Prepared for lenders, CDCs, and federal agencies to SBA SOP 50 10 8, USDA 7 CFR Part 5001, and conventional underwriting standards. Fiduciary duty runs to the lender and the agency, never the borrower. 4,000+ engagements since 1998 covering $41.2 billion in evaluated project value. So far in 2026: 41 engagements and $1.54 billion evaluated — 17 SBA, 11 USDA.
ASC feasibility is case-volume arithmetic with a regulatory frame: the surgeons who will bring cases, the case mix they perform, the payer rates each case commands, and the licensure, certification, and (where applicable) certificate-of-need posture that gates the door. The study documents committed surgeon utilization — an ASC without signed surgeon commitments is an operating room searching for a reason — models case volume by specialty against credentialed capacity, and prices the case mix through Medicare ASC rates and commercial contracts rather than hospital benchmarks that do not transfer.
Case modeling from surgeon-by-surgeon commitments and historical volumes, room-utilization mathematics — cases per operating room per day against staffed hours — payer-mix yield with the migration trend toward higher-acuity outpatient procedures documented, and a physician-ownership structure review against program eligibility rules.
Every Wert-Berater financial model is fully linked with no hardcoded values, so any reviewer can stress any input. Deliverables comprise a complete narrative report and the linked Excel model, with ten-year pro forma, sensitivity analysis at ±5, 10, and 15 percent, interest-rate stress from +0.5 to +3.0 percent, and ratio analysis benchmarked against RMA and IBISWorld data.
SBA engagements are prepared to SOP 50 10 8, including its debt-service-coverage minimums of 1.15x operating and 1.00x global. USDA engagements follow RD Staff Instruction 5001 across the Business & Industry, Community Facilities, REAP, and Value-Added Producer Grant programs. Conventional engagements are built to the lender's stated coverage standard, typically 1.20x. Physician-owned centers fit SBA structures subject to ownership rules; joint-venture and system-affiliated centers route conventional; equipment-heavy buildouts suit 504 debenture economics.
The firm's procedural-facility work connects to its broader clinical real-estate record, with surgeon-commitment evidence treated as the demand study it is. Independence is non-negotiable: determinations follow the evidence and are not revised under pressure, and studies are built to pass lender, agency, and third-party review without exception items.
A feasibility study for an ambulatory surgery center is not a generic healthcare projection dressed in surgical terminology. Every element of the scope is anchored to the specific operating mechanics of an ASC: per-case revenue rather than per-bed revenue, room-turn economics rather than occupancy rates, and surgeon-by-surgeon commitment letters rather than catchment-area population curves. The study is built to answer the question a credit officer actually asks: given these surgeons, this case mix, and these payer contracts, does the center cover its debt at the required ratio?
Demand for an ASC does not emerge from population density alone. The analysis begins with the surgeons, not the market area, because an ASC's volume is a function of committed physician behavior rather than a share of a regional procedure pool. That distinction changes the data sources used and the counting method applied.
Surgeon-level data comes from Medicare Provider Utilization and Payment Data, which publishes procedure counts by individual provider and HCPCS code. Those counts establish a baseline of what each committed surgeon has historically performed and in what setting. State ambulatory surgery center licensing registries and certificate-of-need databases identify existing licensed facilities, their approved specialties, and, where disclosed, their ownership. Health system capital plans and physician group press releases supplement the competitive-supply picture. State health department annual survey data, where published, provides aggregate outpatient procedure volume by county or planning district.
On the supply side, the study maps every licensed ASC within the relevant service area, notes its specialty mix and ownership structure, and assesses whether existing capacity is absorbed or available. Drive-time isochrones establish the realistic patient-origin geography for the proposed specialties. Payer-contract intelligence comes from the committed surgeons' existing agreements and, where available, from state all-payer claims databases. The result is a demand picture grounded in documented physician behavior rather than a market-share assumption applied to a population figure.
Four inputs account for most of the variance in an ASC coverage ratio. A study that does not isolate and stress each of them independently is not a feasibility study — it is a projection dressed as one. The fully linked model allows any reviewer to move any of these inputs and watch the coverage ratio recalculate in real time, which is the practical meaning of independence.
SBA, USDA, and conventional lenders share a common concern — surgeon concentration — but apply it differently depending on program rules and collateral structure.
The same concentration analysis is applied at larger scale in acute-care and specialty hospital feasibility studies, where an inpatient component, an emergency department and a broader payer mix change the underwriting question materially.
