Kompanie Healthcare Partners LLP

Orthopedic Surgery, Spine & Musculoskeletal (MSK) Platform Architecture

Capture high-margin physical therapy ancillaries, accelerate outpatient ASC surgical migration for total joints and spine fusions, and command premium 12x–15x EBITDA multiples.

Musculoskeletal (MSK) care, encompassing orthopedic surgery, interventional spine, and sports medicine, is among the highest-margin sectors in private equity healthcare. The transition of total joint replacements (total hip and total knee arthroplasty) and cervical/lumbar spine fusions from inpatient hospitals to outpatient Ambulatory Surgery Centers (ASCs) has unleashed unprecedented EBITDA generation. Kompanie LLP structures comprehensive MSK platform roll-ups: integrating high-capture in-office physical therapy (PT) and MRI ancillaries, structuring implant vendor bulk purchasing agreements, and designing doctor rollover equity governance.

Deliverables

  • Comprehensive Management Services Agreement (MSA) structuring capturing clinical, imaging, and PT ancillaries.
  • Total joint and spine ASC migration blueprints compliant with commercial payer outpatient site-of-service mandates.
  • Surgical implant carve-out and vendor rebate compliance protocols under Stark Law and AKS safe harbors.
  • Subspecialty surgeon equity tiers (Joints, Spine, Hand, Foot/Ankle, Sports) balancing clinical call coverage with MSO equity.

Frequently asked questions

What ancillary services create the highest EBITDA lift in an orthopedic MSO?

In-office Physical Therapy (PT), extremity and spine MRI imaging, durable medical equipment (DME), and physician-owned Ambulatory Surgery Center (ASC) facility fees collectively generate up to 55% of total normalized platform EBITDA.

How does an orthopedic MSO handle older surgeons nearing retirement versus younger associates?

We design dual-class equity structures: senior partners receive upfront cash and rollover equity in the MSO holding company, while junior associates earn into synthetic equity or regional operating units through productivity-linked wRVU conversion milestones.