Mount Sinai Health System is fast‑tracking the construction of several joint venture ambulatory surgery centers (ASCs) through Peak Point Partners, the holding company it co‑owns with Merritt Healthcare.
The goal: to move routine procedures into lower-cost settings, and stay competitive with self‑insured employers and commercial payers.
The New York-based health system shifted from small, passive stakes in ASCs to a dedicated, system‑wide build‑out over the past five years, Brent Stackhouse, managing director of Mount Sinai Ventures, said on the HealthTalk Insights podcast.
“It is much easier and cheaper to build ambulatory surgery ORs,” Stackhouse said. “Originally, [Mount Sinai was] making investments in ambulatory care companies in order to expand its footprint and to engage with their voluntary provider community.”
Those small holdings proved lucrative, he said, but the real inflection point came in 2018, when Mount Sinai leadership asked whether minority positions met the system’s long‑term surgical capacity needs or payer expectations for lower‑cost sites of care.
“I think there’s a recognition that ambulatory surgery centers, and I hope this doesn’t sound pejorative, are factories, and they’re factories in the sense that they are focused on the delivery of a very specific thing, day in and day out, with a real eye towards safety and efficiency,” Stackhouse said.
That sense of focus helps surgeons secure predictable block time and helps payers steer routine cases away from high‑cost hospital settings, he added.
The meat and potatoes
To keep incentives aligned and antitrust worries at bay, Stackhouse said Mount Sinai and partner Merritt Healthcare created a shared holding company rather than stacking bilateral deals.
“We built Peak Point Partners, where Mount Sinai and Merritt are co-owners of Peak Point Partners, and Peak Point Partners goes and invests in the surgery centers,” he said.
The arrangement lets the venture borrow construction money without putting Mount Sinai’s entire balance sheet on the hook, he added.
Still, moving hospital‑based faculty into an ASC requires more than just real estate, he said.
“We’ve had to invest more time around scheduling than I ever anticipated, and that aligning the scheduling systems of the hospital with the surgery center was absolutely critical because the friction that exists by which an academic medical center doctor has to go through to the bureaucracy of the scheduling team to be able to move patients from one setting to another is totally different than for a community doctor who can just, you know, talk to the front desk and say, ‘I’m doing this today,’” Stackhouse said.
Leadership attitudes toward physician equity can also slow momentum, he said.
“There was resistance among some members of leadership to allow their physicians to have ownership in these businesses, and I think that has been something that we have continued to work through on every single surgery center that we’ve developed,” Stackhouse said.
Yet allowing selected employed surgeons to buy in has proved a helpful recruitment and retention lever, Stackhouse said.
“If we start building ambulatory surgery centers, they could co‑invest with us, they could be owners with us, and that would have greater stickiness and be able to recruit doctors when a lot of our competitors in the market weren’t providing that opportunity,” he said.
Growing sideways – and up
With three ASC locations already live and more in development, Stackhouse is eyeing both horizontal and vertical expansion.
“I see us growing vertically in that way, and I think there’s a lot of exciting opportunities for us to be able to increase our margin and save on costs and leverage our own expertise by bringing some of those businesses in house,” he said.
And solutions platforms, revenue‑cycle management, and supply services suppliers have started circling.
“I get inundated with entrepreneurs approaching me to try to implement their solutions in our ambulatory surgery portfolio,” Stackhouse said.
For now, the team is cautious, and any artificial‑intelligence tool or platform must withstand Mount Sinai’s cybersecurity and quality vetting before entering their centers, Stackhouse said.
“I want to make sure that the quality and the safety and the cybersecurity risk is being managed by people who have that subject‑matter expertise,” he said.
