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The Due Diligence Imperative

Technology This article provides a peek at one of the six-part healthcare installments and provides an overview of the due diligence imperative for valuation professionals, in the context of the Four Pillars of Healthcare Value, i.e., Reimbursement, Regulatory, Technology, and Competition. The second, third, and fourth installments, already published, reviewed the due diligence process related to the reimbu ...

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The Due Diligence Imperative

Competition (Part Four of a Six-Part Series) The first part of this six-part series provided an overview of the due diligence imperative for valuation professionals, in the context of the Four Pillars of Healthcare Value, i.e., Reimbursement, Regulatory, Technological, and Competitive environments. The second and third installments reviewed the due diligence process related to the reimbursement and regulato ...

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Trade Secrets

Considerations for Fair Market Value Healthcare enterprises are increasingly relying on intangible assets to enhance their ability to provide timely, quality professional medical services to patients. Trade secrets are one such class of intangible asset that may be owned by a healthcare enterprise. A trade secret is any information that has economic value and is not generally known by the public. Technical ...

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Management Services Agreements

This article briefly discusses the current trends in the practice management industry, as these trends may directly and indirectly affect both the management company and the healthcare entity. This overview of the services provided by practice management groups, is followed by a discussion of the competitive, reimbursement, regulatory, and technological environments in which practice management groups opera ...

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The Due Diligence Imperative

Healthcare Regulatory Environment (Part III of VI) In the March/April 2018 issue of The Value Examiner, the author underscores the importance of undertaking rigorous due diligence to better understand the regulatory burdens and operational risks notwithstanding efforts to repeal and replace. ...

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The Due Diligence Imperative

Healthcare Reimbursement Environment, Part II of VI In the January/February 2018 issue of The Value Examiner, the author provides readers with an overview of the U.S. healthcare reimbursement system and details the due diligence process as it relates to reimbursement. This brief article is an excerpt, which is part of the series on healthcare reimbursement, where the author provides more in-depth explanatio ...

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The Due Diligence Imperative for the Valuation of Healthcare

Enterprises, Assets, and Services With the emergence of value-based reimbursement, such as accountable care organizations (ACOs), clinically integrated networks (CINs), and bundled payment models, which rely on achieving the “Triple Aim” of healthcare at lower cost, U.S. hospitals are increasingly looking to change how services are being delivered by seeking more collaborative relationships with physicians, ...

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Valuation of Compensation for Physician Services

Medical Director Compensation This article is the fourth in a series involving current healthcare management issues. An in-depth article on this issue was published in The Value Examiner’s September/October 2017 issue. In that issue, the authors discuss issues setting forth medical director services and establishing defensible compensation arrangements. ...

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Valuation of Compensation for Physician Services

Physician On-Call Services This article focuses on physician on-call services and issues that valuation professionals must anticipate and consider in such an engagement. The article is a distillation of an in-depth article published in The Value Examiner July/August 2017 issue. In that issue, the authors also discuss classification and valuation of compensation for physician services and valuation of medica ...

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Valuation of Compensation for Physician Services

Executive Services (Part II of IV) In the May/June 2017 issue of The Value Examiner, the authors gave a detailed description of how clinical services for physicians can be calculated. QuickRead is pleased to present an overview of this series, which will be presented in four parts. Please look for the more detailed analysis in The Value Examiner. This article is a follow up to the April 23, 2017 QuickRead a ...

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Protect Yourself from Anti-Kickback Penalties

What Physicians Don’t Know About Their Agreements Could Hurt Them Nearly 45 years after the enactment of the federal Anti-Kickback Statute, it is still not uncommon to hear of physicians facing bribery allegations, large settlement amounts, and even jail time for breaking the statute’s anti-fraud measures. While evolving case law has certainly added to the complexities and prevalence of the statute’s enforc ...

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Valuation of Compensation for Physician Services

Clinical Services (Part I of IV) In the March/April 2017 issue of The Value Examiner, the authors gave a detailed description of how clinical services for physicians can be calculated. QuickRead is pleased to present an overview of this series, which will be presented in four parts. Please look for the more detailed analysis in The Value Examiner. ...

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Physician Practice Acquisitions

Deal Structuring and Workforce in Place Considerations Under IRC and Stark Law What complications arise when two separate transactions are used to structure an asset sale of a physician practice? The key to compliance is to hit a reasonable middle ground under somewhat competing frameworks, and carefully drafting, documenting, and reporting accordingly. Valuators play a key role not only in establishing and ...

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Goodwill

Why it Shouldn’t be A Dirty Word in the Valuation of Physician Practices The topic of goodwill in a physician practice acquisition continues to be hotly debated. There are very different viewpoints from reputable appraisers on how to value physician practices and whether hospitals can pay for goodwill in an acquisition. I often hear healthcare professionals involved in acquisitions say, “Hospitals can’t pay ...

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Stark Realities Continue

The Compensation-Productivity Nexus Affiliate employer agreements that do not involve designated health services may not be subject to Stark Law. However, where there is an ownership nexus—shared parent or direct subsidiary—between the hospital and affiliate employer, regulators may be able to find Stark Law violations. As governmental agencies drill down well beyond simple compensation comparatives, into t ...

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Book Review—The Adviser’s Guide to Healthcare, Second Edition

An Era of Reform—The Four Pillars, Volumes I and II Since 1950, the U.S. population has doubled from just more than 152 million to an estimated 320 million. In this same period, the average life expectancy has increased from approximately 68 years to over 78 years. This increased life expectancy and accompanying rise in the incidence and prevalence of diseases, conditions, and injuries is driving demand for ...

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Utilization of the Asset/Cost Based Approach

In Appraising Outpatient Enterprises Healthcare related outpatient enterprises are those that provide services that do not require hospital admission and may be performed outside the premises of a hospital. Valuation of healthcare related outpatient enterprises, similar to the valuation of any business, should include consideration of the three general approaches to valuation, i.e., the income approach, the ...

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The CY 2016 Work Relative Value Units

The Impact on Employed Physician Groups The CMS 2016 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System downwardly revised reimbursement for GI/endoscopy services and reduced by 0.77 percent the Physician Fee Schedule to all services because CMS failed to meet the one percent net reduction target for misvalued codes in 2016. In this article, the author discusses how ...

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The Utilization of the Market Approach

In Appraising Outpatient Enterprises Healthcare related outpatient enterprises provide services that do not require hospital admission and may be performed outside the premises of a hospital. Similar to valuation of any business, valuations of outpatient enterprises should include consideration of the three general approaches to valuation (i.e., the income approach, the market approach, and the asset/cost a ...

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