Completed Optometry Office Startup Financing

We just completed a new optometry startup financing project in Houston Texas. The practice will provide the full scope of vision care services including: comprehensive eye exams, contact, contact lens fitting, treatment of ocular diseases and trauma, pediatric vision exams, LASIK laser eye surgery consultations, sports vision & eye nutrition, and latisse. Updated pictures from the launch of the new optometry office are posted on our website.

Practice Valuation for Associate Doctor Buy-in

There are many considerations in an associate buy-in/buy-out arrangement. Practice valuation is one of these important aspects to consider in deal negotiation. Appraisal can also impact the mechanics of a structured buy-in occurring over many years. In these types of arrangements, the buying doctor often purchases multiple minority interests from the selling doctor on a piecemeal basis over a set time line. This makes the proper calculation of discounts and premiums of utmost importance. Check out the article about appraisal for buy-in on MomMD, a website geared towards the female physician.

Completed Sale: Medical Dermatology Practice In Maryland

We just completed the sale of a dermatology practice in Prince George’s County, Maryland. This is a medical dermatology practice collecting $500,000 on 3 days per week of MD coverage. The practice is well regarded and has been in the same area for over 35 years. In the structured deal, the Seller will remain with the practice buyer for a post-employment period to assist with transition.

Optometry practice appraisal and vision care industry

We just completed the appraisal of an optometry practice in the midwest for a partnership buy-in. As part of this project we analyzed the overall vision care industry and specific market in which the practice was located. In assessing fair market value for an optometry practice is it important to consider how health care reform may affect the growth rate and the optometric market overall. The expansion of insurance plans and vision care coverage for small businesses may be a potential benefit to optometric offices. The small business health options program will be a method for small businesses to obtain better rates and plans through pooling. The increase in coverage may be a positive aspect for vision care providers who will have a larger potential patient base to serve. Added to the growing need for optometric services of our aging population, the vision care industry will be a definite area of growth into the future.

Also see my upcoming articles on dermatology appraisal and the practice use of a medical valuation.

Selling Family Medical Practice - Long Island New York

Selling a medical practice in Long Island New York. Well established primary care practice collecting ~1,500,000+ in revenue annually. Also provides a host of ancillary services and respiratory therapy. High quality of care has contribute to the practice growth. Strong referral base from other local physicians. Buyer has the option of retaining the practice seller for long term transition period following the sale. Medical practice purchase financing is available for qualified buyer.

Book Review: Guide to Healthcare Valuation (2010 Edition)

I am currently reading the Guide to Healthcare Valuation (2010 Edition), published by Business Valuation Resources (BVR) and the American Health Lawyer’s Association (AHLA). This is a great resource written by Dietrich and a number of other experienced authors. They cover a wide array of healthcare valuation topics and industry subsectors; it’s hard to find this collective wisdom all in one place. The book is thick…921 pages inclusive of appendices. A valuation book of this size typically means you’re in for a monster technical read, but this book is refreshingly different. There are plenty of practical insights and applications offered by multiple authors over diverse chapters. I was impressed by the 2009 edition of this book, which I would also recommend, and the 2010 edition clearly builds on the first issue in a major way. As I get through more of the book I’ll update this blog with reviews about specific topics and chapters. I’m especially looking forward to the chapters devoted to ambulatory surgery, dialysis, home health, and imaging. Stay tuned.

Using a medical practice appraisal

New article about the use of a medical practice appraisal
I've written a Q&A article about the application of a medical practice appraisal when involved in the purchase or sale of a medical practice. A clear approach and expectation when going through the valuation process can be of great assistance when negotiating a deal. You can find the article on our website.

Q&A from the Institute of Business Appraisers

Great article on the Institute of Business Appraisers website entitled "Building on a History of Excellence – A Discussion with IBA Headquarters on the Future of Business Valuation in the United States". Great information about leadership, standards, and trends within the business valuation community. Visit IBA's News blog to read the entire Howard Lewis interview.

