Quick answer. We tracked 10 active US anesthesiology MSO private equity platforms in 2024 to 2026 across general hospital-based anesthesia, pain management, pediatric anesthesia, ASC-integrated anesthesia, and CRNA-only models. Three top-line findings drive the rest of this tracker. First, the FTC consent order with Welsh Carson, proposed January 17, 2025 and approved as a final order in May 2025, is the most material 2024 to 2026 healthcare-services antitrust development. Welsh Carson is now subject to a 10-year term, an equity freeze at its current US Anesthesia Partners (USAP) minority stake, a single non-Chair board seat, a nationwide FTC prior-approval gate on any new US anesthesia investment, and a 30-day cross-specialty notice requirement for any hospital-based physician practice acquisition. Second, several widely circulated sponsor attributions are incorrect: NorthStar Anesthesia has been a Cranemere majority since June 2018 with TPG Growth retaining a minority, not TPG alone, per the TPG release; NAPA has been an American Securities and Leonard Green co-investment since April 2016, per the Leonard Green portfolio page, not American Securities alone. Third, the workforce setup is unfavorable for buyers: HRSA projects an anesthesiologist shortage of 8,450 by 2037, ASA reported more than 60,000 members in its 2025 Annual Report, AANA represents approximately 65,000 CRNAs, 25 states plus DC and Guam have opted out of the federal CRNA Medicare supervision requirement per the ASA Opt-Outs page, and the CMS CY 2026 anesthesia conversion factor of $20.4976 for non-APM clinicians per the Federal Register filing 2025-19787 creates structural compression for procedure-heavy platforms. Last verified: June 16, 2026.
This tracker is a primary-source M&A intelligence brief intended for sell-side and buy-side advisors, lender groups, physician owners considering recapitalization, and platform CFOs benchmarking comparable transactions. The scope is limited to the United States anesthesiology managed services organization (MSO) market, with a tracking window from January 1, 2024 through June 16, 2026.
We define an anesthesiology MSO as any platform that delivers anesthesia care under shared corporate ownership, whether the underlying employment model is W-2 physician employment, independent contractor, or 1099 CRNA staffing, and whether the care delivery setting is hospital operating room, ambulatory surgery center, office-based suite, pain clinic, or critical access facility. We include platforms whose primary identity is anesthesia (USAP, NAPA, NorthStar) and platforms with material anesthesia service lines inside a multi-specialty parent (TeamHealth, post-bankruptcy Envision). We exclude pure pain interventional physician groups that do not deliver anesthesia for surgical procedures.
Sponsor stack data are drawn from FTC consent statements, Federal Register filings, sponsor portfolio pages, SEC filings, sponsor press releases, and verified PitchBook profiles. Every numerical and dated claim in this tracker carries an inline source URL. Where a fact could not be verified to a primary source within our search horizon, we mark the cell or claim GAP and disclose it in Section 18.
Per-cell confidence ratings follow a four-grade convention. HIGH means the claim is sourced to a primary filing (FTC, SEC, Federal Register, state AG) or the sponsor’s own portfolio page or press release. MEDIUM means the claim is sourced to a reputable trade publication or industry analysis that aggregates primary sources, or the claim is corroborated by two or more independent secondary sources. LOW means the claim is sourced to a single secondary source without primary corroboration. GAP means the claim could not be verified within our research horizon and should be confirmed before use.
The tracker is intentionally conservative on multiples and platform-level valuations. Anesthesia-specific quarterly multiple trackers from Mertz Taggart and Provident Healthcare Partners were not available within our search horizon for the 2024 to 2026 window. Where we cite an EV or implied multiple, we triangulate from FOCUS Investment Banking physician-practice benchmarks, Stout staffing market analyses, and disclosed strategic transactions.
Five quantitative anchors define the macro spine for anesthesia M&A: the total active anesthesiologist count, the CRNA and CAA pool, the Medicare conversion factor trajectory, the No Surprises Act IDR provider-win rate, and the state-level CRNA opt-out roster. We summarize each below with primary source citation.
The Association of American Medical Colleges 2022 Physician Specialty Data Report counts 42,264 total active anesthesiologists in the United States, of whom 39,195 are in patient care, 531 in teaching, and 178 in research, per the AAMC tally as summarized by Becker’s ASC. The Bureau of Labor Statistics Occupational Employment and Wage Statistics program counted approximately 33,500 employed anesthesiologists in 2023, per Statista’s compilation of BLS data. The gap between the two figures is methodological. AAMC counts all licensed active physicians (including academics and researchers). BLS counts W-2 employment only. (Confidence: HIGH.)
The American Society of Anesthesiologists reported more than 60,000 members in its 2025 Annual Report, a record high for the society. ASA remains the largest medical specialty society for anesthesiologists in the United States. (Confidence: HIGH.)
The American Association of Nurse Anesthesiology counts approximately 65,000 CRNAs nationally, with more than 2,400 new CRNAs graduating each year from one of 141 accredited programs per AANA workforce data. BLS counted 49,900 employed CRNAs in 2023 and projects expansion to 55,100 by 2033, a 10 percent growth rate per the BLS Occupational Outlook Handbook. (Confidence: HIGH.)
Certified Anesthesiologist Assistants (CAAs) are a smaller and faster-growing cadre. As of the most recent ASA workforce data there are 17 accredited AA training programs nationwide collectively graduating more than 300 CAAs per year per ASA program data. Two additional programs are launching: Kansas City University begins a master’s program in January 2026 and Lipscomb University is preparing a Tennessee launch per Becker’s ASC coverage. (Confidence: HIGH.)
CMS released the CY 2026 Medicare Physician Fee Schedule final rule on October 31, 2025, with provisions effective January 1, 2026, per Holland & Knight. The rule was published in the Federal Register on November 5, 2025 as filing 2025-19787. The CY 2026 anesthesia conversion factor is $20.6000 for qualifying APM clinicians and $20.4976 for non-APM clinicians, a 0.88 percent increase over CY 2025 per Ventra Health analysis. However, CMS finalized a 2.5 percent efficiency adjustment reducing work RVUs and intraservice time for most non-time-based services, with the net revenue impact on anesthesia at approximately negative 1 percent for CY 2026 per Ventra Health’s overview. Over 2019 to 2024 the Medicare anesthesia conversion factor dropped 8.2 percent, from $22.27 per unit to $20.44 per unit per Stout staffing market analysis. (Confidence: HIGH on the CY 2026 figures; MEDIUM on the precise efficiency-adjustment net effect, which is sourced to a secondary modeling estimate.)
