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 ...

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, ...

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. ...

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 ...

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 ...

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 ...

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. ...

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 ...

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 ...

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 ...

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 ...

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 ...

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 ...

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 ...

An In-Depth Series on Healthcare Valuation, Part 2 of 4 This article focuses on utilizing an income approach to value outpatient enterprises, while subsequent articles in this topic series will address the use of a market approach and an asset/cost approach to value outpatient enterprises. ...

An In-Depth Series on Healthcare Valuation This first installment will discuss Fair Market Value, the most prevalent standard of value in the healthcare industry, and why this is the required standard of value for most healthcare transactions. This article will also discuss the premise of value, which further defines the circumstances of the transaction, and how to determine which methods may be applicable ...

Five Remaining Leading Misconceptions (Part II of II) The following discussion summarizes and responds to common misconceptions many analysts have with regard to the valuation of healthcare entity property and/or services transfers. These analyst misconceptions typically involve a misunderstanding of one or more of the relevant regulatory provisions. These analyst misconceptions typically relate to an erron ...

Five of the 10 Leading Misconceptions (Part I of II) The following discussion summarizes and responds to common misconceptions that many analysts have with regard to the valuation of healthcare entity property and/or services transfers. These analyst misconceptions typically involve a misunderstanding of one or more of the relevant regulatory provisions. These analyst misconceptions typically relate to an e ...

Healthcare Valuation Considerations when Valuing Outpatient Services With healthcare evolving, how can practitioners project the future benefit stream related to outpatient services? In this article, the authors discuss the use of hypothetical and extraordinary assumptions. They argue that use of these assumptions requires careful consideration as they can have a significant effect on value. In addition, th ...

The Structure of Physician Compensation The structure of compensation for hospital/health-system employed physicians is a constant struggle for administrators with the rise of physician practice acquisitions and subsequent employment of these physicians. Based on estimates from Jackson Healthcare1, approximately 35 percent of all physicians are employed by a hospital/health-system. As a result, the issue of ...