Medical practice appraisal

East Texas Ophthalmology practice for sale | Dallas | eBay Classifieds (Kijiji) | 1189716

East Texas Ophthalmology practice for sale | Dallas | eBay Classifieds (Kijiji) | 1189716

Ophthalmology Practice for Sale: JUST SOLD

SOLD: Ophthalmology practice in Orange County. We just complete the sale of this long established general ophthalmology practice. This practice is located in a popular beach community of Orange County, Southern California. Gross collections of $1,500,000+ annually on part-time physician coverage by the seller. Much growth potential realizable through expanding the scope and coverage of the practice. Payor Mix: PPO: 44% Medicare: 25% Cash: 18% VSP: 8% HMO: 2% Other insurance: 3%. Optometrist and optician are also employed in the practice. Retiring seller is providing transition assistance.

Medical Practice for Sale

Medical practice for sale in the Lake Tahoe area on the border of California and Nevada. This is a primary care practice providing a variety of services including cosmetic and aesthetic procedures (e.g. vein & hair removal and acne treatment). Long established outfit providing office based internal medicine care as well as allergy testing and treatment. Robust income with gross collections averaging $700,000k+ annually and a high net income. Primarily Medicare and PPO insurance with no Medicaid or HMO. The practice is fully equipped and has highly trained staff as well as an EMR System. Medical practice seller will assist new buyer with transition assistance.

Designing an Optical Dispensary for an Optometry Practice

I found an older article on the Review of Optometry website about building a startup optometry practice from scratch, written by Dr. Diecidue OD. An interesting excerpt discusses the design and building of an optical dispensary: Combining the dispensary with the reception area gives patients the opportunity to browse frame inventory while staff helps to pre-select eyewear. Designing the dispensary and reception area to be open and airy is important to create a non-confining or claustrophobic environment. Higher ceilings (9 foot+ ceilings) and windows foster an open atmosphere for browsing frame inventory. The presentation and showcase of frame inventory is also important in driving optical sales. Mapping out the dispensary for patient flow is an equally important part of this process. On the practical aspect of completing a project, the article also discusses startup optometry loan financing.

Funding is usually the crucial first step in getting the project underway. The nuances of project based financing for start-up optometry practices and other vision care offices need to be carefully planned for. I've previously written about the importance of having an optometry business plan and projections, which are good tools in developing an approach to foreseeable challenges when starting from scratch. The transition phase from construction/build-out of the physical space, into the actual practice opening and development of the business as a going concern can be treacherous if not properly addressed in advance.

Urgent Care Startup versus Urgent Care for Sale

I recently read an article discussing urgent care practice start-up alternatives. Many of the options listed involved taking over or purchasing an existing underperforming urgent care center. The points made in the article were fair, but didn’t fully address the option of purchasing an existing urgent care practice with good cash flow. The “fixer upper” mentality may work for real estate but doesn’t always pan out for going-concern medical practices. Buying a successful urgent care practice may be one of the better options available to urgent care physicians. Acquiring a marginal, underperforming practice or converting another specialty practice into a high volume treatment center may cost more in the long run. It can take substantial time to build a location into a well-established practice generating sufficient profits to warrant the specific risk premium. Another factor to consider is the opportunity cost of foregoing better income while the practice is being built up. This is an additional risk added to the actual cost of investing into the practice. Buying an urgent care medical practice which is already proven and generates robust income from the onset may be a better option. This may involve paying a higher price point and taking a larger medical practice purchase loan but can be less risky and more profitable in a shorter timeframe. View one of our current listings: Urgent Care for Sale

Dermatology Practice for Sale in Washington State & accessible to Seattle Metro

Dermatology Practice for Sale accessible to Seattle Metro, located in Washington State. Thriving solo medical and surgical dermatology practice collecting $1,9000,000+ annually on 4 days/week. Beautiful 4000+ sq/ft freestanding building, well designed for optimal efficiency and patient comfort. Approximately 11,000+ active patient charts: 50% PPO, 48% Medicare & 2% Cash. Well trained dependable staff includes 2 physician assistant extenders. Substantial growth potential by opening an additional day and accepting new Medicare patients. Largely untapped cosmetic dermatology market. Small town charm with access to big city amenities in nearby Seattle Metro. Dermatology Practice Acquisition Financing Available.