The No Surprises Act federal Independent Dispute Resolution (IDR) process continues without a finalized operations rule. ASA wrote to the Departments of Treasury, Labor, and Health and Human Services in October 2025 urging release of the final IDR Operations Rule originally proposed in November 2023 per the ASA Washington Alert. Providers prevailed in approximately 85 percent of IDR payment determinations in 2024, up from 80 percent in 2023, and the median anesthesia IDR award ran at approximately twice the Qualifying Payment Amount (QPA) per the Peterson-KFF Health System Tracker and Health Affairs Forefront early-look 2025 data. IDR administrative costs totaled $844 million in the first half of 2025 across all specialties. CMS publishes quarterly IDR data at the No Surprises Act Reports portal. (Confidence: HIGH on provider-win share; MEDIUM on the 2x QPA median, which varies by specialty mix and dispute-batch composition.)
The defining event of the 2024 to 2026 anesthesiology M&A cycle is the Federal Trade Commission case against US Anesthesia Partners and Welsh, Carson, Anderson & Stowe. The proceedings span more than two and a half years and culminate in a final consent order against the sponsor and a separate stayed-litigation track against the platform. The complete chronology follows.
September 21, 2023. The FTC filed a complaint in the United States District Court for the Southern District of Texas, Case No. 4:23-cv-03560, naming USAP and Welsh Carson as defendants. The complaint alleged an anticompetitive roll-up scheme to consolidate Texas anesthesia practices and to fix prices in coordination with a third-party anesthesia services contractor per the FTC case docket and press release. (Confidence: HIGH.)
November 20, 2023. Welsh Carson filed a motion to dismiss arguing that as a minority investor it was not subject to FTC Section 13(b) injunctive jurisdiction. USAP filed a parallel motion to dismiss per the USAP filing. (Confidence: HIGH.)
May 13, 2024. The district court denied USAP’s motion to dismiss but dismissed Welsh Carson on procedural grounds, holding that the FTC had not pleaded a sufficient ongoing relationship between Welsh Carson and the alleged anticompetitive conduct for Section 13(b) purposes per ABA Business Law Today. The ruling did not reach the merits of the alleged anticompetitive conduct; it addressed only whether Section 13(b) reaches a private equity minority investor on the facts pleaded. (Confidence: HIGH.)
January 17, 2025. The FTC announced a proposed administrative consent order with Welsh Carson, settling the agency’s claims against the sponsor outside federal court per the FTC release. The proposed order was opened for a 30-day public comment period. (Confidence: HIGH.)
February 18, 2025. The Federal Register published the FTC’s Analysis of Agreement Containing Consent Order to Aid Public Comment as filing 2025-02719. The analysis set out the FTC’s theory of market harm and the rationale for each operative provision of the consent order. (Confidence: HIGH.)
May 2025. The FTC voted 3-0 to approve the final consent order per the FTC release. The bipartisan 3-0 vote is consequential: it signals that the order is unlikely to be unwound by an administration transition and that the FTC’s posture on private equity roll-up theories has institutional weight beyond any single Commissioner. (Confidence: HIGH.)
April 23, 2026. The FTC and USAP filed a joint motion to stay the federal litigation pending finalization of a settlement in principle per the docket filing. The FTC simultaneously announced the agreement in principle in a public release describing the framework as a path to restore competition to Texas anesthesia markets. (Confidence: HIGH.)
May 26, 2026. The Southern District of Texas granted the joint stay, pausing the litigation while the parties finalize settlement documentation over a 180-day implementation window. USAP confirmed the stay in its April 2026 statement, noting that the related putative class action by patients continues separately. (Confidence: HIGH.)
Separately, Colorado Attorney General Phil Weiser settled with USAP in February 2024, requiring USAP to unwind its Colorado market position, divest certain operations, and submit to state-level competition monitoring per the Colorado AG release. The Colorado action is the template for state-level follow-on enforcement and should be expected to recur in other state attorneys general pursuing roll-up theories within their borders. (Confidence: HIGH.)
The operative provisions of the Welsh Carson consent order set the template for how the FTC may police private equity sponsors holding minority stakes in regulated healthcare platforms. Five mechanics define the order. Each is sourced to Federal Register filing 2025-02719 and corroborated by the FTC’s Welsh Carson consent statement.
Term. The order runs for 10 years from the effective date of the final order in May 2025. The 10-year duration ties Welsh Carson’s M&A optionality to a horizon longer than a typical private equity fund hold. (Confidence: HIGH.)
Equity freeze. Welsh Carson must hold its USAP ownership at the current minority pro rata level and must not provide new financing that would increase that share. Welsh Carson’s pro rata stake was reported at 23 percent (noncontrolling) in 2017 per its FTC consent statement. Because USAP’s physician partners are collectively the largest shareholder class, the equity freeze prevents Welsh Carson from rebuilding ownership concentration via primary or secondary capital injections. (Confidence: HIGH on the equity freeze mechanic; MEDIUM on the precise current Welsh Carson percentage, since cap-table updates since 2017 are not publicly disclosed.)
Board cap. Welsh Carson is limited to a single board seat at USAP, and that seat may not be the board chair. The single non-Chair seat constrains Welsh Carson’s ability to set the strategic direction of USAP and effectively removes the sponsor from operational decision authority over future M&A or capital allocation choices at the platform. (Confidence: HIGH.)
Prior approval requirement. Welsh Carson must obtain prior FTC approval for any new investment in any United States anesthesia business and for certain acquisitions by any majority-owned Welsh Carson anesthesia portfolio company. The geographic scope is nationwide, not limited to Texas. The product scope is anesthesia broadly defined, encompassing hospital-based, ambulatory, pain management, and CRNA-only models. (Confidence: HIGH.)
Notice requirement. Welsh Carson must give 30-day advance notice of any acquisition of any other US hospital-based physician practice, regardless of specialty. This cross-specialty notice provision is the most strategically significant element of the order for the wider physician-practice MSO market. It signals the FTC’s view that the sponsor cannot avoid prior-approval consequences by pivoting to a different specialty while retaining the same roll-up posture. (Confidence: HIGH.)
The FTC also requires regular compliance reporting throughout the 10-year term, with specified financial and transactional information delivered on a fixed cadence. Industry analysis at Stevens & Lee and Katten reads the bipartisan vote and the broad scope of the order as a durable precedent applicable to other sponsor stacks in physician-practice M&A.
The market-wide implications of these mechanics are addressed in Section 14.
The No Surprises Act (NSA) took effect January 1, 2022. Through 2024 to 2026 the federal IDR process remains the dominant out-of-network payment mechanism for anesthesiology services delivered at in-network facilities. For platform PE economics, the IDR provider-win rate is one of the most consequential single statistics in the sector.
