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Segment Reporting
 12 Months Ended
Dec. 31, 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 includes the operation of ASCs, surgical hospitals and anesthesia services. The Ancillary Services segment consists of multi-specialty physician practices. Prior to 2021, the Ancillary Services segment also included a diagnostic laboratory, which was closed during the third quarter of 2020. The Optical Services segment for the years ended December 31, 2020 and 2019 reflected in the table below consisted of an optical products group purchasing organization, which was sold on December 31, 2020. The "All other" line item primarily consists of amounts attributable to the Company's corporate general and administrative functions.
The following tables present financial information for each reportable segment (in millions):
Year Ended December 31,
202120202019
Revenues:
Surgical Facility Services$2,157.8 $1,793.4 $1,748.2 
Ancillary Services67.3 63.6 79.4 
Optical Services— 3.1 3.8 
Total$2,225.1 $1,860.1 $1,831.4 
Adjusted EBITDA:
Surgical Facility Services$422.0 $339.3 $328.9 
Ancillary Services1.7 (3.4)2.6 
Optical Services— 1.4 1.4 
All other(84.1)(80.7)(74.3)
Total$339.6 $256.6 $258.6 
Reconciliation of Adjusted EBITDA:
Income (loss) before income taxes$81.2 $(18.8)$54.6 
Net income attributable to non-controlling interests(141.6)(117.4)(119.9)
Depreciation and amortization98.8 94.8 76.5 
Interest expense, net221.0 201.8 178.9 
Equity-based compensation expense17.4 13.2 10.2 
Transaction and integration related costs (1)
46.1 38.2 36.1 
Loss (gain) on disposals, net2.2 5.7 (4.4)
Litigation settlement and other litigation costs (2)
5.6 6.4 4.6 
Impairment charges— 33.5 7.9 
Gain on escrow release (3)
— (0.8)— 
Loss on debt extinguishment9.1 — 11.7 
Hurricane-related impacts (4)
(0.2)— — 
Tax receivable agreement expense— — 2.4 
Adjusted EBITDA$339.6 $256.6 $258.6 
(1)For the year ended December 31, 2021, this amount includes transaction and integration costs of $39.8 million and start-up costs related to a de novo surgical hospital of $6.3 million. For the year ended December 31, 2020, this amount includes transaction and integration costs of $23.2 million and start-up costs related to a de novo surgical hospital of $15.0 million. For the year ended December 31, 2019, this amount includes transaction and integration costs of $19.0 million and other acquisition costs and start-up costs related to a de novo surgical hospital of $17.1 million.
(2)This amount includes litigation settlement costs of $1.2 million and $0.2 million for the years ended December 31, 2020 and 2019, respectively, with no comparable costs in 2021. This amount also includes other litigation costs of $5.6 million, $5.2 million and $4.4 million for the years ended December 31, 2021, 2020 and 2019, respectively.
(3)Included in other income in the consolidated statement of operations for the year ended December 31, 2020, with no comparable gain in 2021 and 2019.
(4)Reflects the impact of insurance proceeds received net of operating losses incurred in the six months ended December 31, 2021, at a surgical facility that was closed following Hurricane Ida.
December 31,
20212020
Assets:
Surgical Facility Services$5,552.8 $4,962.4 
Ancillary Services47.5 35.0 
All other517.3 415.8 
Total assets$6,117.6 $5,413.2 
Year Ended December 31,
202120202019
Cash purchases of property and equipment:
Surgical Facility Services$55.0 $38.7 $65.9 
Ancillary Services0.5 0.4 1.1 
All other2.1 3.8 6.6 
Total cash purchases of property and equipment$57.6 $42.9 $73.6