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

Selling a Medical Practice to a Hospital

The number of physician practices which are sold to hospitals and other healthcare entities has varied widely over the last few decades. In recent months there has been increased talk regarding hospitals making these purchases. In the annual meeting of the NSCHBC, great sessions were offered regarding a number of issues concerning medical and dental practices. One particular session discussed hospital-physician integrations and the sale of medical practices to hospitals. It was surprising to hear that the volume of these hospital deals have been picking up, but as expected, hospitals are largely unable to pay physician sellers for the full market value of their practices (largely comprising goodwill). A piece in the AMA News was also written recently about physician practice management companies getting back into the game and buying medical practices. But the volume of these deals pales in comparison to the acquisition mania of the 1990's and they mostly seem to be inpatient practice purchases. Corporate deals and larger-entity acquisitions are still happening but have not picked up major traction as many had expected. Large corporate buyers and other healthcare entities may be cautious in an uncertain regulatory and reimbursement climate. However, physician-to-physician practice sales still seem to be flowing at a steady rate. The ability of hospital purchases to be successful depends on how the selling doctor is able to function (or not) within the structure of the acquiring entity. It is often difficult to give up the autonomy of a private practice and work under the direction of a larger entity, even with the added security and economies of scale available to the seller. Also crucial is how the post-sale physician compensation agreement is structured. It will be interesting to monitor the staying power of these deals and see whether they will unravel over time. The changing dynamic in regional markets dictates much of this. It may be a good option (or the only option) for some practices to sell to hospitals, but for the ones which are more marketable it is generally better to sell to another group or individual physician buyer. Hospitals can't pay sellers for goodwill value like other buyers can. Most physician sellers continue to seek all-cash transactions for the sale of their practices and are largely able to receive these deals from buyers who can obtain practice acquisition financing. As long as private party transactions continue in number, the volume of hospital purchases at lower valuations will not increase exponentially as many have speculated. Many retiring doctors who hear about these transactions may wonder if selling their practice to a hospital is a viable option. The answer truly depends on a number of factors but many of the determinants are ultimately related to the accurate assessment of the fair market value of the practice.

Physician Practice Appraisal Valuation Services

Medical Practice Appraisers - Specializing in the valuation of medical practices and clinics.

MPA's medical practice appraisers and valuation analysts apply deep knowledge and technical expertise in determining fair market value for your medical practice.

Utilizing accepted standards of value and specific understanding of medical market dynamics enables us to provide accurate practice valuations. Appraisals are used for various purposes including:

• Sale of a medical practice
• Partner buy-in or buy-out
• Medical practice merger or consolidation
• Practice financing
• Divorce, estate, tax, or financial planning
• Practice performance evaluation and analysis

A medical practice may be one of your most valuable assets, making the accurate determination of its value especially critical. Why rely on unsubstantiated rules of thumb, gross multipliers, and inaccurate comparable transactions to determine value?

Hammer Museum Forum on Health Care Reform

It will be interesting to see the effect of health care reform on the valuation of medical practices and the sale of medical practices. Reform touches on numerous areas which can impact practice valuation and ultimately affect the purchase, sale, and merger of these healthcare business entities. I will be attending a forum on Wednesday at the Hammer Museum in Los Angeles entitled: Health Care Reform - Government Takeover or Corporate Welfare? I've attended some of these events at the Hammer Museum in the past and they've been very informative. The speakers are usually very accessible, which is great for getting your questions answered.

Dedicated practice valuation service: Medical Practice Appraisers

We've launched a dedicated service for practice valuation: Medical Practice Appraisers. Click the picture below to arrive at our landing page.

Healthcare Economic Forecast - UC Irvine

For many of us who are not able to attend this event, UC Irvine has been gracious enough to post video of the Annual Healthcare Economic Forecast. This is a phenomenal conference featuring heavyweights from public and private institutions. I hope to attend next year's forum.

"Over the past 19 years, the annual Health Care Forecast Conference has become a leading national forum for discussing the economics and politics of healthcare. Each conference includes an economic forecast for the healthcare industry, a federal budget outlook, updates on state healthcare issues, and the latest industry trends, giving participants a broader and deeper understanding of the forces that affect the way health care is delivered in this country. This highly respected event provides knowledge and insights to leaders in the private and public healthcare sectors who are grappling with complex problems during an era of unprecedented change."