Provider outcomes through 2024 ran at approximately 85 percent of IDR payment determinations decided in the provider’s favor, up from 80 percent in 2023, per the Peterson-KFF Health System Tracker. The median anesthesia IDR award is approximately twice the Qualifying Payment Amount (QPA), and the median across all specialties has trended materially above QPA throughout the 2024 to mid-2025 window per Health Affairs Forefront’s 2025 early-look data. IDR administrative costs totaled $844 million in the first half of 2025 across all specialties per the same Health Affairs analysis. (Confidence: HIGH on the 85 percent figure; MEDIUM on the 2x QPA median by specialty.)
The IDR Operations Final Rule originally proposed in November 2023 remains unreleased as of June 16, 2026. ASA continues to lobby for release per its October 2025 Washington Alert. CMS publishes quarterly IDR data at the No Surprises Act Reports portal.
For sell-side advisors and physician-owner platforms considering recapitalization, the IDR data have three implications. First, the favorable provider-win rate is structurally supportive of out-of-network revenue collection through dispute resolution but is conditioned on continuing administrative capacity at the IDR entities, which the operations final rule will codify. Second, payor pushback through reduced commercial rates and contractual exclusion from network panels is the asymmetric risk to monitor. UnitedHealthcare’s 15 percent reduction in CRNA personally-performed case reimbursement, implemented in fall 2025 per Stout’s analysis, is the most consequential commercial-payor action of the cycle. Third, the IDR landing point will materially affect platform-level EBITDA forecasts, and any acquirer should treat the operations final rule release as the single highest-probability binary event affecting the sector through 2027.
Outpatient migration of surgical procedures from hospital operating rooms to ambulatory surgery centers (ASCs) is the most durable structural trend reshaping anesthesia M&A. CMS continued to expand the ASC Covered Procedures List throughout 2024 and 2025, with notable additions in orthopedic and cardiovascular categories. VMG Health’s 2024 year in review reported total joint replacement cases in ASCs grew approximately 50 percent in volume in the most recently reported quarter, with total outpatient orthopedic volume up 23 percent year-over-year. ASC News site-of-care reporting documents the migration arc, and a May 2025 update cataloged the top ten surgical procedures migrating outpatient.
The ASC migration has two opposing effects on platform-level anesthesia economics. On hospital-contract anesthesia, falling case volumes plus declining acuity mix compress per-FTE revenue and intensify hospital stipend negotiations. On ASC-attached anesthesia, growing case volumes plus favorable commercial-payor mix accelerate revenue per case-hour and lift platform EBITDA. The net effect for platforms with mixed hospital and ASC exposure is a structural divergence in unit economics by site of care.
Hospital anesthesia subsidies have moved sharply in response. Where roughly 40 to 50 percent of US hospitals subsidized anesthesia coverage in 2015, more than 95 percent now do so per Becker’s Hospital Review and corroborating Coronis Health and Stout commentary. The inversion of the historical PE anesthesia thesis is set out in Section 14: the consolidation play that once relied on commercial-payor bargaining now relies materially on hospital-stipend bargaining, and the most attractive ASC-attached platforms are commanding the highest multiples.
The federal Medicare Conditions of Participation require CRNA supervision by a physician unless a state has formally opted out under the 2001 CMS rule. As of mid-2025, 25 states plus Guam and the District of Columbia have opted out of the Medicare CRNA supervision requirement per the ASA Opt-Outs reference page. The roster includes Alaska, Arizona, California, Colorado, Delaware, Idaho, Iowa, Kansas, Kentucky, Maine, Massachusetts, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Oregon, South Dakota, Tennessee, Washington, Wisconsin, Wyoming (partial), and several others; the canonical roster is maintained at the ASA reference page.
Recent opt-out additions are tightly clustered. Massachusetts opted out in May 2024. Delaware did so in June 2023. Wyoming opted out in May 2023 on a partial basis applicable to Critical Access Hospitals and hospitals with 25 or fewer licensed beds. Colorado opted out in 2023. Utah maintains a partial opt-out restricted to Critical Access Hospitals and specified rural facilities per the Massachusetts CRNA association presentation. (Confidence: HIGH.)
The opt-out roster matters for platform PE strategy because it segments the country into two distinct labor-cost regimes. In opt-out states, a CRNA-only practice model is legally cleaner and substantially less expensive per case. In non-opt-out states, the Anesthesia Care Team (ACT) structure with physician medical direction remains the dominant model for federal Medicare billing purposes, and platforms cannot capture CRNA-only labor savings at hospital sites without exposing themselves to billing risk. The bifurcation creates a clear strategy: CRNA-only platforms scale fastest in opt-out states, particularly in Critical Access Hospitals and rural facilities; ACT platforms scale fastest in non-opt-out states and at high-acuity hospital sites in either regime.
Federal Medicare medical-direction billing under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) caps the anesthesiologist-to-CRNA supervision ratio at 1:4 per Anesthesia Business Consultants. Some states cap medical-supervision ratios more tightly (1:2) under hospital licensing or state insurance rules. ASA’s 2025 advocacy track tightened the supervision ratio in South Carolina from prior practice per Becker’s ASC, although the precise state-by-state 1:2 mandate roster is not enumerated in our search horizon and is flagged as GAP in Section 18.
The Anesthesia Care Team model, with one anesthesiologist medically directing 2 to 4 CRNAs or CAAs, remains the dominant labor structure for high-acuity hospital sites. CRNA-only practice (no physician supervision) is concentrated in opt-out states and disproportionately in Critical Access Hospitals and rural facilities, where more than 80 percent of rural community anesthesia providers are CRNAs per Nurse Journal. The federal 1:4 cap is the practical ceiling for ACT productivity at billing-compliant Medicare sites. State 1:2 caps, where in force, halve the labor productivity of the ACT structure and materially constrain hospital-contract platform margins.
Platform PE buyers should treat the ratio environment as a primary diligence input. The presence or absence of a state 1:2 cap is the single most consequential variable for forecasting CRNA-to-MD compensation ratios and therefore for projecting platform contribution margin across a multi-state footprint.
The Certified Anesthesiologist Assistant cadre is small in absolute terms (a few thousand nationally) but represents the most consequential supply story in 2024 to 2026 anesthesia workforce planning. Practice authority expanded materially across three states in 2024 and 2025, and two new accredited training programs launched.
Washington state licensed CAAs in 2024. Tennessee and Virginia did so in 2025. South Carolina tightened CAA supervision ratios in 2025. Total CAA practice-authority states now stand at 23 plus DC, with Kansas, Michigan, Pennsylvania, and Texas using delegatory frameworks rather than direct state licensure per ASA’s CAA advocacy page and Becker’s ASC 2025 update. (Confidence: HIGH.)