Healthcare Practice Sales and Financing firm develops new division specializing in Appraisal

Check out our press release Announcing Medical Practice Appraisers as an independent service for valuation and appraisal engagements. We have been retained by a number of medical practices, clinics, and healthcare business entities for these assignments. As a result, our team of valuation consultants and appraisers has grown into a separate division providing a dedicated service. Medical Practice Appraisers (MPA) is a division of Transition Consultants, a recognized leader in practice financing solutions, healthcare business consulting, and medical practice brokerage. For more information call 800-416-2055 or visit Transitionconsultants.com

Internal Medicine Practice For Sale - Lake Tahoe Area

Practice medicine in a fantastic resort area location near outdoor recreation and serene Lake Tahoe. Long established, solo primary care practice providing office based internal medicine, allergy testing & treatment. Also provides some cosmetic procedures including vein & hair removal and acne treatment. Gross collections averaging $700,000k + annually with high net income. Primary payors are Medicare and PPO insurance. No Medicaid or HMO. Fully equipped office, highly trained staff, and EMR System. Seller will assist new buyer with transition assistance.

Business Valuations: Putting a value on valuation

Business Valuations: Putting a value on valuation This is an older article from Accounting Today (2007) covering the development of standards for business valuation and appraisal. Interesting to see how the field has fared under multiple governing bodies trying to promulgate their own standards which don't come in conflict with other standards. These developments are great progress considering the questionable and unfounded valuations that float around out there. Some of the appraisals I've seen are exceptionally bad. Appraisals can involve quite a bit of subjective judgement, but it's widely accepted that appraisers should use generally accepted principles under standards USPAP and other bodies. A bad valuation opinion can be especially detrimental to those who rely on the judgement of valuation professionals in order to make appropriate business decisions (pretty much everyone). One of the best undertakings has been development of standardized language under the international glossary of business valuation terms.

Central California - Pain Management Clinic for sale

Long-established outpatient pain management practice with emphasis on both evaluations and pain management. Collecting $1,600,000+ annually. Services include medication management, pain pump refills, trigger point injections, epidural steroid injections, facet blocks, pump implants. Balanced payor mix and referral sources. Well trained staff and management in place. Seller is willing to provide generous transition assistance to new buyer to ensure a successful transaction. Ideal opportunity for a physiatrist, anesthesiologist, or other physician specialist trained in pain management. 100% financing available.

Refinance Practice Loan - Medical and Optometry

Refinancing a practice loan and consolidating debt can greatly improve cash flow and alleviate working capital needs. However, the process by which a doctor can obtain this type of financing may be less apparent. In a tight economic environment where capital guidelines may be more stringent it is important to plan ahead for this process. A practice loan application may have one opportunity to be considered, and approved or denied based on a myriad of factors which must be anticipated in advance. To have a clear picture of the application going into the process it is vital to keep organized financial statements and tax returns. This will allow a loan consultant to preempt possible issues and prepare supplemental information to support the request. A well-formulated business plan and projections may be required as well. Ample time and sufficient documentation are the key components to preparing for a practice loan refinance and debt consolidation as well as other practice financing requests.

Loans tide over L.A. County health clinics

Community clinics in Los Angeles who rely on Medi-Cal as their primary payor have been dealing with reimbursement shortfalls due to California's budget problem. Cash flow from payor reimbursements is the lifeline of these clinics and they can be especially susceptible when a small number of payors comprise a large portion of their business. Lines of credit and practice staff cuts are some of the short term actions being made to bridge the gap until normal reimbursements return. "Stung by a budget stalemate that is costing Los Angeles County community clinics more than $330,000 a day in reimbursements, many clinic managers have been forced to take out loans and contemplate cuts to staff and services." Small rural practices and health clinics with less access to capital in the interim, likely will find it even more difficult to keep their doors open.

Poll: Buy a practice or start your own?

I found an interesting poll on SDN Forum (from 2009) about practice options as a new physician. The results were interesting but not surprising. As I mentioned on the thread, I see this response from many new physicians who are coming out of medical school with a mountain of debt and are looking for stability. It would be interesting to see the same optometrists and ophthalmologists polled with the same questions after three to five years into their careers. It probable that the response would shift. Producing for a group as an employed physician can have a profound effect on a doctor's perspective. Work experience and production capability can lend confidence in being able to successfully start or acquire a practice.

