NY/NJ Ambulatory Surgical Center Portfolio, 10-11 Locations

$225.0M

Revenue

$55.0M

SDE

7.3x

Multiple

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Full Editorial Writeup

This is a Tri-State portfolio of 10 to 11 fully equipped ambulatory surgical centers spread across New York and New Jersey, with individual facilities ranging from 6,000 to 15,000 square feet in prime locations. The listing claims roughly $225 million in combined gross revenue, split evenly across the two states at $100 million to $130 million each, producing a reported $55 million in cash flow. The operation runs with an established executive management team, specialized surgeons, and full on-site clinical staff across 110 employees.

Surgical centers are among the most durable assets in healthcare because they capture higher-margin procedural volume that would otherwise flow to hospitals, and payers actively steer cases to lower-cost outpatient settings. A portfolio of this scale, if the numbers hold, represents a rare institutional-sized acquisition target in a fragmented ASC market that private equity and health systems have been aggressively consolidating.

The asking price is $400 million against $55 million in cash flow, a 7.27x multiple. The founder is retiring after roughly two decades and requires NDA, photo ID, and proof of funds before disclosing locations. This is not a typical BizBuySell listing; it is priced and positioned as a middle-market platform deal, and the buyer pool is limited to sophisticated capital with the ability to underwrite a nine-figure healthcare transaction.

Why we like it

Ambulatory surgical centers throw off genuinely durable, high-margin cash flow because payers and patients both favor outpatient procedures over hospital settings. A reported $55 million of cash flow on $225 million of revenue is a roughly 24 percent margin, which is healthy for multi-site ASCs and suggests real operating leverage if verified.
The moat here is regulatory and relational: ASC licensing, Certificate of Need where applicable, payer contracts, and surgeon relationships are all hard to replicate and create meaningful switching friction. Ten to eleven established sites with existing surgeon rosters and clinical staff is a defensible footprint that a new entrant cannot simply build overnight.
The ASC market has a powerful tailwind as CMS and commercial payers keep expanding the list of procedures approved for outpatient settings and steering volume out of hospitals to cut cost. Consolidators, health systems, and private equity are paying premium multiples for scaled multi-site ASC platforms, so an exit at institutional pricing is plausible.
A management team is already in place, so a financial or strategic buyer can step in without the founder-dependency risk that kills most small healthcare deals. That existing infrastructure plus a retiring, motivated seller creates a clean platform for either a hold-and-optimize strategy or a bolt-on roll-up thesis.

How to improve it

Renegotiate and optimize the payer contract mix in the first 90 days by benchmarking reimbursement rates across sites and pushing underperforming centers toward the best-contracted terms. Even a few points of rate improvement on $225 million of revenue drops directly to cash flow and materially changes the return math.
Standardize case scheduling and block utilization across all 10-11 centers to lift procedures per operating room per day. Underused OR time is the single biggest hidden margin lever in ASCs, and centralizing scheduling can raise throughput without adding a dollar of fixed cost.
Recruit and add surgeon partners or expand specialty lines at the higher-square-footage locations to increase case volume. The listing itself flags advertising and growth potential, but surgeon supply, not marketing, is the real constraint on ASC revenue, so physician recruitment should be the priority.
Implement portfolio-wide supply chain and implant purchasing at scale to compress the cost of goods on high-ticket procedures like orthopedics. A single group purchasing arrangement across all sites can capture volume discounts that individual centers cannot.
Build a rigorous revenue cycle and coding function to reduce denials and accelerate collections. In a business this size, tightening days sales outstanding and cutting write-offs by even a small percentage frees up meaningful working capital and lifts realized margin.
Pursue tuck-in acquisitions of smaller single-site surgical centers in the same metro to add volume onto the existing G&A base. The platform is already built, so each bolt-on can be integrated at incremental cost and immediately accretive multiples.

Diligence notes

Verify the $55 million cash flow and $225 million revenue against audited financials, tax returns, and site-level P&Ls, because the listing is vague and rounds every figure. A nine-figure ask on unverified, evenly-split revenue claims demands quality-of-earnings work before any letter of intent.
Scrutinize the surgeon and referral relationships for compliance with Stark Law, the Anti-Kickback Statute, and state self-referral rules, since physician ownership and referral arrangements are the primary legal risk in ASCs. Any improper arrangement can void reimbursement and create massive successor liability.
Examine payer contract concentration, terms, and renewal dates, along with the mix of commercial versus Medicare/Medicaid volume. A portfolio dependent on a few commercial contracts or out-of-network billing strategies carries reimbursement risk that could impair cash flow post-close.
Confirm state licensing, accreditation, and any Certificate of Need requirements for each of the 10-11 sites, plus whether they transfer cleanly on a change of ownership. ASC licenses do not always convey automatically and re-credentialing delays can interrupt revenue.
Clarify the real estate arrangement at each location, since the listing mentions prime-location facilities but not whether leases are market-rate, long-dated, or tied to the seller. Above-market related-party leases or short remaining terms could quietly erode the reported margin.
Assess the credibility of the broker and the deal itself, given the informal listing quality, gmail contact, and the mismatch between a BizBuySell format and a $400 million ask. Confirm the seller is real, motivated, and that the portfolio is one coordinated entity rather than a loosely assembled group before committing diligence resources.

Source

Originally listed on BizBuySell. View original listing →