Two new accredited programs are entering the pipeline. Kansas City University begins its CAA master’s program in January 2026. Lipscomb University is preparing a Tennessee launch. These additions augment the existing 17 accredited programs that collectively graduate more than 300 CAAs per year per ASA program data. (Confidence: HIGH.)
For platform PE strategy, CAA-friendly states are a positive supply asymmetry. CAA labor costs run materially below anesthesiologist labor costs while delivering comparable care under medical direction. State legislative cycles over the next 24 months are the inflection point: each additional CAA-authority state expands the platform labor pool in that state and reduces dependence on the constrained CRNA and MD pipelines.
The post-FTC US anesthesiology MSO market is a concentrated set of large platforms, each with distinct sponsor stack, geographic footprint, and exposure to the FTC consent precedent. The table below summarizes the active platforms tracked in 2024 to 2026, with sponsor stack and key 2024 to 2026 items. Per-row confidence ratings follow the four-grade convention defined in Section 1.
| Platform | Current sponsors | Sponsor entry | Segment | Footprint | 2024 to 2026 key items | Confidence |
|---|---|---|---|---|---|---|
| USAP | Welsh Carson (frozen minority, capped board representation), Berkshire Partners, GIC, physician partners | Welsh Carson founded the platform in 2012; Berkshire and GIC invested in 2017 | General hospital-based and ASC-integrated; commercial-payor-heavy | TX, FL, CO (divestiture in process), MD, IN, NV, WA | Welsh Carson FTC consent order finalized May 2025; Colorado AG settlement Feb 2024; FTC agreement in principle April 23, 2026; Dec 5, 2024 JV with Greater New York Anesthesia Services | HIGH on regulatory posture; MEDIUM on precise Berkshire/GIC ownership splits |
| NorthStar Anesthesia | Cranemere (majority since June 2018) with TPG Growth minority | TPG Growth October 2013; Cranemere acquired majority June 2018 | ACT-model hospital-based and ASC; CRNA-heavy care team | HQ Irving TX; strongest in Midwest, Texas, and Southeast | Three Cranemere-era tuck-ins since 2018 including Epix Anesthesia (Oct 2021); no large-platform exit through Q2 2026 | HIGH on sponsor (Cranemere portfolio confirmation public) |
| NAPA | American Securities (majority since April 2016), Leonard Green & Partners | American Securities April 2016 (recapitalization from NexPhase Capital); Leonard Green co-invested same transaction | Anesthesia, pain management, perioperative care; hospital-based plus ASC | 21 states post-American Anesthesiology acquisition; concentration in Northeast and Mid-Atlantic | NAPA acquired American Anesthesiology from MEDNAX/Pediatrix May 6, 2020 for $50M cash plus contingent earnout up to $250M; PESP 2024 risk assessment flagged workforce and reimbursement risks | HIGH on sponsor stack; MEDIUM on contingent payout settlement |
| TeamHealth (Anesthesiology) | Blackstone (since 2017 take-private at ~$6.1B) | Blackstone February 2017 | Multi-specialty physician services; anesthesia line covers hospital-based plus ASC | National | No public divestiture of anesthesia line through Q2 2026; Blackstone hold is in year 9 with distressed-debt commentary on parent throughout 2024-25 | HIGH on current ownership; MEDIUM on anesthesia line standalone EBITDA |
| Envision Healthcare (Anesthesiology) | Post-bankruptcy lender group | KKR took private 2018 at $9.9B; equity wiped out in 2023 Chapter 11 | Emergency, hospital, anesthesiology (post-bankruptcy split from AMSURG) | ~430 facilities, ~55 health systems, ~8,000 clinicians as of late 2025 | Emerged from Chapter 11 November 2023 with 70% debt reduction; Jason Owen appointed CEO April 2024; lender-group structure not granularly disclosed | MEDIUM. Post-bankruptcy lender ownership not granularly disclosed |
| American Anesthesiology | Absorbed into NAPA | NAPA closed acquisition May 6, 2020 | Hospital-based and ASC anesthesia plus pediatric subspecialty | Footprint integrated under NAPA brand | Brand wound down inside NAPA; contingent earnout to MEDNAX/Pediatrix not finally disclosed | HIGH on absorption; MEDIUM on integration timing |
| Resolute Anesthesia & Pain Solutions | Acquired by Sheridan Healthcare (2016) | Goldman Sachs PCIG formed Resolute 2013; Sheridan acquired 2016 | General and pain anesthesia | Florida-anchored at formation | Current standalone presence limited; sponsor stack subsumed in MEDNAX/Sheridan reorganization sequence | MEDIUM. Limited standalone visibility 2024-26 |
| Carolina Anesthesia Associates | Public sources show no PE sponsor; presumed independent | Operating since 1997 | Ambulatory-focused general anesthesia | 150-provider, 75-facility footprint, Hickory NC anchored | Treat as PE-independent for tracking; flag for confirmation | LOW. Confirmation needed |
| Capital Anesthesia Partners | Public sources show no PE sponsor; presumed independent | Chevy Chase MD-anchored; date of formation not disclosed | General hospital-based and office-based | Maryland and DC; ~36,000+ patients annually | Treat as PE-independent for tracking; flag for confirmation | LOW. Confirmation needed |
| Premier Anesthesia | No PE link; markets as debt-free and PE-free | n/a | Anesthesia management at hospital sites nationwide | National | Useful control for PE-platform unit economics benchmarking | HIGH on self-disclosed PE-free status |
Greater Anesthesia Solutions and Anesthesia Healthcare Partners, often cited in third-party trackers, do not have current verifiable PE-sponsor attribution within our 2024 to 2026 search horizon. Both are flagged as GAP items in Section 18.
USAP merits a standalone treatment because its trajectory through 2024 to 2026 is the single most consequential platform-level case study in the sector. Welsh Carson founded USAP in 2012 by combining Greater Houston Anesthesiology with several other Texas anesthesia practices. The platform grew to a national footprint across Texas, Florida, Colorado, Maryland, Indiana, Nevada, and Washington. In 2017 Berkshire Partners and GIC took minority positions, with Welsh Carson’s pro rata share reported at 23 percent per its FTC consent statement. Welsh Carson’s stake is now frozen per the May 2025 final order. USAP’s physician partners collectively constitute the largest shareholder class.
Colorado divestiture is in process under the February 2024 Colorado AG settlement. Texas divestiture is in process under the April 23, 2026 FTC agreement in principle. The specific divestiture buyers and asset perimeters have not been publicly disclosed as of June 16, 2026.
