An Accelerating Trend in Physician Practices
超过100,2019年至2021年期间,000名bet8网站备用从独立执业转为受雇于医院和其他公司,[1] in a continuing trend of accelerated physician practice acquisitions. By the end of 2021, 74% of physicians were employed by health systems, 医院, or corporate entities, and 22% of those physicians were employed by corporate entities.[2]
While virtually every specialty has been affected, 初级保健实践需求量很大,特别是在bet8网站备用和其他购买者能够从按bet8娱乐收费的合同转变中实现重大价值的情况下, where providers are paid for each service performed (for example, office visits and tests), to value-based contracts. With value-based contracts, bet8网站备用被激励去更好地管理病人的治疗计划,并消除不必要的bet8娱乐, which reduces the cost of care, 通过风险分担安排,这种成本的减少与bet8网站备用的实践分享.
High Primary Care Practice Purchase Prices
35岁以上[3] 在过去五年中,与公开可用数据的医师执业交易已经结束,并以息前利润(ebitda)进行交易, 税, depreciation, and amortization—multiple of 10x or higher. Of those transactions, 12 were primary care, and none of the buyers were health systems. Many had significant purchase prices; the chart below lists some recent transactions.
The authors have seen the large multiples firsthand. Of the last 25 primary care practices they valued, more than half of those transactions have closed with EBITDA multiples greater than 10x.
许多非医疗系统的买家不需要遵循公平市场价值(FMV)标准:“房产在有意愿的买家和有意愿的卖家之间易手的价格。, 既不受买卖的强迫,又对有关事实有合理的了解.”[4] 因此,他们可以提供比bet8网站备用更有竞争力的医师实践报价. bet8网站备用如果要有机会获得初级保健团体,就需要在保持FMV范围内配合这些出价, including practices with only a few providers.
Three Valuation Approaches for Physician Practices
Valuation of a physician practice begins with three approaches: the income approach, the cost approach, and the market approach.
- 收益法是根据预计将来产生的现金流的现值来估计企业或安排的价值.
- 市场方法通过考虑可比企业的价格或类似企业的交易价格来估计企业的价值. This approach also includes an analysis of past transactions, with adjustments for differences between the subject business and market data.
- 成本法旨在确定重置成本,通常通过对业务估值中的相关资产和负债的分析来执行. In this approach, 有形资产和无形资产分别进行评估,然后汇总估算价值. 成本法需要估计再现从业务或安排中获得的利益的成本. This approach is most useful in the valuation of investment-holding companies, asset-intensive companies, and businesses considering or undergoing liquidation.
The income and market approaches require the practice’s EBITDA to be greater than zero; this value is unusual in smaller physician practices, where the physician-owners receive all income of the practice as a distribution. 为了支持收购价格,业主将不得不在交易后减少他们的工资.
Without a salary reduction, the practice would be valued under the cost approach. 因为bet8网站备用的业务资产基础小——初级保健业务尤其如此——在成本法下评估业务会导致低估值,也会降低bet8网站备用考虑出售业务的动机.
然而, 收入方法使bet8网站备用能够量化参与风险分担安排的机会. There is significant value in effectively managing patient lives, especially Medicare Advantage patients, given the high cost of managing this population. bet8网站备用和更大的做法更加重视基于价值的合同,并可以利用这一额外的收入来源, whereas few physician practices are sophisticated enough to do this on their own.
How to Maximize Physician Practice Purchase Price
The FMV standard requires the consideration of a hypothetical buyer and hypothetical seller; meaning, 当评估使用市场数据且不针对特定买方时,可以考虑将患者转变为基于价值的合同的附加价值. While non–health system buyers might pay up to $12,000 per Medicare Advantage life, 如果不违反斯塔克法和反回扣法规,bet8网站备用就不能直接以生命数量来衡量一种做法. 而不是, 他们需要与经验丰富的顾问合作,这些顾问能够恰当地预测假设买家从基于风险的合同中可能获得的未来现金流.
To accurately reflect what would happen once a hypothetical buyer owns the practice, 这些增量现金流的一部分应该支付给bet8网站备用,以激励他们继续每天少看病人,而这些病人需要bet8网站备用花更多的时间. 增量现金流的另一部分用于基础设施和护理管理成本. 剩下的现金流要么用于再投资于公司,要么作为分配支付给实际所有者. Larger cash flow yields a higher valuation, 与盈余现金流在收益法和市场法中被量化的方式相同, 并使bet8网站备用能够提供与公司实体具有竞争力的购买价格.
A Comparison of Cost Approach and Income Approach
The example below lists a recent valuation with one physician and three APPs. 它展示了传统的成本方法以及量化基于价值的安排机会的收入方法.
In addition, the graph below includes some examples of the difference in profitability between physician practices that maintain a fee-for-service approach and those that enter into two-sided risk arrangements in high-cost regions and successfully manage the patient population.
The Benefit of Quantifying Value-Based Arrangement Opportunity
As more primary care physicians are made aware of the value of their practices, they will no longer accept fixed asset purchase prices. 对管理式护理和价值导向安排有深刻理解的评估人员可以通过以下方式提供帮助:
- Developing a detailed forecast of the potential value of moving to risk-based contracts.
- Supporting the health system in providing a competitive offer in a fast-changing landscape.
评估专家可以帮助bet8网站备用量化基于价值的安排机会,同时确保分析具有竞争力并符合FMV标准.
Is Your Organization prepared to provide competitive offers in a fast-changing landscape?
bet8网站备用应确保其评估人员适当考虑初级保健实践在成功管理人口时所产生的价值.
bet8娱乐Copyright 2023, American Health Law Association, Washington, DC. Reprint permission granted.
编辑: 苏做饭
脚注
- 1.
PAI-Avalere关于2019-2021年bet8网站备用就业趋势和实践收购的报告:主要研究成果,” Physicians Advocacy Institute.
- 2.
同前.
- 3.
Scope Research, http://www.scoperesearch.co/.
- 4.
Published February 22, 2023