Optometry Startup Project Completed

St. Cloud Eye Care is a start-up optometry office in Florida which we helped to secure loan financing... The physical build out just came to completion it really turned out well. Previous pictures of this vision care office during construction can be found here: St Cloud Eye. Fantastic job!!

LA Times Article - ACO's, Physician-Hospital Practice Sales, Employment, Alliances

An article in the LA Times discussing Accountable Care Organizations and Physician-Hospital Practice Sales, employment arrangement, and alliances. The article touches on many points of a multifaceted phenomenon without going into additional depth. It's an interesting read for some basic observations of many issues pertaining to healthcare mergers, acquisitions, and alliances. Below I've included some key passages from the article. The last quote I've highlighted is important to note. The changes occurring are undeniable but the level of fear seems to drive many into a frenzy. There will be many more mergers and consolidations among medical practices, hospitals, and health systems, but whether these deals are driven by logic or fear will depend on how changes in the greater healthcare environment will actually play out.

"Three of San Antonio's hospital systems are competing to form alliances with local doctors who are giving up their private fee-for-service practices in exchange for paid positions on a hospital's team. Healthcare experts have long argued that such a unified approach to medical care offers the best hope for improving quality and saving money. While a few institutions such as the Mayo Clinic and Kaiser Permanente have thrived doing this, the entrenched, competing interests of providers were widely seen as a barrier to nationwide change. It is possible the current rush will fail to reproduce the best models or their results. Further consolidation in the $2.5-trillion healthcare industry might drive up costs for everyone. It could also reprise problems from the 1990s, when HMOs were criticized for restricting patient choice and access to care...

...But some experts and providers see the new courtship dances as a surprisingly hopeful sign. The healthcare debate may have helped spark doctors, hospitals and others to rethink what they do, raising the prospect of better outcomes for millions of Americans. Not everyone is interested in these overtures. Dr. Manuel M. Quinones Jr., who dissolved a partnership with Santa Rosa several years ago, said physicians should be wary. "When a hospital controls the lion's share, it will always be first in line to get the money," he said. But like Carrier, many doctors in San Antonio see a changing world in which it's increasingly difficult to practice on their own. "It's scary," said Dr. A. Charles Rabinowitz, a cardiologist who has watched many colleagues sell their practices. "There is a lot of paranoia out there."

Allied Health and Healthcare Businesses for Sale - New Category on TC Website

We've recently added a new category on the website for Allied Healthcare Practices and Healthcare Businesses for sale. This is the result of new listings for a variety of businesses including Diagnostic Service Facilities, Home Health, and Assisted Living, as well as Allied Health including Physical Therapy and Podiatry practices. These haven't been traditional areas of focus for us but we've taken on selective assignments and affiliate listings as deemed appropriate. There are number of good opportunities for buying healthcare businesses through our organization.

Inland Empire California - Selling Assisted Living Home Health Business

Assisted living business for sale. Real estate included. Live-in quarters and office included in this large 2,000 square feet home, built in 1972. Included in the purchase is a van used for transportation of patients. This business has an excellent reputation in the surrounding community. Buyer needs criminal clearance, live scan, with DOJ and FBI. May take 6 months to qualify but will be a condition of the sale of the business to obtain the proper permits. The seller is able to stay on board as the administrator and the care-giver of record until the process is completed. Many patients come as referrals. Potential for growth opportunity through maintaining a higher occupancy rate. Average patient pay is $2500 per month; high-end patient pay from those who are financially capable is ~$4300 per month. Assisted living facilities can be rewarding healthcare business opportunities, providing safe, secure, and welcome environments for those in need during the later stages of life. Please inquire for details.

Orange County California - Selling an Urgent Care Clinic

Orange County California - Selling an Urgent Care / Primary Care medical practice. Gross collections in excess of $1,500,000 annually on 1.5 FTE MD providers. Providing an array of testing and ancillary services including X-Ray, Lab, Dexa scan, Spirometry, EKG, Scope sigmondoscopy & EGD, Drug screening. Large 3000+ square foot medical office space with 10 exam rooms, three doctor's offices, x-ray room and lab. Payor mix: Medicare: 45% PPO: 30% Patient Pay: 10% Medicaid: 5% Other Insurance: 10%. Source of new patients: patient referrals, other physicians, walk in patients. Well-run operation with efficient staff and good payor mix. Seller is willing to remain with the practice and work part time, if desired by Buyer. Medical practice loan financing available.

Selling Optometry Office - Philadelphia area

Selling optometry office in a Philadelphia Suburb. Practice grossing $920,000+ in 2009. Reputable, long established with an emphasis on contact lenses and primary care. Located in a desirable, rapidly growing community. Optometry acquisition loan financing available.