The December 5, 2024 joint venture with Greater New York Anesthesia Services, recorded in PitchBook’s USAP profile, is the most strategically interesting USAP transaction of the cycle. The JV is consummated at the USAP level rather than at Welsh Carson, which means it does not trigger the Welsh Carson prior-approval gate. The structure suggests USAP is using JV mechanics to expand without triggering sponsor-level FTC review. PitchBook also lists a March 31, 2025 transaction at USAP, with structure and counterparties undisclosed; we flag this as GAP. (Confidence: HIGH on the JV date; MEDIUM on the strategic rationale; GAP on the March 2025 transaction.)
USAP’s market messaging has shifted from market-share growth to clinical-quality positioning. The April 2026 FTC agreement in principle is expected to require additional Texas market divestitures, with specific terms confidential during the 180-day implementation window per the USAP April 2026 statement.
NorthStar and NAPA are the two most material non-USAP platforms and are the most commonly misattributed in third-party coverage.
NorthStar Anesthesia has been a Cranemere majority since June 2018, with TPG Growth retaining a minority position. The transition was disclosed in the TPG release announcing Cranemere’s acquisition of TPG Growth’s controlling interest. Cranemere’s portfolio page confirms the ongoing relationship at the NorthStar Anesthesia portfolio listing. NorthStar is headquartered in Irving, Texas, with its strongest footprint in the Midwest, Texas, and Southeast. The platform operates predominantly through the ACT model with CRNA-heavy care teams. Three Cranemere-era tuck-ins have been disclosed since 2018, the most recent being Epix Anesthesia in October 2021 per the Cranemere release. No publicly disclosed large-platform exit process has been documented through Q2 2026. (Confidence: HIGH on sponsor stack, footprint, and tuck-in history.)
Cranemere’s permanent-capital structure is structurally well-suited to the post-FTC environment. Where traditional PE funds operate on 5 to 7 year hold horizons that align poorly with the 10-year Welsh Carson consent order and the lengthening implied exit horizon for the sector, Cranemere’s open-ended hold horizon allows NorthStar to compound organic growth through tuck-ins without requiring a defined exit clock.
NAPA has been an American Securities majority with Leonard Green & Partners co-investment since April 2016. The 2016 transaction was a recapitalization from NexPhase Capital, with both sponsors entering simultaneously. The Leonard Green portfolio page documents the relationship at the NAPA portfolio listing. NAPA’s segment scope covers anesthesia, pain management, and perioperative care across hospital and ASC sites. Post-American Anesthesiology, NAPA employs more than 6,000 clinicians and staff serving over 500 facilities and 3 million patients annually per the 2020 NAPA-NMSC announcement, making NAPA the largest anesthesia staffing company in the United States by clinician count. (Confidence: HIGH.)
The May 6, 2020 American Anesthesiology acquisition from MEDNAX (now Pediatrix) closed at $50 million cash plus a contingent earnout of up to $250 million, per the MEDNAX 8-K filing. The realized earnout amount has not been publicly disclosed and is flagged as GAP. NAPA’s geographic concentration is in the Northeast and Mid-Atlantic, with footprint extending to 21 states. The Private Equity Stakeholder Project’s 2024 risk assessment flagged NAPA workforce and reimbursement risks per the PESP report.
NAPA’s most material 2024 to 2026 narrative is the absence of a sponsor turn. American Securities and Leonard Green have held since April 2016, which puts the hold in its 10th year as of 2026. This duration is well beyond a typical PE hold period, and industry observers expect a recap or exit within the next 12 to 24 months. No formal process has been publicly disclosed as of June 16, 2026. (Confidence: HIGH on the hold duration; MEDIUM on the recap-or-exit expectation.)
TeamHealth’s anesthesiology line operates under Blackstone ownership since the February 2017 take-private at approximately $6.1 billion per the TeamHealth release. The company markets anesthesia services nationally at its anesthesiology partner page. Blackstone has not filed any 8-K signaling a sale process for the anesthesiology line as of June 16, 2026.
The hold horizon merits attention. Blackstone’s TeamHealth hold is in its ninth year, which is well past a typical PE fund hold period. Combined with TeamHealth’s well-documented distressed-debt commentary throughout 2024 and 2025, the prior probability of a 2026 to 2027 transaction at the parent or carve-out of the anesthesia service line is materially elevated. However, no SEC filings or public M&A disclosures confirm this expectation, and TeamHealth’s anesthesia-line standalone EBITDA is not publicly disclosed. We flag both as GAP. (Confidence: HIGH on current ownership; GAP on transaction timing and standalone EBITDA.)
Envision Healthcare emerged from Chapter 11 in November 2023 with the company split into Envision (emergency medicine, hospital medicine, anesthesiology services) and AMSURG (ambulatory surgery centers). Lender groups received the equity in the restructuring per Healthcare Dive’s emergence coverage. The reorganization achieved a 70 percent reduction in debt per Healthcare Finance News. Jason Owen was appointed President and CEO in April 2024 per Becker’s ASC one-year update.
As of late 2025 Envision serves approximately 430 facilities and 55 health systems with about 8,000 clinicians. The post-bankruptcy lender ownership structure has not been fully disclosed publicly, and we flag the granular cap-table composition as GAP. (Confidence: HIGH on emergence date, debt reduction, and CEO appointment; GAP on lender-group composition.)
Specialty MSOs in gastroenterology, orthopedics, urology, and ophthalmology increasingly own captive anesthesia capacity attached to their owned ambulatory surgery centers. This structure is partly an antitrust-arbitrage play: cross-specialty integration avoids the narrowly defined anesthesia roll-up theory that drove the FTC’s USAP complaint. It is also a margin-capture play: anesthesia attached to a GI ASC is a high-contribution-margin add-on whose revenue would otherwise accrue to an independent contracted anesthesia provider.
The Welsh Carson consent order does not directly reach cross-specialty MSO buyers. However, the order’s 30-day notice requirement explicitly extends to any hospital-based physician practice acquisition regardless of specialty by Welsh Carson, which signals FTC intent to monitor cross-specialty integration as the next likely vector for sponsor roll-up activity. Edgeworth Economics’s analysis reads the cross-specialty notice requirement as the FTC’s signal that future enforcement actions may extend to specialty MSOs with captive anesthesia ancillaries.
The implication for specialty MSO platform sponsors is that diligence on captive anesthesia ancillaries should now include explicit FTC-review modeling for any transaction with a roll-up posture. The implication for anesthesia platform sponsors is that the historical buyer universe (large anesthesia-only platforms) may be supplemented by specialty MSO buyers acquiring captive anesthesia capability, but at multiples reflecting the structural integration premium rather than the pure-play anesthesia comparable. We address this in Section 15.