Under SBA SOP 50 10 8, the study must demonstrate 1.15x operating debt-service coverage and 1.00x global coverage. For a physician-owned ASC, the lender will scrutinize the ownership percentage held by each referring surgeon against Stark Law and anti-kickback safe-harbor thresholds, because a structure that fails those tests is not eligible for SBA financing regardless of its financial projections. The feasibility study documents the ownership structure and flags any condition that the borrower's counsel must resolve before closing.
USDA Business & Industry and Community Facilities programs apply RD Staff Instruction 5001 standards. Rural ASC projects often serve communities where the center is the only outpatient surgical option, which strengthens the community-need narrative but does not relax the coverage test. The study addresses both dimensions.
Conventional lenders typically require 1.20x coverage and place additional weight on the quality of surgeon commitments: are they letters of intent, executed participation agreements, or informal representations? The study characterizes each commitment precisely, because a lender's credit committee will ask. Collateral for an ASC is primarily equipment and leasehold improvements — assets with limited secondary-market liquidity — so coverage adequacy carries more weight than collateral value in the underwriting conversation. The study is built to that reality.
The fee is fixed and quoted in writing within one business day of an inquiry. No portion of the fee is contingent on the finding, and the finding is not revised under pressure. That structure is the operational definition of independence: the analyst has no financial interest in a favorable conclusion.
Standard delivery is ten to fifteen business days from a complete data room. The data room for an ASC engagement is specific: executed or draft surgeon commitment letters, each surgeon's Medicare utilization data or equivalent case logs, the proposed operating-room schedule and staffing plan, available payer contracts or fee-schedule addenda, the project's construction or lease cost budget, and the proposed ownership and governance documents. Incomplete data rooms extend the timeline; the engagement clock starts when the room is complete, not when the deposit is received. Rush delivery is available and is quoted at the time of engagement.
Every engagement is published to a secure client portal where the linked Excel model stays live. When a lender's credit officer wants to test a different utilization assumption or a revised payer mix, the model recalculates immediately — no revised report required, no additional fee for a single input change. The deliverable package includes the bound narrative report, the ten-year pro forma, sensitivity tables at plus and minus five, ten, and fifteen percent, interest-rate stress from plus 0.5 to plus 3.0 percent, RMA and IBISWorld ratio benchmarks, and an explicit statement of conditions that documents what must remain true for the projections to hold.
The fee is fixed and quoted in writing within one business day of inquiry. It does not vary with the finding, and no portion is contingent on loan approval. Because scope varies by project complexity — number of operating rooms, number of committed surgeons, CON state versus non-CON state — the quote is specific to each engagement rather than published as a standard rate.
Standard delivery is ten to fifteen business days from a complete data room. The data room for an ASC must include surgeon commitment letters, case-volume documentation, payer contracts or fee-schedule information, the staffing plan, and the project cost budget. Rush delivery is available. The timeline begins when the data room is complete, not when the engagement is initiated.
Surgeon concentration is the primary difficulty. An ASC with three or four committed surgeons can meet its projections only if those surgeons actually bring their cases. Unlike a hospital, which draws from a broad medical staff, an ASC lives or dies on a small number of individual physician decisions. The feasibility study documents each surgeon's historical volume, characterizes the commitment precisely, and stress-tests the coverage ratio under partial surgeon attrition.
No. A feasibility study documents whether the evidence supports a conclusion of financial viability under stated conditions. Loan approval is the lender's determination, made on the full credit file. An independent study prepared to the applicable program standard — SBA SOP 50 10 8 or USDA RD Staff Instruction 5001 — gives the lender a defensible analytical foundation, but it does not predetermine the credit decision.
Yes, in states that retain CON authority over ambulatory surgery centers. The study documents the applicable state's CON status, whether the project requires a certificate, and the current posture of any pending application. A projection that assumes operations beginning before CON approval is obtained will be conditioned accordingly. In non-CON states, licensure pathway and timeline are documented in place of CON analysis.
A single study can serve multiple reviewers if it is prepared to the more demanding standard — typically SBA SOP 50 10 8 — and the model is structured to display coverage at both 1.15x operating and 1.20x conventional thresholds. The live model in the client portal allows each lender to apply its own coverage test without requiring a separate report. If program-specific narrative is required by a second agency, a supplemental section is added.
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Wert-Berater, Inc. is an independent provider of feasibility studies and other related services. The firm does not provide financing or equity investment advice, and does not arrange, broker, or place debt or equity capital of any kind.
All appraisal assignments are performed by Bruce E. Jones, MAI, ASA-GC, BCA, CMEA, a member of the Appraisal Institute since 2006, a staff member of Wert-Berater, Inc. and owner of Special Purpose Realty Valuation.