HST Pathways

It is always great to see an ASC lean into change and see meaningful results on the other side. 👏 Center for Sports Medicine & Orthopaedics (10 ORs, ~700 cases/month) proved that by moving off paper and into a fully digital workflow. The impact: 1️⃣ Days to bill improved by 40%, largely by eliminating lag between surgery and documentation. 2️⃣ Collections accelerated by 26%, creating more predictable cash flow. 3️⃣ Same day operative notes became standard, removing a revenue cycle bottleneck. 4️⃣ Case costing became precise down to individual supply items, giving physicians real visibility into variation. 5️⃣ Automated payments now process hundreds of thousands of dollars monthly, reducing manual work and errors. When documentation, billing, and reporting are connected, operators stop reacting to problems and start managing performance in real time. Read their full story here: https://lnkd.in/gwkTRft5

Many ASC owners are sitting on a valuable but often overlooked asset: their real estate. On our most recent podcast episode, Jon Vick, ASC Realty Advisors, explained how sale-leasebacks are becoming an increasingly common strategy for physician owners. Here’s why. 1️⃣ ASC real estate is currently selling for roughly 14-17× rent, compared to 6-9× EBITDA for operations. Structuring ownership so real estate and operations are separate will increase value. 2️⃣ Physicians sell the building to an investor but sign a long-term triple-net lease, meaning they continue operating the center exactly as before while accessing liquidity. 3️⃣ To maximize value, physicians typically need to sign a 10+ year lease, which means the ideal time to consider a sale-leaseback is about a decade before retirement. 4️⃣ Selling the real estate before a strategic partnership or private equity deal often simplifies the ownership structure and removes debt from the balance sheet. It’s not the right strategy for every ASC, but it’s a conversation more owners should be having earlier in their lifecycle.

HST Pathways has been named 2026 ASC Software of the Year by Healthcare Tech Outlook, marking our third consecutive year receiving this recognition! 🎉    This award reflects what we believe matters most: • A platform built intentionally for ASCs  • One integrated system that continues to innovate  • Structured, transparent implementation  • Ongoing, measurable support    Thank you to Healthcare Tech Outlook for this continued recognition, and to the 1,800+ surgery centers and 75,000+ users nationwide who trust us every day to help them care for their patients.    https://lnkd.in/g_uFb5F9

Exciting news: HST Pathways has expanded its platform by adding J.L. Morgan & Associates to its family of solutions! They’re a CMS-approved CAHPS survey vendor that supports OAS CAHPS and other patient experience and quality measurement programs for ASCs and other healthcare facilities.   OAS CAHPS is required and linked to reimbursement for Medicare-certified ASCs and HOPDs, and surgery center leaders deserve a clear, reliable path to meet the requirement without adding unnecessary manual work.   J.L. Morgan brings deep experience as a CMS-approved CAHPS survey vendor, and HST brings the platform trusted by more than 1,800 ASCs. Together, we plan to help more ASCs turn patient experience feedback into actionable operational improvements.   Read the full announcement for all of the deets: https://lnkd.in/g4M5VhYj   #ASC #OASCAHPS #PatientExperience #QualityReporting #surgerycenters

If you’re thinking about selling your ASC, even someday, it’s worth pressure-testing your readiness now. We had an excellent discussion with Stephanie Terry (Physician Transaction Advisors) to talk through what to expect during the transaction process so your ASC is prepared well in advance.  Here are 3 takeaways worth bookmarking. 1) “Readiness” is often the biggest value lever and the biggest risk. Common gap: a high-performing center that’s majority-owned by one physician. Many buyers want to see multiple physician owners with equity at stake to help protect post-transaction volume. If you’re recruiting partners, expanding, or tightening RCM, it can be smarter to pause and go to market later when your story and valuation is stronger. 2) The Letter of Intent (LOI) isn’t just about price: it’s about alignment and your next 5 years. Naturally, price catches your eye first. But the real decision is often in the terms: management fees + term length (evergreen vs. fixed)  billing/collections structure  non-competes + tail provisions  cultural fit + alignment with the buyer’s strategy 3) The Quality of Earnings (QOE) report will make or break your deal. This is where buyers validate EBITDA, confirm fair market value, and test your financial story. If adjustments surface late, purchase price renegotiation can follow. The smartest operators prepare for this before going to market. The smoother this phase runs, the fewer surprises you’ll face at the closing table. Listen to our full episode with Stephanie to hear even more crucial tips!

If you’re thinking about selling your ASC, even someday, it’s worth pressure-testing your readiness now. We had an excellent discussion with Stephanie Terry (Physician Transaction Advisors) to talk through what to expect during the transaction process so your ASC is prepared well in advance.  Here are 3 takeaways worth bookmarking. 1) “Readiness” is often the biggest value lever and the biggest risk. Common gap: a high-performing center that’s majority-owned by one physician. Many buyers want to see multiple physician owners with equity at stake to help protect post-transaction volume. If you’re recruiting partners, expanding, or tightening RCM, it can be smarter to pause and go to market later when your story and valuation is stronger. 2) The Letter of Intent (LOI) isn’t just about price: it’s about alignment and your next 5 years. Naturally, price catches your eye first. But the real decision is often in the terms: management fees + term length (evergreen vs. fixed)  billing/collections structure  non-competes + tail provisions  cultural fit + alignment with the buyer’s strategy 3) The Quality of Earnings (QOE) report will make or break your deal. This is where buyers validate EBITDA, confirm fair market value, and test your financial story. If adjustments surface late, purchase price renegotiation can follow. The smartest operators prepare for this before going to market. The smoother this phase runs, the fewer surprises you’ll face at the closing table. Listen to our full episode with Stephanie to hear even more crucial tips!