The following chronological summary captures the publicly disclosed transactions and regulatory events that defined US anesthesiology M&A from January 2024 through June 16, 2026. Where a date is not publicly verifiable, the row is flagged GAP.
| Date | Event | Counterparties | Significance | Source | Confidence |
|---|---|---|---|---|---|
| Feb 27, 2024 | Colorado AG settlement with USAP | Colorado AG (Phil Weiser) and USAP | State-level antitrust unwind; template for follow-on state enforcement | Colorado AG release | HIGH |
| April 2024 | Jason Owen appointed Envision CEO | Envision Healthcare | Post-bankruptcy leadership stabilization | Becker’s ASC | HIGH |
| May 13, 2024 | District court denies USAP motion to dismiss; dismisses Welsh Carson on procedural grounds | SDTX, USAP, Welsh Carson | Procedural reset on FTC Section 13(b) reach over PE minority investor | ABA Business Law Today | HIGH |
| May 2024 | Massachusetts opts out of CRNA Medicare supervision | State of Massachusetts; CMS | Brings total opt-out states to 25 plus DC and Guam | Mass CRNA presentation | HIGH |
| 2024 | Washington state licenses CAAs | State of Washington | First of 2024 to 2025 CAA practice-authority expansion sequence | Becker’s ASC | HIGH |
| Dec 5, 2024 | USAP and Greater New York Anesthesia Services joint venture | USAP, Greater New York Anesthesia Services | Structure designed to expand without triggering Welsh Carson prior-approval gate | PitchBook profile | HIGH on date; MEDIUM on strategic rationale |
| Jan 17, 2025 | FTC proposes consent order with Welsh Carson | FTC, Welsh Carson | First nationwide forward-looking consent obligations on a PE sponsor in healthcare | FTC release | HIGH |
| Feb 18, 2025 | Federal Register publishes consent order analysis | FTC | Opens 30-day public comment period | Federal Register 2025-02719 | HIGH |
| Mar 31, 2025 | USAP-listed transaction (PitchBook) | USAP, counterparty not disclosed | Structure and counterparties undisclosed | PitchBook profile | GAP |
| May 2025 | FTC approves final consent order with Welsh Carson (3-0 vote) | FTC, Welsh Carson | Bipartisan vote signals durable precedent | FTC release | HIGH |
| 2025 | Tennessee and Virginia license CAAs; South Carolina tightens supervision ratios | States; ASA | Total CAA practice-authority states reach 23 plus DC | ASA | HIGH |
| Fall 2025 | UnitedHealthcare implements 15 percent reduction in CRNA personally-performed reimbursement | UnitedHealthcare | Most consequential commercial-payor action of the cycle | Stout | HIGH |
| Oct 31, 2025 | CMS releases CY 2026 MPFS final rule | CMS | $20.4976 non-APM CF, $20.6000 APM CF | Holland & Knight | HIGH |
| Nov 5, 2025 | Federal Register publishes CY 2026 MPFS final rule | CMS | Effective Jan 1, 2026 | Federal Register 2025-19787 | HIGH |
| Jan 2026 | Kansas City University CAA program begins | KCU | First of two new CAA programs entering the pipeline | Becker’s ASC | HIGH |
| Apr 23, 2026 | FTC and USAP file joint motion to stay litigation; FTC announces agreement in principle | FTC, USAP, SDTX | 180-day implementation window opens | FTC release | HIGH |
| May 26, 2026 | SDTX grants joint motion to stay | SDTX | Litigation paused pending settlement finalization | USAP statement | HIGH |
Public-source multiple benchmarks for anesthesia M&A in 2024 to 2026 are limited. FOCUS Investment Banking reports median healthcare services EV/EBITDA multiples moderated to approximately 11.5x in 2025, down from 14.5x in 2024 against the publicly traded healthcare services benchmark. The same FOCUS reference notes platform transactions command 3 to 5 multiple turns above add-on deals in physician practice M&A. Practices with $5 million or greater EBITDA typically trade 2 to 4 turns above smaller add-on deals; ancillaries such as owned ASCs, imaging, pathology, and cath labs commonly add 1 to 3 turns. Large PE-backed physician platforms can achieve multiples into the teens per FOCUS and corroborating Sofer Advisors data. (Confidence: HIGH on benchmark range; MEDIUM on the anesthesia-specific application.)
Anesthesia-specific quarterly multiple trackers from Mertz Taggart and Provident Healthcare Partners were not available within our search horizon for the 2024 to 2026 window. The FOCUS Healthcare EBITDA Multiples 2026 Dashboard is the closest publicly available anchor.
USAP’s last publicly disclosed equity transaction was the 2017 GIC and Berkshire Partners minority investment, which valued USAP at a reported $7 billion enterprise value per industry compilations. Following the FTC consent order and the agreement-in-principle requirement of additional Texas divestiture, an implied 2026 enterprise value would need to discount for the 10-year overhang on Welsh Carson buyer-side optionality and the divestiture requirement. Public-market data do not support a precise implied USAP multiple as of June 16, 2026, and we flag this as GAP.
Triangulating from FOCUS data, healthcare services trends, the post-FTC regulatory premium specific to anesthesia, and conversations across the M&A advisory bar, our estimated anesthesia platform multiple range for 2024 to 2026 is set out below. These are estimates, not transaction comparables.
The most material valuation gap in 2024 to 2026 is hospital-contract anesthesia versus ASC-attached anesthesia. Hospital-contract economics are squeezed by escalating stipends, Medicare CF compression, and rising labor costs. ASC-attached economics benefit from favorable commercial payor mix, growing case volumes, and operating efficiency on case-density scaling. Coronis Health and Becker’s Hospital Review data show 95 percent of hospitals now subsidize anesthesia coverage versus 40 to 50 percent in 2015. This structural divergence is widening the multiple gap between hospital-contract and ASC-attached anesthesia platforms.
The following six observations represent contrarian or nonconsensus views drawn from the primary-source record. Each is sourced and each runs against at least one widely held conventional view in the sector.
1. The USAP FTC consent order is the most material 2024 to 2026 healthcare-services antitrust development. Welsh Carson’s 10-year prior-approval gate is unprecedented in scope. It is the first time the FTC has imposed nationwide forward-looking consent obligations on a private equity sponsor as a remedy for an alleged roll-up scheme. Other PE sponsors with hospital-based physician practice exposure (Blackstone-TeamHealth, the lender-group Envision, American Securities-NAPA, Cranemere-NorthStar) face elevated prior probability of similar review and must price compliance overhead into investment committee deliberations going forward per Federal Register filing 2025-02719.
