Core Finance Team Affiliates, LLC v. Maine Medical Center—The Distinction Between Quantum Meruit and Unjust Enrichment What is the difference between a claim of quantum meruit and unjust enrichment? This very issue was addressed in Core Finance Team Affiliates, LLC v. Maine Medical Center and is discussed in this article. The legal profession is famously hidebound; for goodness’ sake, they still where robes and wigs in English courts. As a result, they still throw around many Latin phrases, which can lead to confusion. In Core Finance Team Affiliates, LLC v. Maine Medical Center, 2024 ME 78, 2024 Me. LEXIS 85…
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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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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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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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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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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 operate.
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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 explanation of the due diligence process.
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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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Compensation for PCPs is increasing The increasing supply shortage of primary care physicians (PCPs) will have a significant impact on physician compensation. In turn; this will have an equally powerful effect on the valuation of PCP practices.
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Four things valuators should know about medical claims and coding In this second installment of his review of medical claims coding, Mr. Moffatt sets forth his final two examples that explain the unique circumstances of the medical practice revenue cycle that affect cash flow and how they relate to the valuation of a medical practice. Part 1 of this article was published on March 4, 2014.
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Changes in the capital markets utilized in financing healthcare transactions have transformed the way that the healthcare providers and enterprises operate within the current transactional marketplace, explains Robert James Cimasi. These changes, particularly in recent years following the “Great Recession,” relate to both the availability of capital sources and the types of financial instruments used. As the healthcare industry faces a changing paradigm, the increased need for healthcare consulting services has been met by professionals who have entered the consulting arena from a diverse array of professional backgrounds, e.g., accounting, finance and economics, insurance, etc.