Ascension Health Alliance's $3.9 billion acquisition of ambulatory surgery management company AmSurg has received Federal Trade Commission approval, contingent on the divestiture of seven outpatient surgery centers in markets the agency said would otherwise face reduced competition.
The proposed consent order allows the transaction to proceed provided Ascension sells specific AmSurg ambulatory surgery centers in Panama City, Florida; Tulsa, Oklahoma; Waco, Texas; Wichita, Kansas; and Nashville, Tennessee, where two facilities are located.
Six of the centers will be divested to SC Affiliates, a national ambulatory surgery center operator, while the Panama City facility will be transferred to Florida Gastroenterology Center, a physician group that already holds a minority stake in the site.
Under the terms of the order, the divestitures must be completed by the time the transaction closes. The FTC also requires Ascension and AmSurg to provide up to one year of transition assistance, maintain facility viability during the transfer period, and avoid interfering with employment relationships at the divested sites. In addition, Ascension must provide prior notice to the FTC for any future ASC acquisitions in the affected metropolitan areas for 10 years.
AmSurg operates more than 250 ambulatory surgery centers across 34 states, making it one of the largest ASC operators in the country. The FTC argued that combining AmSurg with Ascension's outpatient footprint could reduce competition in markets for procedures performed by gastroenterologists, ophthalmologists and orthopedists, including colonoscopies, cataract surgeries, and orthopedic interventions commonly performed in outpatient settings.
The agency said reduced competition in these local markets could lead to higher reimbursement rates negotiated with insurers, which may ultimately translate into higher premiums for fully insured employers, increased costs for self-insured employers and greater out-of-pocket expenses for patients.
Ascension, a nonprofit health system with roughly $28 billion in annual operating revenue and about 97,000 employees, said the approval marks a key step toward closing the deal.
"Ascension is pleased to share that we have received approval from the Federal Trade Commission (FTC) to move forward with our acquisition of AMSURG's ambulatory surgery center (ASC) business," the organization said in a statement. "This regulatory milestone is a significant step toward our expected official closing in the near future."
If completed, the deal would significantly expand Ascension's ambulatory footprint, positioning it as the country's third-largest ASC platform with more than 300 locations.
The FTC said the remedy is designed to preserve competition in local outpatient surgical markets and prevent reductions in quality, access or innovation. The Commission voted 2–0 to accept the consent agreement for public comment.
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