Poll Options

• How do you plan on beginning your career?
• Starting your own private practice
• Buying somebody's private practice
• Joining a group
• Working in a University setting
• Other

Medical device markets with import restrictions

An article from DotMed on countries who forbid the re-sale of used medical equipment. Worries over safety have led to these countries to impose import restrictions on anything but new medical equipment. With so many underutilized capital assets in Western countries, there are plenty of uses for safe equipment especially in underdeveloped nations.

Selling a dermatology practice in Ohio Northeast

Ohio Northeast - Selling dermatology office, long established solo medical/surgical practice collecting $600,000 annually on part time hours. High net income of $400,000. Lots of growth potential by expanding scope of the practice and accepting more insurance. Well established and good reputation for providing high quality care. 96% Medical/surgical dermatology, 4% cosmetic. Excellent staff. Tremendous growth potential by expanding practice scope and provider coverage. Retiring seller will assist to facilitate a successful transition. 100% Dermatology Practice Loan Purchase Financing Available.

Optometry practice for sale

Optometry practice appraisal and sales. Florida west coast optometry practice for sale Exceptional opportunity grossing $1,300,000 + in 2009. Exhibiting strong organic growth rate of 10-15% over the last three years. Additional revenue potential by expanding optometrist coverage hours. Optometry loan financing available.

On the Flipside: When trimming overhead in a medical practice goes too far

I wrote an article about managing medical practice overhead expenses by looking for some creative ways to cut cost. Also found this blog entry on MGMA about being mindful about not going too far. When margins get leaner it can be tough to manage all of these aspects, but cash flow in the practice tantamount to operating a successful practice. The important thing is ascertain which expenses need to go and which cuts would cause strife within the practice. Running an efficient operation is also very important to the pre-sale planning process when a selling doctor is looking to transition out.

Suddenly Solo: Blog from Urologist on Starting a practice

Found an interesting blog called The Independent Urologist, and a posting regarding starting up a practice from scratch. He makes a good point about dealing with obstacles in a practice from the ground up:

"....My obstacles in February 2006 included lack of office space, little practice management knowledge, not enough money, no patients, no hospital staff privileges, no referring doctors, etc. Your obstacles may be similar to mine, but might be different, but you will have obstacles. Identifying them will help you to overcome them. It is essential that you list all--I mean all---of your obstacles. Slowly but surely, in a systematic fashion, you’ll overcome them."

Also makes a keen point about establishing concrete goals, not just grandiose ideas of the amount of income or level of success one would like to achieve by having their own practice:

"Finally, you must have goal. And not something like “to make a lot of money.” You’ll never have enough money. I mean to set a professional goal. What you want from your practice, profession, life, etc. My goal was my ideal practice—my dream practice. The practice I always wanted, but never thought I could have. If you don’t have a goal, get one. If your goal is nebulous, focus it, on paper."

Good blog. Looks like he's got a book too.

Cutting overhead in the Medical Practice

HEALTH PLAN ACQUISITIONS TARGET SMALL- TO MEDIUM-SIZED COMPANIES

HEALTH PLAN ACQUISITIONS TARGET SMALL- TO MEDIUM-SIZED COMPANIES
Analysts say Medicaid-heavy health plans also will be especially attractive to private equity firms and others.
By Emily Berry, amednews staff .

As a newly reformed health system takes shape, private equity firms are eyeing investments in health plans. "Private equity funds are out to make money, to invest money, and they've got money they want to put to work now," said Chip Clark, partner in the provider care sector in Ernst & Young's North America Transaction Advisory Services practice. The practice, among other services, advises corporate clients on merger and acquisition strategies. Investments are likely to target small- to medium-size plans that won't elicit intense regulatory scrutiny, as well as Medicaid contractors likely to continue making money from growing Medicaid rolls and cash-strapped states, observers said. Experts said investment groups now see the consequences of health system reform clearly enough to consider putting some money into health care ventures, even if major elements of the new health system have yet to take shape. [...]

Read the entire article in American Medical News:

www.amednews.com/2010/bisa0809

SENDER'S COMMENT: FYI...maybe we should try to get a piece of this pie!

Nationwide - Dermatology Jobs - Employment positions for Dermatologists

Nationwide - Dermatology Jobs - Employment positions for Dermatologists