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Segment Reporting
 12 Months Ended
Dec. 31, 2022
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 year ended December 31, 2020 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,
202220212020
Revenues:
Surgical Facility Services$2,470.4 $2,157.8 $1,793.4 
Ancillary Services68.9 67.3 63.6 
Optical Services— — 3.1 
Total$2,539.3 $2,225.1 $1,860.1 
Adjusted EBITDA:
Surgical Facility Services$473.6 $422.0 $339.3 
Ancillary Services(2.3)1.7 (3.4)
Optical Services— — 1.4 
All other(91.1)(84.1)(80.7)
Total$380.2 $339.6 $256.6 
Reconciliation of Adjusted EBITDA:
Income (loss) before income taxes$110.3 $81.2 $(18.8)
Net income attributable to non-controlling interests(141.6)(141.6)(117.4)
Interest expense, net234.9 221.0 201.8 
Depreciation and amortization114.8 98.8 94.8 
Equity-based compensation expense18.4 17.4 13.2 
Transaction, integration and acquisition costs (1)
48.6 46.1 38.2 
Loss on disposals and deconsolidations, net11.1 2.2 5.7 
Litigation settlements and other litigation costs (2)
(24.7)5.6 6.4 
Loss on debt extinguishment14.9 9.1 — 
Undesignated derivative activity (3)
(8.0)— — 
Hurricane-related impacts (4)
1.5 (0.2)— 
Impairment charges— — 33.5 
Gain on escrow release (5)
— — (0.8)
Adjusted EBITDA$380.2 $339.6 $256.6 
(1)This amount includes transaction and integration costs of $47.5 million, $39.8 million and $23.2 million for the years ended December 31, 2022, 2021 and 2020, respectively. This amount further includes start-up costs related to de novo surgical facilities of $1.1 million, $6.3 million and $15.0 million for the years ended December 31, 2022, 2021 and 2020, respectively.
(2)This amount includes a net litigation settlements gain of $29.3 million and a loss of $1.2 million for the years ended December 31, 2022 and 2020, respectively, with no comparable costs in 2021. This amount also includes other litigation costs of $4.6 million, $5.6 million and $5.2 million for the years ended December 31, 2022, 2021 and 2020, respectively.
(3)This amount includes the reclassification of $7.5 million of unrealized gains out of accumulated OCI into income related to the de-designation of a portion of one of the Company's interest rate caps.This amount further includes fair value changes of undesignated derivatives.
(4)Reflects losses incurred, net of insurance proceeds received at certain surgical facilities that were closed following Hurricane Ian in September 2022 and Hurricane Ida in September 2021.
(5)Included in other income in the consolidated statement of operations for the year ended December 31, 2020, with no comparable gain in 2022 and 2021.
December 31,
20222021
Assets:
Surgical Facility Services$6,001.1 $5,552.8 
Ancillary Services41.7 47.5 
All other639.3 517.3 
Total assets$6,682.1 $6,117.6 
Year Ended December 31,
202220212020
Cash purchases of property and equipment:
Surgical Facility Services$74.3 $55.0 $38.7 
Ancillary Services1.1 0.5 0.4 
All other5.2 2.1 3.8 
Total cash purchases of property and equipment$80.6 $57.6 $42.9