High-Acuity Oncology & ASC Platform Consolidation Architecture
Structuring clinical joint ventures, optimizing high-dollar biologic chemotherapy margins (Buy-and-Bill), and scaling surgical facility fee revenues under corporate practice constraints.
Medical oncology and Ambulatory Surgery Centers represent the apex of clinical margin and complexity in private equity healthcare investing. Oncology platforms navigate immense working capital demands driven by Part B Buy-and-Bill biologic drugs (Keytruda, Opdivo), complex 340B drug pricing dynamics, and intense payer prior-authorization latency. Concurrently, ASCs command high facility-fee margins but face intricate surgeon co-ownership structures, Anti-Kickback Statute (AKS) safe harbor tests, and CMS Covered Procedures List restrictions. Kompanie LLP engineers turn-key MSO platforms that consolidate high-acuity surgical and infusion suites, automate specialty revenue cycle forensics, and align physician partners through compliant equity rollover classes.
Deliverables
- Structuring Anti-Kickback Statute (AKS) compliant ASC physician investor ownership syndications (satisfying the 1/3 surgical procedure test).
- Buy-and-Bill biologic pharmaceutical procurement optimization and working capital credit facility structuring.
- Surgical facility fee vs professional fee separation and managed care contract carve-out renegotiations.
- Clinical trial and research revenue stream integration compliant with federal human subjects regulations.
Frequently asked questions
How do private equity platforms navigate AKS safe harbors when acquiring ASCs?
Under the federal Anti-Kickback Statute ASC safe harbor, physician investors must meet rigorous tests: surgeons must perform at least one-third of their outpatient surgical procedures at the ASC, and equity cannot be allocated based on past or expected referrals. We structure clean, compliant subscription models that strictly follow OIG safe harbor rules.
What is the biggest operational risk in medical oncology roll-ups?
Working capital volatility from Buy-and-Bill drug administration. If commercial payers delay claim adjudication for 60+ days on a $25,000 monthly infusion regimen, practice cash flow freezes. We implement pre-adjudication eligibility clears and structured AR financing facilities to insulate the platform.