only going to continue to allow physicians to be more efficient. I just don’t think they can stem the tide of where technology is taking us.”

National Surgical Hospitals partners with local physicians in the development of successful freestanding surgical hospitals. NSH has access to the growth capital necessary to remain competitive.

NSH provides equity capital and acts as equity partners with physicians in hospitals. “For physicians to be partnered with somebody like us gives them a great deal of stability,” says chairman, president and CEO, John Rex- Waller. “We provide the opportunity to partner with a very strong financial player as we go through these interesting and challenging times when equity ownership by physicians in surgical hospitals is being challenged. Having us around is a huge plus for a physicians at this point.”

NSH is skilled at converting existing surgery centers or developing surgical hospitals concentrating in orthopedic surgery, spine and back, pain management and more complex general surgery cases. Once a partnership is formed, NSH negotiates with regulatory groups, managed care providers and governmental agencies to oversee the contractual nuts and bolts necessary to open a surgical hospital, and provides services in all aspects of surgical hospital operations including facility development, day-to-day management, and financial reporting.

NSH management services makes certain that a facility remains true to its goal of providing efficient, friendly, and cost-effective care to all its constituents including physicians, the patients, payors, and the community at large.

The center must maintain the highest standards of healthcare in line with the standards of the community, and must continually self-assess and find ways to improve. Physicians are expected to be actively involved in the affairs of the hospital, and retain control the clinical affairs of the facility, with the manager providing the dayto- day management services.

Following the guiding philosophy that “all healthcare delivery is local,” NSH develops a partnership structure, facility design, and implementation plan for a new facility that best meets the needs of the participating physicians and the local community. Although each facility is unique, the process by which that facility is designed, built and licensed is not. Under the guidance of a single project manager who is there from start to finish, NSH coordinates internal and external resources to keep the process on track.

“I think there are a lot of surgery centers that are converting or that are thinking about converting to a surgical hospital,” says Rex- Waller. “A concern that I have is that many surgery center consultants are advising their clients that converting to a surgical hospital is a piece of cake, and they should be doing it. Running a surgical hospital is a very different animal to running a surgery center. We are now seeing a number of those surgery center operators who thought they could do hospitals being thrown out by physician owners. And we’re being approached to try and manage the hospital. It’s more difficult than it appears. It’s a very different animal.”

Ortmann Healthcare Consultants, LLC, founded in 2001, specializes in building partnerships between physicians and hospitals. “Using my experience both as a hospital administrator and a previous officer in an ambulatory surgery company, I try to bring those two backgrounds together to form strategic relationships between physicians and hospitals in the development of surgery centers,” says Fred Ortmann, president of Ortmann Healthcare.

The partnership of physicians and hospitals leads to improved decision making and ultimately to lower cost in the healthcare industry, Ortmann says.

Ortmann Healthcare provides full services that begin with a feasibility study and proformas all the way through full accreditation and operation. Because of its experience and knowledge in healthcare, the company is capable of assembling one of the best development teams in the country. “Our primary objective is that we don’t just want to develop a surgery center,”

Ortmann says. “We want to make sure that whatever we’re doing or participating in is going to be financially successful and produce high quality patient care at the end.”

Physicians Endoscopy specializes in the development and management of freestanding endoscopic ambulatory surgery centers (EASCs) in partnership with practicing GI physicians. Focusing exclusively in the area of GI endoscopy, PE is quickly establishing itself as a leading developer and manager of endoscopy centers in the United States.

“By helping our physician partners to develop and operate an EASC which is majority owned and controlled by them, we accomplish several very important things,” says president and CEO Barry Tanner, CPA. “The physicians acquire controlling ownership of a facility in which they can perform the majority of their endoscopic procedures safely and efficiently, within an environment that is patient friendly, cost effective, and supported by a highly trained and dedicated staff. Because the physicians own the facility, they can determine their procedure block times. And because the staff is entirely focused upon endoscopy, the clinical efficiency of that staff improves both patient as well as physician satisfaction and outcomes.”

Because such facilities, if well managed, can be profitable, the physicians can benefit from distributions of those profits, reasons Tanner. “This is important especially since the professional fee component that physicians are reimbursed for performing endoscopic procedures has declined approximately 50 to 60 percent over the past ten years. Owning a facility offers the physician an opportunity to make money from facility fees in addition to professional fees.”