2. Welsh Carson’s 10-year buy-side bar reshapes anesthesia M&A competitive dynamics in favor of permanent-capital sponsors. With the single most active US anesthesia sponsor removed from buy-side activity for a decade, sell-side processes lose a price-setting bidder. Expected effects: tuck-in seller multiples compress by 1 to 2 turns; platform-level sellers face fewer strategic acquirers and must run more limited auctions; cross-border buyers (Canadian and European specialty MSO platforms) and physician-led independents gain bargaining power; Cranemere’s permanent-capital structure becomes more competitive versus 5 to 7 year horizon traditional PE funds because the post-FTC environment lengthens implied exit horizons.
3. Anesthesia inside specialty MSOs (GI, ortho, urology, ophth) now faces direct FTC scrutiny precedent. Welsh Carson’s 30-day notice requirement explicitly extends to any hospital-based physician practice regardless of specialty. This signals FTC retention of jurisdiction over cross-specialty integration even when an anesthesia line is captive within a GI or orthopedic MSO. Specialty MSOs with anesthesia ancillaries should expect heightened HSR review of any anesthesia tuck-in, state AG follow-on actions modeled on Colorado, and physician-led counter-organizing inside specialty MSOs as anesthesiologists exit employed structures to recapture spread on captive anesthesia revenue.
4. Hospital anesthesia subsidies have inverted the historical platform thesis. Hospital anesthesia subsidies grew from 40 to 50 percent of US hospitals in 2015 to more than 95 percent in 2024 per Becker’s and Stout’s commentary. The historical PE anesthesia thesis (consolidate practices and extract commercial-payor margin) is structurally weaker than the inverted thesis (consolidate practices to negotiate higher hospital subsidies and to extract ASC-attached margin). Platforms that can credibly threaten to walk away from a hospital contract have new pricing power on the stipend side, but they also bear the political risk of being framed as exploitative. The thesis has shifted from payor-side bargaining power to facility-side bargaining power.
5. CAA expansion is the most consequential structural supply story, not CRNA growth. CRNA supply is large (65,000 nationally) but growing modestly (10 percent BLS projection 2023 to 2033). CAA supply is small (a few thousand nationally) but growing fast from new state licensure (Tennessee, Virginia, Washington in 2024 and 2025), new accredited training programs (Kansas City University January 2026, Lipscomb), and rising employer demand. For platform PE strategy, CAA-friendly states are positive supply asymmetry: limited current competition, expanding labor pool, and material wage differential versus anesthesiologists. The next 24 months of state legislative cycles are the inflection.
6. The Welsh Carson order plus the No Surprises Act IDR backlog creates a regulatory squeeze that favors physician-owned independents over PE platforms. PE-backed anesthesia platforms face four overlapping pressures: FTC prior-approval overhang on M&A; IDR uncertainty pending the operations final rule; UnitedHealthcare’s 15 percent CRNA-personally-performed reimbursement cut; Medicare CF compression. Physician-owned independent groups bear less of the first and benefit from the same exposure to the other three. The contrarian implication: the 2024 to 2026 cycle is the first in 15 years where the relative attractiveness gap between independent and PE-backed anesthesia practice has narrowed in favor of independents.
Workforce dynamics are the binding constraint on platform scaling through the rest of the decade. The two most consequential figures are HRSA’s projected anesthesiologist shortage of 8,450 by 2037, cited by Medicus Healthcare Solutions in its 2025 provider shortage white paper, and AANA’s projection that 12 percent of CRNAs will retire by 2027, roughly 8,000 total retirements over the 2025 to 2027 window per Medicus’s reporting of AANA workforce projections at the Medicus shortage resource.
Workforce demographics underpinning these projections are: 59 percent of practicing anesthesiologists are 55 or older; 17 percent are nearing retirement age; by 2033 the combined anesthesiology workforce may experience a shortage of approximately 12,500, representing nearly 22 percent of current staff per Medicus’s projections.
The training pipeline does not fill the gap. The 2025 Match returned 1,805 PGY-1 anesthesiology positions, approximately a 6.5 percent increase versus 2024, against more than 3,000 applicants, leaving 1,200 or more unmatched per Becker’s ASC workforce coverage. 78 percent of facilities reported anesthesia staffing shortages in 2023 versus 35 percent pre-COVID per the same Becker’s analysis.
For platform PE strategy, the workforce constraint produces three structural conclusions. First, CRNA and CAA expansion are the only credible supply-side responses on a 5-to-10-year horizon, which reinforces the importance of CAA-friendly state legislative cycles. Second, MD compensation will continue to escalate, which means physician-owner sellers entering recapitalization processes can demand higher base compensation plus retention equity than in prior cycles. Third, the hospital subsidy escalation is structurally durable: hospitals cannot easily recruit replacement coverage if a platform walks away from a contract, which is why subsidy negotiations have shifted in favor of the platform.
The matrix below distills the platform tracker into actionable guidance for a physician-owner group considering recapitalization. Rows reflect seller profile; columns reflect optimal buyer category given the post-FTC environment.
| Seller profile | Optimal buyer category | Rationale | Expected multiple range |
|---|---|---|---|
| Large hospital-contract platform with $20M+ EBITDA, multi-state | Permanent-capital sponsor (Cranemere-type), strategic non-PE (publicly traded health system), or sovereign wealth coinvestor | Traditional PE faces lengthening implied hold horizon; permanent capital matches post-FTC time scale | 9x to 11x |
| Mid-market regional anesthesia platform with $5M to $15M EBITDA, two to four states | Adjacent specialty MSO (GI, ortho) with captive ASC capacity OR regional independent strategic | Specialty MSOs benefit from anesthesia margin capture; regional independents avoid HSR review | 7x to 10x |
| ASC-attached anesthesia group with strong commercial payor mix, $3M to $10M EBITDA | Specialty MSO partner, ASC operator, or PE-backed anesthesia platform seeking ASC pivot | Premium multiple reflects high contribution margin and case-density scaling | 9x to 13x |
| CRNA-only platform in opt-out state Critical Access Hospital footprint | CRNA-focused PE platform, regional independent, or rural-health-system strategic | Lower labor cost model with limited PE competition; rural payor mix penalty | 5x to 8x |
| Tuck-in independent group ($1M to $3M EBITDA), one state | Adjacent regional independent OR NAPA or NorthStar tuck-in pipeline | Strategic synergy at smaller scale; PE platform pipeline pull | 4x to 6x |
| Pain management plus anesthesia hybrid | Specialty pain MSO with captive anesthesia capability | NAPA-type pain plus anesthesia thesis OR PE-backed pain platform | 6x to 9x |
The matrix should be read as a starting point for seller-side advisor selection, not as a guarantee of multiple. Each row should be diligenced against the specific platform’s payor mix, labor cost structure, contract concentration, and state regulatory exposure.
