Structuring partnerships between physicians and health systems

Physician-owned surgery centers and health systems each bring something the other needs: clinical entrepreneurship and case volume on one side, capital, contracting leverage, and infrastructure on the other. The friction is almost never clinical. It is governance.

Durable joint ventures define, in writing and early, who approves capital expenditures, how new physician investors are admitted, how distributions are calculated, and what happens when a partner retires or leaves the market.

Clinical autonomy deserves the same specificity. Physicians choose to invest in a center because it runs differently than a hospital outpatient department. Scheduling authority, block time policy, and vendor and implant selection should be settled explicitly rather than assumed.

Valuation is where deals most often stall, and the cause is usually a difference in projected future volume rather than a difference in current performance. Agreeing on the volume model before agreeing on a multiple resolves most of the gap.

Our role in these conversations is to be the party without a side of the table: modeling the economics, drafting the operating framework, and keeping the process moving so that a good partnership does not fail on process.