Tanner credits PE’s success to hands-on involvement in each facility. “Unlike many ‘managers,’ we do not merely supervise facility activities from a distance,” he says. “The PE team directly performs numerous activities for each partnered facility every single day.” PE performs billing and collection activities, handles accounts payable, cash management activities, all financial accounting and reporting functions, provides human resource management, coordinates and compiles all benchmarking activities, oversees risk management, regulatory and governance matters. “The results of our individual activities are realized in the bottom line performance of each facility and shared proportionately by all owner physicians and PE alike.”

ASCs and EASCs are cost effective for the healthcare system and generally yield significantly higher patient satisfaction. While professional reimbursement that physicians receive for endoscopic procedures has declined in the past decade, costs of providing care have continued to increase dramatically. “Physicians have had to find ways to work harder and smarter just to try to stay even,” says Tanner. Demographics of the U.S. population coupled with better patient education and steadily improving screening technologies continue to result in an increasing patient volume. “GI physicians cannot continue to provide the hospitals with the patient coverage that they want and deserve, while at the same time meeting the demands of their office practices. In order to attract new GI physicians to almost any practice in today’s environment, the efficiency and income associated with owning an EASC is critical.”

“From the very beginning of each physician relationship, we put our money where our mouth is,” says Tanner. “PE invests in each facility pro-rata with each physician investor. We take the same risks and share proportionately in the same rewards. The physicians are firmly in control of all decisions — they call the shots. Our role is to support the physicians and facility staff in every way possible to promote efficiency, and to create an atmosphere that is conducive to patients, physicians, staff and to the persons who accompany the patient to the facility. Our decisions and actions impact us directly and personally, just as they do the physicians. Everyone at PE knows that we need to add value to each facility each and every day. We own each and every problem and success story. We believe that this sort of relationship creates a unique and important alignment of incentives and responsibilities.”

Regent Surgical Health, LLC is a valueadded buyer, developer and manager of high-quality surgery centers and surgical hospitals. In partnership with physicians and hospitals, Regent aims to be the low cost provider of surgical services in each community where it owns and manages facilities.

Founded in 2001, Regent was formed with the express purpose of acquiring underutilized ASCs and re-syndicating them for immediate improvement in revenue and profitability. In addition, Regent has the operational and financial capabilities to acquire successful centers and convert them to surgical hospitals, thereby broadening the scope of services and improving the operations and cash flow.

“We like facilities that are under-utilized,” says CEO and founder Thomas Mallon. “We can identify physicians within the community who will come and in and invest with us in the center, and we can very quickly effect a financial turnaround of the facility.”

The Surgery Center of Southern Nevada is a niche development success story for Regent Surgical Health. “We leased space inside of a long-term acute care hospital,” says Mallon. “It was a brand new building, and they did not know what they were going to do with the two operating rooms. We proposed that they lease them to us, we built a small addition to the building to create the reception area, and then we put together a group of 20 physicians in the community who partnered with us. We opened it in March 2003, and it went cash-flow positive in August.”

“About one third of the centers out there lose money or break even,” says Mallon. “We work with those who are under-utilized. We’ll come in with our recruiting and managing expertise, to recruit additional physicians, to partner with us, and we manage them as efficiently as possible to lower the cost and to bring them to cash flow positive.”

“I think the ASC model is very exciting,” says Mallon. “I think the ASCs in general are pricing our services better than we have in the past. In the past, a lot of our physician partners were signing contracts that did not make economic sense for our business. Today we are more cautious about signing contracts just to ensure patient volume, where we need to sign contracts that allow us to operate at the quality that our physicians and partners expect us to.”

ReSurge Hospitals has the requisite blend of hospital and surgery center expertise necessary to drive the success of surgical specialty hospital ventures. ReSurge’s operating partners and support team have operated hospitals, reorganized general hospitals into specialty or surgical hospitals, and have more than 25 years experience with ambulatory surgery centers and recovery care centers.

“We have the ability to put the whole thing together,” says Rusty Shelton, MBA, CMPE, president, partner and CEO of ReSurge. “What we do at the beginning of the process is perform due diligence feasibility studies where we’re looking longer term down the road. We’ll develop an ASC so it can be converted into a surgical hospital or whatever makes sense.”

“What we bring to the table that the market needs is the ability to restructure healthcare for what meets that community’s need,” continues Shelton. And that may be a number of different things. “It may be freestanding, it may be a joint venture with a local hospital, it may be a combination of different variables to try to bring together what’s good for the medical community. Our background includes hospitals, physicians, surgery centers, a number of different ambulatory care settings. We have a broad knowledge of the entire industry, not just ASCs or surgical specialty hospitals, but the whole industry as a delivery system. We’ll look at defining what the service mix is up front: what is it that you’re trying to do strategically before you enter the process? We back up to that level and then program the services versus the other way around.”

