While other joint ventures are waning, joint-ventured ASC transactions between physicians and hospitals appear to be on the rise. Access to favorable contracts, capital needs and politics are driving doctors and hospitals — otherwise would-be competitors — to partner in the development and ownership of surgical centers. However, these transactions can present challenges, including the hospital partner's need for majority ownership and governance control, along with significant reservations of power to the hospital partner (the ability to approve or block action on a given matter, for example) to preserve the hospital's tax-exempt status.