GHJ enabled an ambulatory surgery center to expand its mission by providing expertise that exceeded expectations and facilitated strategic growth. 

Highlights: 

• Developed a detailed three statement forecast to align with the client’s expansion plans 
• Prepared a comprehensive investor and lender deck that addressed potential concerns and showcased the client’s capabilities 
• Advised the client and its principal owner on key terms and conditions to secure a debt financing deal, avoiding equity dilution for the ownership group 

BACKGROUND 

In keeping with its mission to deliver world-class, safe patient care with excellent outcomes, 90210 Surgery Medical Center also aims to improve efficiencies and reduce costs for its patient. This aligns with ongoing payor and Medicare changes to reimbursement policies. With these changes in mind, 90210 Surgery Medical Center anticipated a significant increase in outpatient procedures from the traditional hospital setting. This projected increase in demand was beyond the ambulatory service center’s (ASC) existing capacity. 

The projected demand exceeded the ASC's current capacity, presenting both a challenge and an opportunity for growth. To accommodate the increase in patient volume and procedural complexity, the ASC proposed expanding its operations by building a new floor at its existing location. This expansion would include state-of-the-art operating rooms, patient waiting areas, nursing stations and supporting infrastructure. The ASC planned to fund this through a combination of debt and equity financing. 

GHJ'S APPROACH 

To support this expansion, GHJ’s Audit and Assurance Practice was asked to assist in creating a three statement (P&L, balance sheet and cash flow) forecast that would help the client understand its future revenue and expenses, risks and opportunities and financing strategy. The GHJ Audit Team reached out to GHJ’s Growth Planning and Strategic Advisory Practice to help prepare these forecasts, a comprehensive investor and lender presentation and to consider a variety of financing alternatives for the construction project.  

GHJ worked closely with management to identify additional operational issues that could impact financing. This proactive approach ensured ASC was fully prepared for lender discussions. Additionally, GHJ leveraged existing relationships with ASC’s preferred lender, Prudential Private Capital, the private capital arm of PGIM, Inc., the global investment management business of Prudential Financial, Inc., to facilitate negotiations and ultimately set favorable terms for the financing deal. 

RESULTS 

GHJ's comprehensive support led to significant positive outcomes for ASC: 

• Favorable Financing: ASC secured a fully debt financed deal, avoiding the need to dilute ownership or solicit additional funds from physician members or its majority owner. 
• Increased Operational Capacity: The financial support paved the way for constructing the planned expansion to ensure ASC could effectively manage the anticipated increase in patient volume. 
• Enhanced Relationship: The thorough preparation and collaborative process strengthened the relationship between GHJ and ASC and established GHJ as a trusted advisor for future growth initiatives. 

GHJ’s dedication to understanding the broader objectives of ASC and providing comprehensive support through every stage of the financing process exemplifies their commitment to empower clients in the healthcare sector.  

“GHJ’s deep understanding of our organization, its goals and challenges was instrumental in securing the financing we needed,” said 90210 Surgery Medical Center Chief Executive Andy Ball. “Their comprehensive support not only helped us navigate the complexities of the process but also positioned us for future success. We truly felt like they were invested in our growth.” 

By identifying and addressing key issues, GHJ ensured that ASC could secure favorable terms for expansion, enhance its operational capacity and pave the way for continued success.