What private practices, hospitals and investors should know about the M&A market in cardiology

In 2025, the payment rates for cardiac ablation procedures performed in ASCs increased significantly. What kind of impact did that move have on the market?

Cardiac ablations were maybe the last major procedural category that wasn’t reimbursable by Medicare in the ASC space. That’s a major change going forward, though there will be an adoption curve at first. Over time, I think you’ll see more and more ablations done at ASCs; it’s a good value proposition since it costs less than performing them at the hospital. Patient selection will be key—there will still be many cases where it is not appropriate to perform the ablation in an ASC. It is appropriate in certain cases, however, and I would expect the number of ablations being performed in that setting will increase over time.

I really expect ablations to drive a cardiology group’s ability to be successful on its own more than in the past. There are certain limits in cardiology to what can be done in an outpatient setting because your patients are often very sick. Those limits will always be there. But being able to perform a certain number of ablations in the ASC can help those facilities meet their economic thresholds and then turn around and invest in other new facilities. 

We’re seeing more PE involvement in the cardiovascular care space. What has been the impact of this increased presence?

PE can be a mixed bag. Its ability to drive meaningful growth and value can be a good thing, of course, but there are limits to when PE-backed groups can achieve that growth. In the cardiology space, I do think there is an opportunity for PE to make a positive impact. With ASCs and OBLs, there are a lot of services that can be done outside of the hospital now. Cardiology groups were not capturing those patients historically, but these newer payment policies for outpatient care have changed things quite a bit. 

Outpatient centers can now pull in vascular surgeons, interventional radiologists and other specialists to perform various procedures that would have maybe routinely been handled by a cardiologist. This all brings the opportunity for a lot of growth.

Any advice for PE investors looking at acquiring a cardiology practice?

It you’re one of these larger PE-backed groups, you would want to be considerate of the fact that cardiology is a very hospital-aligned specialty. When a PE group comes into a market and acquires an existing practice, it will often be the only independent practice in the entire market. Hospitals may see this as a negative thing, because they now view you as competition. 

So the PE groups need to be aware of these dynamics. You need to make sure you will be able to maintain strong relationships with the local hospital, for example, and ensure everyone that the quality of care will not change. 

"Clinics and physician practices are not really viewed as economic engines from a health system’s perspective. However, the health system may still want to acquire a cardiology practice because of alignment ... They don’t want patients to leave and no longer be under their umbrella."

William Holding, Managing Principal, PTS Medical

From what you’re seeing, are today’s hospitals and health systems looking to acquire more private cardiology practices? 

Clinics and physician practices are not really viewed as economic engines from a health system’s perspective. However, the health system may still want to acquire a cardiology practice because of alignment. They want to be aligned with the physicians who are seeing these patients. They don’t want patients to leave and no longer be under their umbrella. 

If a health system has a healthy relationship with a private practice and it’s already working well, that health system may not want to necessarily change anything at all. The health system is getting what it needs, which is coverage for its patients. However, if a health system is worried about a PE group suddenly coming in and buying that private practice, that may make them want to consider a move. 

Health systems also consider buying a private practice if they think doing so can help them improve the services they offer. They may say, ‘If I acquire this group, we can gain affiliations that we just didn’t have before.’ You sometimes see health systems create joint ventures with ASCs and OBLs for this same reason.

In general, though, these large health systems do not want to employ more physicians unless they feel like they really need to do it. 

What about the small percentage of cardiology practices that are still independent in 2026? What kinds of things are going through their mind as they consider whether they want to keep that independence or potentially make a move?

Private practices are either going to be acquired by a hospital or health system, an existing platform like Cardiovascular Associates of American or US Heart and Vascular or a brand new platform that is just getting started. Each scenario involves different factors that need to be considered. 

When we talk about health systems, for instance, they are bound by stricter requirements from a legal/compliance perspective. They can’t overpay for assets due to antikickback statues, so they will typically buy the practice assets and then sign richer employment deals with the physicians. These health systems can provide long-term stability and a better salary. If a practice’s goal is to still be in practice 20 years later, health system employment may make a lot of sense. At the same time, you will lose a certain level of autonomy. The fiercely independent types don’t always like that.

An existing platform, on the other hand, may be able to be more aggressive from an upfront economic standpoint. Of course, those deals would typically include some equity as well; this means you have to wait if you think the practice can become more valuable over time. These existing platforms also have a track record. They’ve been around at least five or six years, and they can point to any past successes when negotiating with a private practice. 

The newer platforms without that track record are probably the riskiest buyers for any independent practice. You may end up with the highest evaluation of your practice in terms of that dollar amount, but it’s ultimately an unknown entity. It’s hard to predict what will happen. They may have a great thesis, but they do not have that track record yet.

Do you see any benefits for cardiology practices staying independent? 

If you’re a successful independent practice with a strong reputation and you have relatively young physicians, it may be best to stay independent. If you can already handle the administrative burden and the reimbursement challenges, if you can already recruit physicians because of the strength of your practice—then why change? I know some groups that are in that situation right now. Staying independent can be a very rational decision.