Forbes.com - The Worst-Paying Jobs for Doctors

An article from Forbes.com regarding the disparity in pay between primary care physicians and specialists: physician employment. This article also discussed student loans which are posing a potential burden on physicians who enter the workforce. Some of the salary data which I've observed myself in the field is even lower than the amounts cited in the article: "At $180,000 for pediatricians and $175,000 for family practitioners, primary care providers make an awful lot less than the typical orthopedic surgeon, who makes $519,000, or a urologist, who earns $400,000, according to the Merritt Hawkins data. That disparity has contributed to a serious shortage of primary care doctors. The American Medical Association predicts a shortage of 35,000 to 40,000 primary care physicians by 2025." Much of the same information regarding physician pay and physician supply has been covered in a variety of media outlets. From my perspective, all of this information is interesting to note as it relates to the value of physician practices. I see truth to these concerns but the overall doom-and-gloom which is preached when it comes to the appraisal of medical clinics is blown out of proportion (in my opinion). There is such a wide range of variation as it relates to specific practices and regions that it's impossible to apply these broad observations of american healthcare to every practice in this country. That's where an appraiser's competency plays a role in determining the degree to which these variables apply to the specific project.

REITs and Healthcare Real Estate Acquisitions

Interesting news item regarding the acquisition of St. Vincent Medical Office Building in Cleveland by Grub & Ellis Healthcare REIT II. Their list of acquisitions is growing. I've also been looking at growth in a variety of other healthcare REITs including HCP. There certainly will be a growing need for physical space in which to render patient care and house staff. REITs have been buying a variety of properties including medical offices, professional buildings, hospitals, and large tertiary care facilities. I'm interested to see how these healthcare real estate deals will be impacted by changes in health economics and policy. My primary concern is the potential impact of lower reimbursements on healthcare entites who occupy these spaces, and whether occupany and lease rates will suffer as a result. These REITs likely have developed strategies to deal with these future uncertainty, but the spectre of change still looms.

Best Hospitals 2010-11: The Honor Roll

Was reading MSN health and came across this article on rankings of large tertiary hospitals and medical centers.

From MSN Health By Avery Comarow, U.S. News & World Report Best Hospitals 2010-11: The Honor Roll "The new U.S. News rankings showcase 14 hospitals with high scores in six or more specialties.

Rank	Hospital	Points	Specialties
1	Johns Hopkins Hospital, Baltimore	30	15
2	Mayo Clinic, Rochester, Minn.	28	15
3	Massachusetts General Hospital, Boston	27	15
4	Cleveland Clinic	26	13
5	Ronald Reagan UCLA Medical Center, Los Angeles	24	14
6	New York-Presbyterian University Hospital of Columbia and Cornell	21	11
7	University of California, San Francisco Medical Center	20	11
8	Barnes-Jewish Hospital/Washington University, St. Louis	17	10
9	Hospital of the University of Pennsylvania, Philadelphia	16	12
10	Duke University Medical Center, Durham, N.C.	16	10
11	Brigham and Women's Hospital, Boston	14	10
12	University of Washington Medical Center, Seattle	14	8
13	UPMC-University of Pittsburgh Medical Center	13	8
14	University of Michigan Hospitals and Health Centers, Ann Arbor	12	8

Great tool from the American Medical Association - 2009-2010 RBRVS Calculator

Though a bit dated, the AMA has a cool resource which you can download from their website. I just came across it, so maybe I'm the one who's dated!! It's an RBRVS calculator showing the SGR cut without passage of H.R. 3961.

From their website:

Download the 2009-2010 RBRVS Calculator
"Find out how the 2010 SGR cut will affect you if Congress does not pass H.R. 3961, the “Medicare Physician Payment Reform Act of 2009”. This free software program, developed by MIT Solutions, Inc., reports individual RVUs and calculates adjusted and unadjusted totals as well as calculating the Medicare allowable. This program performs both a complete RBRVS analysis for the 2009 database as well as a practice- or physician-specific Medicare financial impact analysis by comparing RVU, conversion factor and Medicare frequencies for 2009 data to 2010 data."

Selling gastroenterology gi clinic missouri

Missouri - Selling gastroenterology GI clinic. Collecting $550,000 annually with a very low overhead & minimal call schedule. Owner's net income of ~$450,000 annually. Specializing in gastroenterology gi procedures and digestive diseases. Good sized medical office space with 3 exam rooms and 2 doctor's offices. Comfortable suburban community near hospital and large referral base of patients. Most common in-office outpatient procedures are infrared coagulation treatment for hemorrhoids and capsule endoscopy. New patients primarily come from patient referrals, other physicians, and directories. No emergency call. Well balanced insurance and payor mix. Seller will provide generous transition assistance to incoming buyer. Physician purchase financing available

Missouri - Gastroenterology Practice for sale

Missouri - Gastroenterology Practice for sale. Collecting $550,000 annually with a very low overhead & minimal call schedule. Comfortable suburban community near hospital. Generous transition assistance. 100% financing available.