HEALTH CARE REFORM IN AN ELECTION YEAR,
February 25-26, 2010

Presented by the
Center for Health Care Management and Policy
The Paul Merage School of Business
University of California, Irvine
Welcome to the taped webcast of
The 2010 Health Care Forecast Conference
This webcast is supported by the
California HealthCare Foundation, based in Oakland, California

Principal Benefactor
California HealthCare Foundation

Major Benefactors
Cigna Health Care of California
Hoag Memorial Hospital Presbyterian
Kaiser Permanente

Benefactors
Anthem Blue Cross
Aon Consulting
Beckman Coulter Foundation
Blue Shield of California
UnitedHealthcare

Co-Benefactor
Orange County Medical Association

Buying a Medical Practice - Practice Evaluation when purchasing

Questions to ask when buying a medical practice

See more presentations by cjrr11 | Upload your own PowerPoint presentations

Sale of physician practices to hospitals and ppmc's

Just got back from the annual meeting of the NSCHBC. Great sessions were offered regarding a number of issues concerning medical and dental practices. One particular session discussed hospital-physician integrations and the sale of medical practices to hospitals. I was surprised to hear that the volume of these hospital deals have been picking up, but as expected, hospitals are largely unable to cash-out physician sellers. I also read a piece in AMA News recently about physician practice management companies getting back into the game and buying medical practices. But the volume of these deals pales in comparison to the acquisition mania of the 1990's and they mostly seem to be inpatient practice purchases. Corporate deals and larger-entity acquisitions are still happening but have not pick up major steam as many had expected. Many buyers will continue to be cautious in an uncertain regulatory and reimbursement climate. However, physician to physician practice sales still seem to be flowing at a steady rate.

Annual Meeting of the National Society of Certified Healthcare Business Consultants

The annual society meeting just finished up today in Palm Beach Gardens Florida. It was a fantastic opportunity to meet colleagues, vendors, and new contacts. Session topics were very informative and covered a broad spectrum of issues concerning medical and dental practices, as well as strategies we can employ as practice consultants:

• Lean six sigma for the medical practice
• Dental practice marketing and trends
• Impact of the New York Ingenix case on setting fees
• The consultant's role in hospital-physician integrations
• Dental practice valuation and transitions
• Dental practice statistical benchmarks
  
• EMR implementation
• LinkedIn and social media marketing
• Medical economics roundtable
• Medical practice legal risks
• Troubled practice turnaround - medical practice debt restructuring
• PQRI registry reporting
• NSCHBC practice statistics
• How to turn satisfied patients into loyal patients

The society has a lot planned for the upcoming year and it's a great time to join our organization. NSCHBC also offers has a practice statistics product which I highly recommend. Check it out: Medical/Dental practice income and expense averages.

Sale of a Medical Practice - Primary Care - San Diego California

Selling a family primary care medical practice in a highly desirable coastal community of San Diego County. 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. Contact one of our practice brokers for details: San Diego Medical

What to consider when selecting a valuation professional for a medical practice appraisal.

Obtaining a professional opinion of the value of your medical practice can be helpful in a number of capacities. One major catalyst when it comes to obtaining a practice appraisal is a transaction or anticipated transition in the practice. This may involve buying or selling a practice, divorce, estate planning, medical practice financing, merger, consolidation, or other business combination. Various considerations come into play when seeking a qualified appraiser to value the practice. An appraiser should take into account the multiple valuation approaches per industry standards and accepted guidelines, in addition to providing a competent application of these principles given the subject practice. Medical practice appraisers should use a number accepted methodologies suggested by the IRS, The Appraisal Foundation’s Uniform Standards of Professional Appraisal Practice, and standards of appraisal for medical practice valuation. Equally important is the value judgment when it comes to gauging the risk factors and growth rates applicable to the subject practice, the medical specialty, and industry as a whole. A good medical practice appraiser will use correct assumptions of growth in the specific specialty and region, and will know how practice value is affected by supply and demand side factors, reimbursements, and structural changes to health systems. The valuation of medical practices can be confusing and fraught with conflicting information, especially when it comes to using appraised value for selling and buying practices. The key to selecting a good practice appraiser is working with one who understands these dynamics yet can provide a valuation at arms-length. The appraiser should be keenly familiar with the medical practice focus, as general business appraisal principals can be grossly inaccurate when they aren’t nuanced for the specific nature of the practice environment. Obtaining a practice valuation opinion is the first step in understanding what the practice may be worth and can be very helpful in structuring deals for outright sales, buy-ins, buy-outs, mergers, and consolidations. Having an informed basis makes it easier to justify value and price points to ultimately achieve the given transition objective.

Medical practice appraisal, valuation, sales, financing, and practice evaluation.