The top ASC multi-state operators own around 28 percent of Medicare-certified ASCs in the U.S., showing how fragmented the market remains today, according to VMG Health Intellimarker.
Here are five key notes.
1. ASC industry consolidation is in full swing and will likely continue over the next few years. Over the past decade, Envision and AmSurg merged, Tenet purchased majority ownership in United Surgical Partners International and Optum, a division of UnitedHealth Group, acquired Surgical Care Affiliates.
H.I.G Capital sold its equity stake in Surgery Partners in May 2017 to BCPE Seminole Holdings, a Bain Capital Private Equity affiliate. Around the same time, Surgery Partners acquired National Surgical healthcare for $760 million.
2. Multi-state ASC operator ownership growth has outpaced the number of overall new ASCs every year. Overall ASC growth has been flat over the past eight years, with just a 1 percent increase in the number of ASCs from 2010 to 2017.
3. As of December 2017, AmSurg reported 264 ASCs, the highest number reported by a public company. The remaining large companies reported:
• USPI: 261
• HCA: 120
• SurgCenter Development: 106
• Surgery Partners: 106
Surgical Care Affiliates had 186 centers when Optum acquired it.
4. Smaller multi-site operators and ASC management companies have 509 centers across the U.S. all together.
5. Independent ASCs still make up around 72 percent of the 5,602 ASCs in the U.S., as of December 2017. The ASC market generates around $15 billion to $25 billion of annual revenue.