Ambulatory Surgery Center with Pain Management Clinic, Portland Metro

$4.7M

Revenue

$937K

SDE

6.6x

Multiple

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Full Editorial Writeup

This is a physician-owned outpatient surgical and interventional pain management operation in the Portland metro (Washington County, OR), established in 2000 and generating roughly $4.75M in revenue on $937K of cash flow. The model is vertically integrated: a certified ambulatory surgery center (ASC) paired with an outpatient pain clinic under common ownership, so patients flow from initial evaluation through diagnostic, medical management, and interventional or surgical treatment within one coordinated system. The ASC is described as the primary profit center, with the clinic feeding it a captive internal referral pipeline.

The economics of an ASC are attractive because outpatient procedural volume carries strong facility margins, and this platform captures both the professional (clinic) and facility (ASC) revenue streams plus in-house ancillary services. The internal referral loop is the real moat here: the clinic manufactures the surgical case volume that fills the center, reducing dependence on outside referral relationships that competitors must court. Management cites few local physician-owned competitors offering a comparable single-platform combination of surgical, clinical, and ancillary services.

The deal includes all assets from both entities plus $1.2M in FF&E. The real estate (a purpose-built 15,756 SF facility) is owned by the seller but excluded from the sale and expected to be leased to the buyer. The selling physician wants to shed ownership responsibilities while continuing to practice as a provider, which preserves patient relationships and referral continuity through the transition. This is a healthcare deal that requires a buyer comfortable with physician ownership rules, payor mix, and reimbursement dynamics.

Why we like it

Earnings quality is anchored by a certified ASC, which is a genuine facility asset with strong procedural margins, not a solo doctor selling their time. Cash flow of $937K on $4.75M revenue implies a healthy ~20% margin, and the ASC is explicitly the primary profit center of the combined platform.
The vertical integration is a real moat: the owned clinic generates a captive internal referral pipeline that feeds the surgery center, so procedural volume is manufactured in-house rather than dependent on outside physicians who could redirect cases. Few local physician-owned competitors offer this combined single-platform model.
Interventional pain management and outpatient surgery are recession-resistant. Chronic musculoskeletal pain does not go away in a downturn, procedures are largely medically necessary, and the payor-funded reimbursement model insulates revenue from consumer discretionary swings.
The seller-physician wants to give up ownership responsibility, not stop practicing, and will stay on as a provider post-close. That preserves the referral relationships and patient panel that drive the ASC's case volume, materially de-risking the transition versus a clean physician exit.

How to improve it

Attack the underinvested marketing function immediately. The listing flags limited current marketing presence, so a targeted outreach program to referring primary care and orthopedic physicians in the metro corridor could lift new patient intake and surgical case volume without new capital.
Recruit additional providers to expand capacity. The listing states existing infrastructure supports higher procedural volume, so adding one or two physicians or advanced practice providers converts unused facility time into incremental high-margin ASC revenue.
Push utilization of the surgery center. Model current block time and open procedural slots, then schedule to fill them, because ASC economics are dominated by fixed facility costs and every added case drops disproportionately to the bottom line.
Expand service lines into additional minimally invasive and advanced interventional procedures. Broadening the procedure menu deepens the internal referral loop and diversifies revenue beyond the current mix without leaving the existing physical footprint.
Optimize payor contracts and coding. Audit the current reimbursement schedule against regional benchmarks, renegotiate underpriced payor agreements, and tighten coding and billing to recover leakage across both entities.
Negotiate the facility lease terms carefully at close. Since the seller retains the real estate and will lease it back, lock in a market-rate, multi-year lease with defined escalators so occupancy cost is predictable and the landlord (seller) cannot squeeze the operation later.
Formalize provider succession and retention. The economics lean on the selling physician's patient panel, so put employment agreements, non-competes, and a recruiting bench in place to ensure case volume survives if the seller eventually fully retires.

Diligence notes

Scrutinize physician ownership and self-referral compliance. ASC plus feeder clinic under common ownership must satisfy Stark Law and Anti-Kickback safe harbors, so confirm the internal referral structure is legally sound and would survive a change of ownership.
Analyze payor mix and reimbursement concentration. Understand the split of Medicare, commercial, and workers comp, because pain management reimbursement has been under pressure and any single payor policy change could materially move both revenue and margin.
Verify how much cash flow depends on the selling physician personally. Separate the facility (ASC) economics from the seller's professional collections and referral influence, and quantify what happens to case volume if the seller reduces hours or exits after the handover.
Confirm ASC certification, accreditation, and licensing transferability. Validate the center's certifications, state licensure, and any CMS conditions of participation, and understand what re-credentialing or re-licensing is triggered by a sale.
Pin down the real estate lease terms. The building is excluded and owned by the seller, so the rent, term, and escalators of the leaseback are a core part of the go-forward P&L and must be negotiated and documented before closing.
Reconcile the combined financials of both entities. The listing blends clinic and ASC figures and promises detail post-NDA, so obtain separate audited statements for each entity to confirm the ASC-heavy profit narrative and validate the $937K cash flow.

Source

Originally listed on BizBuySell. View original listing →