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Segment Reporting
 9 Months Ended
Sep. 30, 2021
Segment Reporting [Abstract]  
Segment Reporting Segment Reporting
The Company currently operates in two major lines of business that are also the Company's reportable operating segments - the operation of surgical facilities and the operation of ancillary services. The Surgical Facility Services segment consists of the operation of ASCs and surgical hospitals and includes anesthesia services. The Ancillary Services segment consists of multi-specialty physician practices and a diagnostic laboratory, which was closed during the third quarter of 2020. The Optical Services segment for the three and nine months ended September 30, 2020 reflected in the table below consisted of an optical products group purchasing organization, which was sold on December 31, 2020. "All other" primarily consists of the Company's corporate general and administrative functions.
The following tables present financial information for each reportable segment (in millions):
Three Months Ended September 30,Nine Months Ended September 30,
2021202020212020
Revenues:
Surgical Facility Services$542.1 $478.6 $1,563.7 $1,262.8 
Ancillary Services17.1 16.7 51.2 46.9 
Optical Services— 0.8 — 2.1 
Total$559.2 $496.1 $1,614.9 $1,311.8 
Adjusted EBITDA:
Surgical Facility Services$96.9 $82.5 $287.5 $229.7 
Ancillary Services— (0.6)(1.0)(3.9)
Optical Services— 0.4 — 1.0 
All other(20.5)(21.2)(61.3)(61.0)
Total$76.4 $61.1 $225.2 $165.8 
Reconciliation of Adjusted EBITDA:
Income (loss) before income taxes$9.4 $(33.0)$26.5 $(61.1)
Net income attributable to non-controlling interests(31.1)(27.3)(98.6)(75.0)
Depreciation and amortization25.2 24.1 76.1 69.3 
Interest expense, net54.2 51.5 160.9 147.8 
Equity-based compensation expense4.1 3.0 13.4 9.9 
Transaction, integration and acquisition costs (1)
10.2 7.5 31.0 30.2 
Impairment charges— 33.5 — 33.5 
Loss on disposals and deconsolidations, net1.9 0.7 2.0 7.1 
Litigation settlement and other litigation costs (2)
2.5 1.1 4.3 4.9 
(Gain) loss on debt extinguishment(0.5)— 9.1 — 
Gain on escrow release (3)
— — — (0.8)
Hurricane-related operating losses (4)
0.5 — 0.5 — 
Adjusted EBITDA$76.4 $61.1 $225.2 $165.8 
(1)This amount includes transaction and integration costs of $10.2 million and $5.4 million for the three months ended September 30, 2021 and 2020, respectively. This amount further includes start-up costs related to a de novo surgical hospital of $2.1 million for the three months ended September 30, 2020.
This amount includes transaction and integration costs of $24.7 million and $15.8 million for the nine months ended September 30, 2021 and 2020, respectively. This amount further includes start-up costs related to a de novo surgical hospital of $6.3 million and $14.4 million for the nine months ended September 30, 2021 and 2020, respectively.
(2)This amount includes other litigation costs of $2.5 million and $1.1 million for the three months ended September 30, 2021 and 2020, respectively.
This amount includes other litigation costs of $4.3 million and $3.7 million for the nine months ended September 30, 2021 and 2020, respectively. This amount further includes litigation settlement costs of $1.2 million for the nine months ended September 30, 2020, with no comparable costs for the nine months ended September 30, 2021.
(3)Included in other income in the condensed consolidated statement of operations for the nine months ended September 30, 2020.
(4)Reflects losses incurred in the month of September 2021 at a surgical facility that was closed following Hurricane Ida.
September 30,
2021		December 31,
2020
Assets:
Surgical Facility Services$5,124.4 $4,962.4 
Ancillary Services32.5 35.0 
All other474.7 415.8 
Total assets$5,631.6 $5,413.2 
Nine Months Ended September 30,
20212020
Cash purchases of property and equipment:
Surgical Facility Services$42.0 $24.1 
Ancillary Services0.4 0.3 
All other1.1 3.4 
Total cash purchases of property and equipment$43.5 $27.8