Competition (Part II of V) This second installment in this five-part series on the valuation of ASCs will discuss the competitive environment of ASCs, by competitor type. [su_pullquote align=”right”]Resources:Valuation of Ambulatory Surgery Centers—Introduction (Part I of V)[/su_pullquote] As noted in the first installment of this five-part series, an ambulatory surgery center (ASC) is a distinct entity that primarily provides outpatient surgical procedures to patients who do not require an overnight stay after the procedure.[1] The facilities typically provide relatively uncomplicated surgical procedures in a non-hospital setting, and most ASC cases are non-emergency, non-infected, and elective.[2] ASCs compete in an increasingly…
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Introduction (Part I of V) Ambulatory surgery centers (ASC) grew dramatically until 2008 and during the growth period provided services previously only available at hospitals. In this five-part series, the authors first discuss the emergence and decline of ASCs, the forces driving growth and contraction, and how the ASC business model differs from that of hospitals. The remaining articles in this series discuss: 1) the regulatory environment of the ASC industry; 2) the reimbursement environment of the ASC industry; 3) the competitive environment of the ASC industry; and 4) the technological environment of the ASC industry. These provide a brief…
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Technology (Part V of V) Over the past decade, there has been a rapid adoption of technological innovations in the U.S., which has fundamentally changed the healthcare delivery system, improving the quality of patient care, as well as the efficiency of healthcare processes and practices. Research indicates that implementation of healthcare information technology (HIT) may lead to improved efficiency and quality management, especially in rural areas. This article, the last in the five-part rural healthcare series, will discuss the various technological advancements that may assist rural health clinics (RHCs) in providing more tailored and advanced care to a greater number…
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Regulatory Issues (Part IV of V) As discussed in the first installment of this five-part series, rural health clinics (RHCs) are statutorily-created entities, established via the Rural Health Clinic Service Act of 1977. These providers face a range of federal and state legal and regulatory constraints, which affect their formation, operation, and transactions. This installment will discuss two important regulatory issues affecting RHCs: licensure requirements, and fraud and abuse law compliance. As discussed in the first installment of this five-part series, rural health clinics (RHCs) are statutorily-created entities, established via the Rural Health Clinic Service Act of 1977.[i] These providers…
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Reimbursement Environment (Part III of V) The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and has a strong influence on healthcare reimbursement. In 2017, Medicare and Medicaid accounted for an estimated $705.9 billion and $581.9 billion in healthcare spending, respectively. The prevalence of these public payors in the healthcare marketplace often results in their acting as a price setter and being used as a benchmark for private reimbursement rates. This is particularly true for RHCs, which tend to serve a disproportionately large Medicare population. This third installment in the five-part series on RHCs will…
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For Rural Health Clinics Competition (Part II of V) As discussed in the first installment of this five-part series regarding Rural Health Clinics (RHCs), the significant proportion of RHCs operating at a loss has led to an overall reduction in the number of RHCs. Despite this decrease, the demand for RHCs continues to rise, limiting access to care for patients in rural communities. This second installment will review the competitive environment of RHCs. As discussed in the first installment of this five-part series regarding Rural Health Clinics (RHCs), the significant proportion of RHCs operating at a loss has led to…
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for Rural Health Clinics (Part I of V) The first of a five-part series where the authors describe the issues encountered valuing rural health care clinics. This first article discusses fair market value considerations for rural health clinics. Introduction Rural health clinics (RHCs) are specially certified entities that were created in order to increase access to primary care services for patients located in rural communities.[1] RHCs were established via the Rural Health Clinic Service Act of 1977, which law was promulgated to address the increasing shortage of healthcare services in rural areas.[2] These clinics are specially licensed healthcare organizations through…
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Private Equity’s Fast and Furious Entry into Healthcare (Part III of III) The third of this three-part series examines why private equity and venture capital firms are targeting the healthcare industry and the issues that they encounter managing their healthcare portfolio. Private equity (PE) and venture capital (VC) firms are attracted by the potential for growth that exists in the healthcare industry; however, significant barriers also exist that may limit the expansion of PE and VC in healthcare, including the requirement for specialized knowledge to understand the operations of a clinical services provider, healthcare industry specific regulatory issues, latent long…
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Fair Market Value Considerations (Part II of II) The first of this two-part series reviewed the unique value drivers that impact the typical valuation approaches, methods, and techniques that are often utilized in determining the value of these enterprises in the current healthcare delivery system. This second part will discuss the value drivers related to home healthcare and hospice enterprises. Introduction As discussed in Part I of this two-part series on the fair market value (FMV) considerations of home health and hospice enterprises, home healthcare enterprises are those enterprises that coordinate the delivery of healthcare services to patients in their…
