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Segment Reporting
 9 Months Ended
Sep. 30, 2020
Segment Reporting [Abstract]  
Segment Reporting Segment Reporting
The Company operates in three major lines of business that are also the Company's reportable operating segments - the operation of surgical facilities, the operation of ancillary services and the operation of optical 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 consists of an optical products group purchasing organization. "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,
2020201920202019
Revenues:
Surgical Facility Services$478.6 $431.1 $1,262.8 $1,250.9 
Ancillary Services16.7 20.0 46.9 60.3 
Optical Services0.8 0.9 2.1 3.0 
Total$496.1 $452.0 $1,311.8 $1,314.2 
Adjusted EBITDA:
Surgical Facility Services$82.5 $77.1 $229.7 $223.9 
Ancillary Services(0.6)0.9 (3.9)3.5 
Optical Services0.4 0.4 1.0 1.3 
All other(21.2)(16.2)(61.0)(54.5)
Total$61.1 $62.2 $165.8 $174.2 
Reconciliation of Adjusted EBITDA:
(Loss) income before income taxes$(33.0)$13.3 $(61.1)$27.6 
Net income attributable to non-controlling interests(27.3)(26.6)(75.0)(78.1)
Depreciation and amortization24.1 18.4 69.3 56.3 
Interest expense, net51.5 45.7 147.8 134.1 
Equity-based compensation expense3.0 2.7 9.9 7.6 
Transaction, integration and acquisition costs (1)
7.5 5.3 30.2 16.8 
Impairment charges33.5 — 33.5 — 
Loss (gain) on disposals and deconsolidations, net0.7 0.6 7.1 (7.0)
Litigation settlement and other litigation costs (2)
1.1 2.8 4.9 2.8 
Gain on escrow release (3)
— — (0.8)— 
Loss on debt extinguishment— — — 11.7 
Tax receivable agreement expense— — — 2.4 
Adjusted EBITDA61.1 62.2 165.8 174.2 
Less: Impact of grant funds (4)
5.4 — (21.9)— 
Adjusted EBITDA excluding grant funds$66.5 $62.2 $143.9 $174.2 
(1)This amount includes transaction and integration costs of $5.4 million and $3.4 million for the three months ended September 30, 2020 and 2019, respectively. This amount further includes other acquisition costs and start-up costs related to a de novo surgical hospital of $2.1 million and $1.9 million for the three months ended September 30, 2020 and 2019, respectively.
This amount includes transaction and integration costs of $15.8 million and $11.6 million for the nine months ended September 30, 2020 and 2019, respectively. This amount further includes other acquisition costs and start-up costs related to a de novo surgical hospital of $14.4 million and $5.2 million for the nine months ended September 30, 2020 and 2019, respectively.
(2)This amount includes other litigation costs of $1.1 million and $2.8 million for the three months ended September 30, 2020 and 2019, respectively.
This amount includes litigation settlement costs of $1.2 million for the nine months ended September 30, 2020, with no comparable settlement costs in the same 2019 period. This amount further includes other litigation costs of $3.7 million and $2.8 million for the nine months ended September 30, 2020 and 2019, respectively.
(3)Included in other income in the condensed consolidated statement of operations for the nine months ended September 30, 2020, with no comparable gain in the same 2019 period.
(4)Represents the impact of grant funds recognized, net of amounts attributable to non-controlling interests.
September 30,
2020		December 31,
2019
Assets:
Surgical Facility Services$4,745.0 $4,580.4 
Ancillary Services34.8 69.6 
Optical Services14.2 17.7 
All other518.9 351.2 
Total assets$5,312.9 $5,018.9 
Nine Months Ended September 30,
20202019
Cash purchases of property and equipment:
Surgical Facility Services$24.1 $42.8 
Ancillary Services0.3 0.5 
All other3.4 6.9 
Total cash purchases of property and equipment$27.8 $50.2