On the subject of potential governmental regulation of ASCs, Shelton has faith that ASCs will prevail. “I think ASCs have proven their value in the market from a competitive perspective, from an efficiency and customer service perspective,” he says. “I think that what will happen is ASCs are going to be fine. I think what we’re seeing is that the surgical specialty hospitals will offer a unique and compelling product that I don’t think the federal legislation will prohibit.”

“The Medicare trust fund, regardless of what they say, is a huge problem,” says Shelton. “We’ve got to allow the physicians to have ownership and participation in that, but I do not believe that if you cut them out completely and stop specialty hospitals it is going to change our healthcare delivery system. We need to change healthcare delivery because it’s not efficient in its current state. My belief is that the American Hospital Association is doing a good job of representing its members, but they’re not looking at what is best in the total overall healthcare industry. I think you have to allow competition and let these entities prove themselves over a period of time because the best ideas are going to come out when the physicians have ownership and participation because they’ve bought into it in terms of ‘It’s part mine, therefore I’m going to make sure it works right.’”

Rowland Companies is a premier construction development manager/general contractor specializing in all types of construction for the healthcare industry. With more than 19 years of experience, Rowland is committed to delivering innovative and comprehensive services: distinctive craftsmanship, expert management, accurate budgets, competitive costs, and timely performances.

“Over the last couple of years, 75 percent of our business has been repeat business from existing clients and another 23 percent has come from referrals,” says Jeff Johnston, principle of Rowland. “Our additional business is growth.” Rowland has constructed 20 percent of all operating orthopedic and surgical hospitals in the United States. Numerous awards have been bestowed upon the company because of its fine work.

“Different than a lot of contractors, we do as much pre-construction work as we do contracting work — part of that is not only for the client’s benefit but for ours,” Johnston says. “If we can participate in a team approach with our clients and the design professionals as the project is being developed, then we can make sure that the outcome at the end of the job meets or exceeds the client’s expectation. Our role during that whole process is to control the schedule and the budget.”

Johnston adds “By managing the front end process efficiently, then the whole project can get done sooner. If we can deliver the project a month or two quicker, it not only saves the client money but it also starts the revenue stream faster.”

Another item that differentiates Rowland from the competition is its eight guarantees. Johnston says “Our biggest guarantee that we give is no surprises. If we’re involved from the very beginning of the project — working in a collaborative effort with the design team and the owner — then we’ll guarantee to the owner that if there are any problems at the end of the project, meaning if there is a conflict between what the architect did and what we priced, we’ll eat those costs. So, there are no surprises unless the owner changes the scope of the work, there are no change orders.”

Johnston, like others, is very much aware of the current unpredictable state of government regulation. “We try to keep abreast of what’s happening there to help assist our clients make the best decisions as those items change. It’s constantly changing, but it just happens that there are some major changes in the wind right know and we’re just trying to prepare for them.”

Surgis, Inc. is a growing network of freestanding ambulatory surgery centers in partnership with local physicians. It also manages hospital- based endoscopic services and programs through its subsidiary, American Endoscopy Services, Inc.

Although begun in 2001, Surgis now has 20 surgery centers in operation, another two in construction and eight in development. “What we’re trying to do is establish a base of centers that let us put together the infrastructure to really support these centers,” says Joseph Hutts, president and CEO. “We’re focusing very hard on each center so that we have the right kind of systems in place. Do we have the right resources? Do we have the controls that are needed?”

Surgis provides proven expertise in critical areas of success for ASCs. “We are pretty much a pure play in the sense that we don’t have rehab centers, imaging centers or hospitals,” Hutts says. “We focus just on surgical services. Secondly, we have a very experienced management team. The people that we’ve brought together have been in this industry for years. Lastly, we’re very well capitalized. There are some very well capitalized companies, but not a lot.”

Hutts notes that ASCs are good for the healthcare system, “It brings healthcare at a lower cost. It’s good for physicians because they have a chance to be more productive in these centers, do more cases, to invest and have the return on that investment at a time when their incomes are under pressure. Patients benefit from the high quality and excellent service too.”

Symbion, Inc. owns and manages surgery centers throughout the United States, providing surgical procedures across many specialties. With a focus on development, efficiency and day-to-day operations, Symbion has established a management team with more than 250 years of combined healthcare experience.