The following items are unverified or partially verified within our search horizon and should be confirmed before use in published intelligence or in any transactional context. Each is sourced to the underlying gap in the public record.
This tracker is part of CT Acquisitions’s healthcare-services PE roll-up tracker series. Sibling trackers cover allied healthcare verticals and provide comparable methodology, primary-source citation, and per-cell confidence convention.
Federal regulatory and antitrust sources are grouped first, followed by association and trade-society sources, payor and benchmark sources, and platform and sponsor sources. URLs are repeated in line throughout the tracker.
USAP’s ownership remains Welsh Carson (frozen minority), Berkshire Partners, GIC, and physician partners as the largest collective shareholder class. Welsh Carson’s stake is frozen at its current pro rata level, capped to a single non-Chair board seat, and subject to a 10-year nationwide FTC prior-approval gate on any new US anesthesia investment per Federal Register filing 2025-02719.
NorthStar Anesthesia has been a Cranemere majority since June 2018, with TPG Growth retaining a minority position from its original October 2013 entry. This is the correct attribution; the common misstatement that NorthStar is solely TPG-owned is inaccurate. The Cranemere portfolio listing confirms the relationship at Cranemere’s NorthStar page.
NAPA has been jointly owned by American Securities (majority) and Leonard Green & Partners since April 2016, following a recapitalization from NexPhase Capital in which both sponsors co-invested. The Leonard Green portfolio page documents the relationship at the NAPA portfolio listing.
The FTC filed its complaint on September 21, 2023, in the Southern District of Texas. The district court dismissed Welsh Carson on procedural grounds on May 13, 2024. The FTC proposed the administrative consent order with Welsh Carson on January 17, 2025, published the Federal Register analysis on February 18, 2025, and approved the final order on a 3-0 vote in May 2025. The FTC and USAP announced an agreement in principle on April 23, 2026, and the SDTX granted a litigation stay on May 26, 2026.
Welsh Carson is subject to five operative provisions over the 10-year term: an equity freeze at its current USAP pro rata minority stake; a board cap of one non-Chair seat at USAP; nationwide FTC prior-approval requirement for any new US anesthesia investment and for certain Welsh Carson anesthesia portfolio company acquisitions; a 30-day advance notice requirement for any US hospital-based physician practice acquisition regardless of specialty; and ongoing compliance reporting to the FTC.
The CY 2026 anesthesia conversion factor is $20.6000 for qualifying APM clinicians and $20.4976 for non-APM clinicians, a 0.88 percent increase over CY 2025 for non-APM clinicians. CMS released the final rule on October 31, 2025; the Federal Register published the rule on November 5, 2025 as filing 2025-19787. The net revenue impact for anesthesia is approximately negative 1 percent after the 2.5 percent efficiency adjustment to work RVUs.
25 states plus the District of Columbia and Guam have opted out as of mid-2025. The most recent state addition is Massachusetts (May 2024); other recent additions are Delaware (June 2023), Wyoming (May 2023, partial), and Colorado (2023). The canonical roster is maintained at the ASA Opt-Outs page.
Providers prevailed in approximately 85 percent of IDR payment determinations in 2024, up from 80 percent in 2023, and the median anesthesia IDR award is approximately twice the Qualifying Payment Amount per the Peterson-KFF Health System Tracker and Health Affairs Forefront 2025 early-look data.
HRSA projects a shortage of 8,450 anesthesiologists by 2037 per the 2025 Medicus Healthcare Solutions white paper. Other commentary projects shortfalls of 6,300 by 2036 (Medicus) and more than 10,000 by 2038 (Envision-cited). The combined anesthesiology workforce may experience a shortage of approximately 12,500 by 2033.
The Anesthesia Care Team (ACT) model has one anesthesiologist medically directing 2 to 4 CRNAs or CAAs under the federal TEFRA 1:4 cap. CRNA-only practice (no physician supervision) is concentrated in Medicare opt-out states, predominantly at Critical Access Hospitals and rural facilities, where more than 80 percent of rural community anesthesia providers are CRNAs.
23 states plus DC, with Kansas, Michigan, Pennsylvania, and Texas using delegatory frameworks rather than direct state licensure. Washington licensed CAAs in 2024; Tennessee and Virginia followed in 2025; South Carolina tightened CAA supervision ratios in 2025. New training programs include Kansas City University (January 2026) and Lipscomb University (Tennessee, in pre-launch).
FOCUS Investment Banking reports median healthcare services EV/EBITDA multiples at approximately 11.5x in 2025, down from 14.5x in 2024. Our triangulated estimate for anesthesia-specific platforms: large hospital-based platforms 8x to 11x; mid-market regional platforms 7x to 10x; tuck-in independents 4x to 6x; ASC-attached anesthesia carries a 2 to 3 turn premium.
No publicly disclosed sale process as of June 16, 2026. Blackstone’s hold of TeamHealth (since February 2017) is in year 9, and parent-level distressed-debt commentary in 2024 and 2025 raises the prior probability of a 2026 to 2027 transaction. No SEC filings or press disclosures confirm a sale, so we flag this as GAP.
Envision emerged from Chapter 11 in November 2023 with a lender-group equity ownership structure that has not been granularly disclosed publicly. The company was split from AMSURG (ambulatory surgery centers) in the restructuring, achieved a 70 percent reduction in debt, and appointed Jason Owen as President and CEO in April 2024.
The Welsh Carson order is the first time the FTC has imposed nationwide forward-looking consent obligations on a private equity sponsor as a remedy for an alleged roll-up. The 30-day cross-specialty notice requirement signals FTC reservation of jurisdiction over hospital-based physician practice acquisitions regardless of specialty. Other sponsors with hospital-based physician practice exposure must price prior-approval and compliance overhead into investment committee work.
A NAPA recap or exit by American Securities and Leonard Green within the next 12 to 24 months is the most likely platform-level transaction given the 10-year hold since April 2016. A TeamHealth anesthesia carve-out is the second most likely event but lacks public confirmation. USAP-side Colorado and Texas divestitures are in process under the state AG and FTC settlement frameworks.
This tracker is part of CT Acquisitions’s healthcare-services PE roll-up tracker series. The series applies a common methodology across vertical trackers: primary-source citation for every numerical and dated claim; four-grade per-cell confidence convention (HIGH, MEDIUM, LOW, GAP); explicit gap disclosure for unverified items; and corrected sponsor attributions where third-party trackers have propagated misattribution. Verticals shipped in this series include home health, behavioral health, ABA therapy, veterinary, dermatology, dental DSO, physical therapy, ophthalmology, gastroenterology, orthopedic, and manufacturing PE roll-ups. The series is maintained at the private equity platform map master index. Inquiries: CT Acquisitions contact.
Last updated: June 16, 2026.