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Segment Reporting (Tables) | 12 Months Ended
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Dec. 31, 2023
Segment Reporting [Abstract] |
Schedule of Segment Revenue and Operating Income | The following tables present financial information for each reportable segment (in millions):
|  | Year Ended December 31,
|  | 2023 |  | 2022 |  | 2021
Revenues: |  |  |  |  |  |
Surgical Facility Services |  | $ | 2,675.8 |  |  | $ | 2,470.4 |  |  | $ | 2,157.8 |
Ancillary Services |  | 67.5 |  |  | 68.9 |  |  | 67.3 |
Total |  | $ | 2,743.3 |  |  | $ | 2,539.3 |  |  | $ | 2,225.1 |
Adjusted EBITDA: |  |  |  |  |  |
Surgical Facility Services |  | $ | 544.0 |  |  | $ | 473.6 |  |  | $ | 422.0 |
Ancillary Services |  | (3.9) |  |  | (2.3) |  |  | 1.7 |
All other |  | (102.0) |  |  | (91.1) |  |  | (84.1) |
Total |  | $ | 438.1 |  |  | $ | 380.2 |  |  | $ | 339.6 |
Reconciliation of Adjusted EBITDA: |  |  |  |  |  |
Income (loss) before income taxes |  | $ | 135.0 |  |  | $ | 110.3 |  |  | $ | 81.2 |
Net income attributable to non-controlling interests |  | (147.2) |  |  | (141.6) |  |  | (141.6) |
Interest expense, net |  | 193.0 |  |  | 234.9 |  |  | 221.0 |
Depreciation and amortization |  | 118.1 |  |  | 114.8 |  |  | 98.8 |
Equity-based compensation expense |  | 17.7 |  |  | 18.4 |  |  | 17.4 |
Transaction, integration and acquisition costs (1) |  | 64.9 |  |  | 48.6 |  |  | 46.1 |
Net loss on disposals, consolidations and deconsolidations |  | 14.4 |  |  | 11.1 |  |  | 2.2 |
Litigation settlements and regulatory change impact (2) |  | 17.5 |  |  | (24.7) |  |  | 5.6 |
Loss on debt extinguishment |  | 15.5 |  |  | 14.9 |  |  | 9.1 |
Undesignated derivative activity (3) |  | 0.6 |  |  | (8.0) |  |  | — |
Other (4) |  | 8.6 |  |  | 1.5 |  |  | (0.2) |
Adjusted EBITDA |  | $ | 438.1 |  |  | $ | 380.2 |  |  | $ | 339.6 |
(1)This amount includes transaction and integration costs of $61.7 million, $47.5 million and $39.8 million for the years ended December 31, 2023, 2022 and 2021, respectively. This amount further includes start-up costs related to de novo surgical facilities of $3.2 million, $1.1 million and $6.3 million for the years ended December 31, 2023, 2022 and 2021, respectively. (2)This amount includes a litigation settlements loss of $10.6 million and a net gain of $29.3 million for the years ended December 31, 2023 and 2022, respectively, with no comparable costs in 2021. This amount also includes other litigation costs of $2.5 million, $4.6 million and $5.6 million for the years ended December 31, 2023, 2022 and 2021, respectively. Additionally, the year ended December 31, 2023, includes $4.4 million related to the impact of recent changes in Florida law regarding the use of letters of protection. (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 for the year ended December 31, 2022. This amount further includes fair value changes of undesignated derivatives for the years ended December 31, 2023 and 2022, with no comparable activity in 2021. (4)This amount includes estimates for the net impact of the May 2023 cyber event and losses from a divested business for the year ended December 31, 2023. Amounts presented for the years ended December 31, 2022 and 2021 reflect losses incurred, net of insurance proceeds received, related to certain surgical facilities that were closed following Hurricane Ian and Hurricane Ida, respectively.
Schedule of Reconciliation of Assets from Segment to Consolidated |
|  | December 31,
|  | 2023 |  | 2022
Assets: |  |  |  |
Surgical Facility Services |  | $ | 6,347.4 |  |  | $ | 6,001.1 |
Ancillary Services |  | 36.3 |  |  | 41.7 |
All other |  | 493.0 |  |  | 639.3 |
Total assets |  | $ | 6,876.7 |  |  | $ | 6,682.1 |
Schedule of Financial Information by Reportable Segment |
|  | Year Ended December 31,
|  | 2023 |  | 2022 |  | 2021
Cash purchases of property and equipment: |  |  |  |  |  |
Surgical Facility Services |  | $ | 87.9 |  |  | $ | 74.3 |  |  | $ | 55.0 |
Ancillary Services |  | 0.8 |  |  | 1.1 |  |  | 0.5 |
All other |  | 0.1 |  |  | 5.2 |  |  | 2.1 |
Total cash purchases of property and equipment |  | $ | 88.8 |  |  | $ | 80.6 |  |  | $ | 57.6 |

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- Definition Tabular disclosure of all significant reconciling items in the reconciliation of total assets from reportable segments to the entity's consolidated assets. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 31 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-31 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 30 -Subparagraph (c) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-30 + Details
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- Definition Tabular disclosure of the reconciliation of profit (loss) from reportable segments to the consolidated income (loss) before income tax expense (benefit) and discontinued operations. Includes, but is not limited to, reconciliation after income tax if income tax is allocated to the reportable segment. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 31 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-31 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 30 -Subparagraph (b) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-30 + Details
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- Definition Tabular disclosure of the profit or loss and total assets for each reportable segment. An entity discloses certain information on each reportable segment if the amounts (a) are included in the measure of segment profit or loss reviewed by the chief operating decision maker or (b) are otherwise regularly provided to the chief operating decision maker, even if not included in that measure of segment profit or loss. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 350 -SubTopic 20 -Section 50 -Paragraph 1 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482573/350-20-50-1 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 25 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-25 Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 22 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-22 Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 30 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-30 + Details
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