Valuation Implications The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and consequently has a strong influence on reimbursement to healthcare providers. The 2025 proposed fee changes are significant. This article focuses on the proposed fee changes and how these changes may affect valuations of healthcare practices. The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and consequently has a strong influence on reimbursement to healthcare providers. The prevalence of these public payors in the healthcare marketplace often results in their acting as a price setter and being used as…
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Patchwork Approach Continues in Congress On March 9, 2024, President Biden signed into law a $460 billion spending package to continue funding the federal government for the remainder of the 2024 fiscal year. Contained within the spending package was legislation to cut in half the 2024 Medicare physician payment update of approximately -3.4%. This article discusses the payment update, other healthcare provisions contained in the bipartisan spending bills, and responses from stakeholders. On March 9, 2024, President Biden signed into law a $460 billion spending package to continue funding the federal government for the remainder of the 2024 fiscal year.[1]…
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Reasons for the Recommendation and Responses On March 15, 2023, the Medicare Payment Advisory Commission (MedPAC) published its annual Report to Congress regarding the status of the Medicare program. Among other areas, the report detailed policy recommendations for the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage (MA) program, and the Medicare prescription drug program (Medicare Part D). This article will review the recommendations made by MedPAC and responses from industry stakeholders. On March 15, 2023, the Medicare Payment Advisory Commission (MedPAC) published its annual Report to Congress regarding the status of the Medicare program.[1] Among other areas, the report…
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Center for Medicare & Medicaid Publishes Proposed and Final Rules on Medical Reimbursement Rates The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and consequently has a strong influence on physician reimbursement. 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. Consequently, changes to Medicare and Medicaid payment rates are notable as they may indicate a shift in the greater healthcare reimbursement landscape. Over the summer, the Centers for Medicare & Medicaid Services (CMS) released…
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Regulatory (Part IV of V) 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. ASCs typically provide relatively uncomplicated surgical procedures in a non-hospital, outpatient setting, and most ASC cases are non-emergency, noninfected, and elective. This fourth installment will discuss the regulatory environment in which ASCs operate. [su_pullquote align=”right”]Resources: Valuation of Ambulatory Surgery Centers—Introduction (Part I of V) Valuation of Ambulatory Surgery Centers—Competition (Part II of V) Valuation of Ambulatory Surgery Centers—Reimbursement…
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Reimbursement (Part III of V) 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. The facilities typically provide relatively uncomplicated surgical procedures in a non-hospital, outpatient setting, and most ASC cases are non-emergency, noninfected, and elective. This third installment on the valuation of ASCs will discuss the reimbursement environment of ASCs. [su_pullquote align=”right”]Resources: Valuation of Ambulatory Surgery Centers—Introduction (Part I of V) Valuation of Ambulatory Surgery Centers—Competition (Part II of V) [/su_pullquote]…
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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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Planning their daily routine in retirement could be less complicated than most clients think, writes a Wall Street Journal columnist. In fact, most of what they will do as retirees are found in their current daily chores. “[T]he average day in retirement involves a fair amount of puttering,” which “typically doesn’t cost a lot of money,” the columnist writes. It is good news for clients who are worried about burning through their savings. To read the full article in Financial Planning, click: Daily Life in Retirement is Loss Costly than Clients Think.
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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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Elder financial fraud happens “at an alarming rate” and is often perpetrated by relatives, said Ted Sarenski, CPA, PFS. Protect against elder financial fraud by safeguarding assets, following scam alerts, and monitoring accounts. To read the full article in The Lifeline Blog, click: Don’t Get Ripped Off! What You Need to Know About Elder Financial Fraud.
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Many long-term investors have amassed substantial capital gains since the market bottomed out in March 2009. While great-looking on paper, such gains have real tax implications for engaging in even routine investment adjustments. To read the full article in FinancialPlanning, click: Kitces: Three Strategies for Managing Big Capital Gains.
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The key to implementing this suggested strategy is establishing auto-IRA plans to workers who lack a 401(k) option with a preset percentage of wages to be contributed to the plan. This would create a retirement nest egg that would not be linked to any one employer, but rather would stay with the worker throughout a career. To read the full article in FinancialPlanning, click: Could this Simple Social Security Strategy Solve the Retirement Crisis?
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Since 2007, the Medicare Modernization Act of 2003 has required high-income Medicare enrollees to pay an Income-Related Monthly Adjustment Amount surcharge, or IRMAA, on their Medicare Part B premiums. This lifts the premium from covering just 25% of costs up to as high as 80% of results, and increased Part B premiums by as much as 219% in 2017 alone. To read the full article in FinancialPlanning, click: The Value of Medicare Surtax Planning.
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Why Annual Medicare Coverage Reviews Benefit Clients Annual reviews can ensure clients who are Medicare beneficiaries have the coverage they need. During the Medicare Open Enrollment period, which starts Oct. 15, clients can select different prescription drug coverage, move to a Medicare Advantage plan, or make other changes to their coverage. PFP/PFS Section members can access over 100 ready-to-go, client-friendly communication pieces about Medicare in Broadridge Advisor. To read the full article in the InvestmentNews, click: Stay Up on Medicare Enrollment with Annual Reviews.
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When helping clients claim Social Security benefits, past planning strategies may act as the best guides. Over the last several months, we published dozens of stories including insight from advisers and analysts on Social Security planning tips and strategies. Some of these include insight related to long-term funding issues, clients working abroad, evaluating the impact of taxes as well as tips for dealing with Gen X and millennial clients. To read the full article in Financial-Planning, click: Social Security: Help Clients Grab Every Last Dollar of Benefits.
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Some American workers are worried about their financial security in retirement, according to a Transamerica survey. In this article, Todd Campbell looks at five common fears involving retirement and how they can be addressed. To read the full article in The Motley Fool, click: How to Address Common Concerns About Retirement.
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Why Clients Need to Discuss End-of-Life Care Baby boomers are at the forefront of the conversation around end-of-life planning, which should include discussing end-of-life treatments with family members and physicians, and designating health care proxies. Elizabeth O’Brien, retirement reporter, also suggests reviewing elder planning tools and resources, which includes a free consumer End of Life Guide. To read the full article in MarketWatch, click: You Need to Talk to Your Doctor About How You Want to Die
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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 the proposed CMS changes announced in July 2015 could impact gastroenterological and endoscopy group practices.
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In this second part of a two-part series, the authors discuss why and when the highest and best use standard should apply.
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Traditional valuation methodologies have relied upon the analysis of historical accounting and other data as predictive of future performance and value. However, this may not hold true with every economy, industry, or even every enterprise within an industry, over time. For example, the turbulent status of the healthcare industry over the last five decades, since the passage of Medicare in the 1960s, has introduced intervening events and circumstances that have had a dramatic effect on the revenue, expense, and subsequent net economic benefit stream of enterprises operating in the healthcare marketplace. Accordingly, the “road map of historical performance” of healthcare…