“It’s very important that doctors in hospitals look at the depth of the financial partners with which they are partnered, and the depth of the management team,” says William VB Webb, chief development officer for Symbion. “There are a number of Johnny-come-lately to the surgery center business; if you peel the onion back their history is not very deep or long in developing or managing surgery centers.”

Symbion differentiates itself from other surgery center providers through flexibility and creativity in developing win-win relationships, provider of multiple physician-linked outpatient services, in-house design team, and access to capital.

Webb, like many others in the field, notes that legislation on healthcare is being closely monitored. “It’s still up in the air in Washington as to what they’re going to do legislatively on physician ownership of surgical hospitals. We are preparing ourselves by monitoring what the regulatory environment is to allow us to expand our range of services in either outpatient surgery or specialty surgery. We are also staying very active in a lobbying sense, both at the federal and state level to continue to advance the causes and opportunities for outpatient surgery in many different respects: reimbursements, increasing the types of cases performed in these settings, and various ownership options across the board.”

Of course, the recent behavior of a few companies have not made the situation any easier for healthcare providers. Webb stresses the importance for companies to police themselves, even private entities. Otherwise, he adds “We all get handed an onerous set of rules and guidelines that we have to add on to already heavy burdens of HIPAA and everything else we have to operate under. So, if we don’t act as good citizens it will make it more complex and more arduous for all of us.”

United Surgical Partners International, Inc. (USPI) is a leader in strategic partnering. USPI acquires or develops surgical facilities in partnership with local physicians and, wherever possible, with a local hospital or health system. The company brings a wealth of management strengths to these partnerships, improving surgical operations both in service and economic results.

“The thing that we’re known for most is the fact that we do partner with not-for-profit hospital organizations,” says Brett Brodnax, senior vice president and chief development officer at USPI. “There’s not that many other companies that actually work in our particular area.”

USPI was founded in 1998 with the vision to “create an organization that could facilitate bringing together physicians and not-for profit hospitals in a partnership model that would deliver high quality service-oriented surgical care to the community that we collectively serve,” Brodnax says.

USPI has ownership interests in or operates 70 surgical facilities in the United States, Spain and the United Kingdom. Of the company’s 58 domestic facilities, 33 are jointly owned with 13 not-for-profit healthcare systems. Some of USPI’s better known partners include Baylor Health Care Systems of Dallas, Texas; Meridian Health System in Wall, N.J.; and St. Rose Dominican Hospital in Henderson, Nev. “We help not-for-profit hospitals protect their existing market share and capture additional market share,” Brodnax says.

As the shift continues to occur from inpatient to outpatient and from outpatient departments of hospitals to free-standing ASCs, Brodnax says that USPI is helping its partners, both physicians and hospitals, make that shift and providing them a vehicle to do so.

Brodnax mentions further that these partnerships are a way for “physicians and hospitals to align their interests and not compete with one another. So, in other words, they’re basically on the same team as oppose to being competitors in a marketplace.”

Founded in 1986, Woodrum/ASD is an experienced leader in operating, developing and managing ambulatory care centers, and offers expertise in operational analysis, predevelopment, management and assessment services. In addition, the firm provides practical businesses experience in the areas of operations, feasibility studies, strategic planning, turnkey development, marketing and management.

“We are really a management development firm,” says managing partner Joe Zasa. “We do quite a bit with physicians and hospitals, physician hospital joint ventures, as well as work for physicians and hospitals separately. We are a low-equity model, meaning that we do not require a large amount of equity in the deals.”

“The skill set needed to run one, two, or three centers is a lot different than the skill set needed to run 10, 15 or 20 centers,” says Zasa. “We have a system that we have been refining since 1986. It’s a well-oiled machine backed up by a lot of experience. Every center is different, but it’s basically: this is how you run a center, this is how you do compliances, etc. It’s very difficult to run numerous centers unless you have enough infrastructure to pull it off. I see a lot of people entering the market saying, ‘We’ll do surgery centers, and we’ll turn around and sell them to some companies who buy them all up.’ I don’t know that that’s really good for the industry as a whole.”

“We’re not seeing a ton of challenges to the ASC industry specifically,” says Zasa. “We’re seeing challenges to the surgical hospital industry. That obviously raises concerns. My concern for the industry right now is the over-proliferation of surgery centers. People are building centers that may or may not be feasible or successful because they haven’t planned for them very well.”

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