ICYMI: Here's what's going on This Week in Surgery Centers.  CMS’ 2026 final rule expands ASC opportunities. It adds 573 procedures to the ASC list, phases out the inpatient-only list over 3 years, and raises payments 2.6%. Some cardiac procedures will see 3.4% increases. CMS is also piloting AI-supported prior authorization. [Source: Becker’s ASC] CBRE facilitated the sale of a fully leased, two-property ASC portfolio anchored by HCA. Built in 2025 with leases through 2035, the assets attracted Montecito, which holds $6.5B in healthcare real estate. A 10-OR facility places Orem in the top 5% of ASCs, signaling strong investor demand for scaled, stable assets. [Source: Realty News Report] Generative AI is creating new cybersecurity risks for healthcare. Experts warn AI tools are harder to monitor, requiring strong “provenance” tracking, identity controls, and rapid response systems. As cybercriminals use AI to move faster, ASCs must detect and isolate threats in minutes to stay protected. [Source: Healthcare Dive] Amazon Pharmacy is expanding same-day delivery to ~4,500 cities and 2,000 new communities in 2026. Faster medication access and discounts can improve post-op compliance and recovery. For ASCs, reliable delivery helps address transportation and access barriers, supporting better outcomes and continuity of care after surgery. [Source: Healthcare Finance News] Check out the full stories on Apple Podcasts, Spotify, or YouTube!   #HealthcareNews #ThisWeekinSurgeryCenters #TWISC 

OrthoCarolina moved from joint venture ASCs to wholly owned centers primarily to fix misaligned incentives and gain operational control. Dr. Leo Spector, CEO, walks us through what that process was like and how changing certificate-of-need laws can help you do the same. 1. Ownership = alignment: In many hospital JVs, shifting cases to ASCs can be a net revenue loss for hospitals, which can quietly limit growth. 2. Post-CON reform is changing the power dynamic: Without CON as leverage, the question becomes: what value does each partner actually bring? 3. Expansion must be disciplined: Don’t overbuild. OR capacity must match surgeon supply, anesthesia coverage, and staffing. 4. Anesthesia is still the #1 growth constraint: ASC growth planning must include deep alignment with anesthesia partners and backup models. 5. Strategy starts internally: Align physician partners on the why, be honest about operational capabilities, and know your leverage before negotiating.  Groups that are aligned and intentional about ownership now will have the advantage over the next 3-5 years.

Case mix does not equal revenue mix. If you’re only tracking volume, you may be missing what’s actually driving your ASC’s financial performance. HST Pathways analyzed 5.3M+ cases across 635 surgery centers (Q1 2020–Q2 2025) and found a consistent pattern: three specialties anchor the majority of payments across the ASC industry — orthopedics, ophthalmology, and GI – but, they don’t contribute equally to revenue. 📊 Orthopedics continues to carry a massive share of total payments, often ~30% or more of overall revenue, even when case counts don’t dramatically increase.  📈 Total joints have gained economic weight since 2023. Even without huge volume jumps, payment share is rising as more complex procedures shift outpatient. ⏱️ Meanwhile, fast-turn specialties like GI and ophthalmology are growing case share and driving utilization, but not always payment share at the same pace. What we’re seeing nationally is a divergence: Case growth is often happening in shorter, high-throughput specialties… while revenue growth is still anchored in higher-acuity procedures like ortho. Takeaway: If your volume is up, but revenue feels flat, your specialty mix may be the reason. Track payment share by specialty and pressure-test your growth strategy. High-throughput specialties keep rooms full, but higher-acuity procedures often drive margin and long-term financial stability.  The centers that understand this balance will be best positioned to grow profitably. 

ASCs are hitting a tipping point, and it’s not just about “selling.” It’s about surviving and thriving in a much more complex operating environment. In a recent conversation with Jim Freund (Managing Partner, Physician Transaction Advisors), he shared what’s pushing more physician-owned centers to explore partnerships and transactions: ✅ There’s rarely one “forcing function” that begins the discussion around selling. It’s usually the cumulative burden that makes owners ask: Can we keep doing this alone and still hit our goals?  ✅ The biggest readiness signal: leadership starts questioning whether they can stay profitable and maintain autonomy while meeting today’s operational demands.  ✅ Partnership options are broader than many owners realize: from management-service support (no equity) to minority/majority deals, hospital JVs, and PE-backed platforms. And a big valuation reminder: your ASC isn’t “worth” a fixed number. Buyers look beyond EBITDA at physician age mix, specialties, contracts, market dynamics, lease terms, staffing strength, and growth runway. The market ultimately sets the price. If you’re even considering a partnership, start with alignment. Get your physician owners on the same page about goals, timelines, autonomy, and what support you actually need. Then evaluate multiple options before you commit to one path.