Investing in an Ambulatory Surgery Center: A Guide for Physicians

How physician ASC ownership is structured

Most ambulatory surgery centers are owned through an LLC or partnership. Physician investors buy units, often alongside a hospital, a health system or a national operator that manages the center. Owners share in the center's profits in proportion to their investment.

Ownership is attractive because surgeons gain a share of the facility income from their cases and a say in how the center runs. It also comes with federal rules, because physicians are referring patients to a facility they own.

The federal safe harbor

The Anti-Kickback Statute safe harbor for ASCs (42 CFR 1001.952(r)) protects physician investment if its conditions are met. Key ones:

• One-third income test: for surgeon-owned and single-specialty centers, at least one-third of each surgeon investor's medical practice income in the prior year must come from performing procedures.
• One-third procedures test: in multi-specialty centers, each physician investor must also perform at least one-third of their procedures at the center.
• Investment terms cannot relate to the volume of referrals.
• The center and other investors cannot loan funds or guarantee a loan for an investor to buy in.
• Returns must be directly proportional to capital invested.
• Patients must be told about the physician's investment.

Have a healthcare attorney confirm your situation. Falling outside the safe harbor is not automatically illegal, but it adds risk.

How buy-ins and buyouts are priced

VMG Health, a healthcare valuation firm, notes most ASC operating agreements require ownership to be bought back at a stated multiple of profits or at fair market value when a physician retires, leaves the market or stops meeting case requirements, and that buy-ins typically use the same method. Ask which method your center uses, because it decides both what you pay and what you get back.

Distributions and taxes

Because centers are usually partnerships or LLCs, investors generally receive a Schedule K-1 for their share of the center's income. Distribution timing varies by center. Talk to your accountant about the tax treatment for you.

What to check before you invest

1. The operating agreement: buy-in price, redemption terms, case-volume requirements and transfer restrictions.
2. Financial statements, case volume by specialty and payer mix.
3. Who manages the center, the management fee and governance rights.
4. Whether you will meet the safe harbor tests based on your own practice.
5. Any planned sale of the center. Surgery centers are in demand: VMG Health reported a 7.9x median deal multiple for ASCs in 2025.

Selling your stake or a whole center instead? See selling an ambulatory surgery center.

Common questions

Related reading

• Sell an ambulatory surgery center
• Medical practice M&A trends 2026
• Join the Medical Exit Group buyer list
• All medical practice M&A guides