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Fair Market Value Considerations (Part I of II) The valuation of home healthcare and hospice enterprises and services are influenced by certain market forces related to the Four Pillars of Healthcare Valuation, i.e.,: (1) regulatory; (2) reimbursement; (3) competition; and, (4) technology—each of which relates to almost all aspects of the U.S. healthcare delivery system. This first of a two-part series on home health and hospice enterprises will review the unique value drivers that impact the typical valuation approaches, methods, and techniques that are often utilized in determining the value of these enterprises in the current healthcare delivery system. Introduction…
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Introduction: The Fundamentals of Private Equity (Part I of III) Why is private equity becoming increasingly involved in the business of healthcare? How will their involvement affect the delivery of services? This first installment of a three-part series will describe the fundamentals of the private equity industry, in general, and set forth a common terminology that will be utilized throughout the series. The second and third installments will further discuss the trends in private equity utilization in the healthcare industry. A more detailed version of this article appears in The Value Examiner, January/February 2019 issue. The remaining issues will be…
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About the Business of Healthcare Araliya Valuation Consulting (AVC), based in Tampa, FL, surveyed over 1,000 physician business owners to find out their perspective on the current healthcare environment, in a business context. AVC team surveyed several medical specialists, including: dentists, ophthalmologists, psychiatrists and psychologists, family medicine practitioners, chiropractors, podiatrists, physical medicine and rehabilitation providers, pediatrics, orthopedic surgeons, and internal medicine providers, among other disciplines. This article summarizes the survey results. Araliya Valuation Consulting (AVC), based in Tampa, FL, surveyed over 1,000 physician business owners to find out their perspective on the current healthcare environment, in a business context. AVC…
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In an Era of Reform: Value Drivers (Part II of II) As stated in Part I of this II-part series, as the demand for healthcare services continues to grow, the site at which these services are performed is experiencing a simultaneous transformation from the inpatient (e.g., hospital) setting to the outpatient setting—e.g., at ambulatory surgery centers (ASCs). This article will review the unique value drivers that impact the typical valuation approaches, methods, and techniques that are often utilized in determining the value of ASCs in the current healthcare delivery system. Introduction As stated in Part 1 of this two-part series,…
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In an Era of Reform (Part I of II) As demand for healthcare services continues to grow, the site at which these services are performed is experiencing a simultaneous transformation from the inpatient (e.g., hospital) setting to the outpatient setting. This transformation is being driven by factors such as: (1) technological advancements; (2) an increasingly consumer-driven and convenience-driven healthcare delivery environment; (3) pressure from payors; (4) patient demand; and (5) the entrance and diversification of new and different outpatient enterprises. One such example of a growing subset of outpatient enterprises includes ambulatory surgery centers (ASCs). ASCs can be affiliated with…
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Conclusion (Part Six of a Six-Part Series) The first installment of this six-part series set forth 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 through fifth installments reviewed the due diligence process related to the reimbursement, regulatory, competitive, and technological environments, respectively. This series conclusion will review the due diligence process generally as it relates to the healthcare industry. For more detailed information, see the September/October issue of The Value Examiner.
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Finding Value in the Continuum of Care Under Changing Healthcare Reform
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to Valuation of a Healthcare Practice or Entity A valuation consultant must understand the type of healthcare entity he or she is valuing, the opportunities and risks as discussed above, the potential buyers, the marketplace, and typical valuation multiples for specific types of deals. Extensive research into these areas will lead to a significantly better and more informed valuation. The author discusses the different buyers, motivations, and trends.
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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 reimbursement, regulatory, and competitive environments, respectively. This fifth installment reviews the due diligence process as it relates to technology in the healthcare industry. For more detailed information, see the July/August issue of The Value Examiner.
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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 regulatory environments, respectively. This fourth installment will review the due diligence process as it relates to competition in the healthcare industry.
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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 and specialty research may be considered the “work-in-progress” of patents, copyrights, trademarks, or other intangible assets, and this research usually entails the use of trade secrets, i.e., special “know how” that is often protected (or padlocked), in contrast…