International Medical Graduates in General Surgery: Increasing Needs, Decreasing Numbers

International Medical Graduates in General Surgery: Increasing Needs, Decreasing Numbers

Conclusion of this study: "General surgeons are in high demand, and until now have remained inherently dependent on IMGs to reinforce their ranks. Current numbers of IMGs in practice are declining. This decline, coupled with inadequate numbers of trainees in domestic general surgery programs, creates a crisis of urgency."

Interesting to review this study in light of the general surgery practice selling in New Jersey. The physician supply will affect the valuation of medical practices in different ways depending on the specialty, other supply-demand factors, reimbursements, and the prevailing appraisal formula used in medical practice valuation. There is a great demand in general surgery and a declining supply of providers.

ADA: American Dental Association - ADA sees new PECOS enrollment requirement as 'unnecessarily burdensome'

ADA: American Dental Association - ADA sees new PECOS enrollment requirement as 'unnecessarily burdensome'

UC Irvine - Great opportunity for continuing education on minimally invasive surgery!!

UCI has been putting on great seminars and forums. I've especially enjoyed the forum on health policy and economics. They consistently get heavyweights from the public and private sectors to speak at these event. This has been a golden source of information for my research on health economics and the effects on physician practice valuation. UCI is putting on a continuing eduction opportunity in August regarding minimally invasive surgery. It will cover the currently utilized approaches as well as potential future uses. Sounds like a great resource for physicians, surgeons, extenders, and healthcare administrators alike. Minimally invasive surgery is especially applicable to specialized care in Bariatrics, Colon & Rectal, Endocrine, Esophageal & Gastric, Endovascular, Gynecology, Pancreas, Thoracic, Transplant, Urology, and Vascular. Here is the link to the program brochure: http://www.meded.uci.edu/CME/CMEBrochures/MISInviteFinalSinglePage.pdf

Calling all entrepreneurial Dermatologists.....

Are you an entrepreneurial Dermatologist?
Do you have the mojo to successfully own and run a Dermatology practice?
Want to carve out your own niche and purchase a profitable, cash-flowing Dermatology practice?

Selling dermatology practices in the following locations:

Idaho Dermatology Practice Sale - Idaho-Derm-Sale

New York Dermatology Practice Sale - NewYork-Derm-Sale

Texas Dermatology Practice Sale - Texas-Derm-Sale

Maryland Dermatology Practice Sale - Maryland-Derm-Sale

Nevada - Open MRI and Ultrasound facility for sale

Open MRI and Ultrasound facility for sale in Nevada. Gross collections of 1,000,000 annually. GREAT location surrounded by a vibrant medical community. The facility boasts a beautiful environment unlike any other facility in the marketplace. High back leather chairs, walls of artwork, soft colors, hard wood floors, etc. give the facility a home-like, non-clinical and soothing setting that leads to a high level of patient satisfaction. The facility is fully staffed and all equipment (Hitachi Aris II, 2 Ultrasound units, and one Bone Density unit) fixtures, supplies and systems will allow for a first day, first scan opportunity.

*actual equipment not shown*

Selling a Dermatology Practice - Dallas Texas Practice Sale

Selling a Medical Practice - San Diego Family Practice for Sale

Practice sale: Family medical practice located in a highly desirable coastal community. Exceptional primary care practice collecting $1,700,000 annually with solid earnings. Beautifully designed, state of the art facility with x-ray, lab, and dedicated surgical suite. Established practice providing top notch care with a host of ancillary services. Well-run and efficient operation.

Additional Info on Sale of Dermatology practice in Texas

Additional information on the practice sale mentioned below: Dermatology Practice for sale in Dallas Metro area. This solo-MD practice consistently collects $2,000,000+ annually with owner’s income in excess of $1,000,000. Situated in an upscale 5,000 square feet freestanding building with 6 fully equipped exam rooms, 3 surgery suites, lab, offices, spacious reception area, conference room, on-site storage and employees room. Service mix: 95% medical dermatology, 5% cosmetic dermatology. Payor mix: PPO 60%; Medicare 25%; HMO 10%; Self pay 5%. Owner would be interested in continuing to work based on buyer’s desires and is available as necessary to facilitate a smooth transition.

Texas - Dermatology practice for sale in Dallas Fort Worth Metro

I have an exceptional dermatology practice coming up for sale in Texas, Dallas Fort Worth Metro area. This is a great opportunity to buy a dermatology practice with strong cash-flow in a great market. Below is a picture of the outside...Great looking building and excellent location. For further details please call directly at 800-416-2055 or use the following contact form to speak with a practice broker. Thanks. -Chris