Inflation and high interest rates continued to negatively impact hospital net income in 2023, forcing hospital systems to further assess their business portfolio for cost-saving opportunities. 结果是, capabilities and facilities that were acquired by hospitals over the last 10 to 20 years to increase their service offerings—such as long-term care, 家庭健康, 康复, 护理, 临终关怀, 诊断实验室, 而bet8网站备用的执业——现在正在被剥离. These transactions typically involve either a full sale or the formation of a joint venture where a portion of the business is sold, 这两种方法都能产生额外的现金,让医院投资于其他项目 区域.
为他们的生意做出最好的决定, 医院领导必须了解资产的真正价值, which can only be accomplished by ensuring accurate supporting valuations and 会计 for all expenses. 否则, hospitals risk entering a sale process with an inaccurate understanding of the value of their service line, 这可能会加剧他们的财务困境.
错误一:管理费用核算不准确
遵守斯塔克法和反回扣法, the standard of value used in assessing a service line is fair market value (FMV). 像这样, a valuator must consider the service line as it would be operated as a stand-alone entity by a hypothetical buyer. 这意味着必须充分考虑所有费用, even if the hospital is currently operating the business in a way that does not directly account for the expense.
Overhead expenses encompass all 管理 and staff costs required to operate the business; 然而, hospital financial business unit statements often only include costs related to direct staff (i.e.、临床支援人员). 金融bet8娱乐, 计费, 管理, 策略, 会计, 市场营销, 人力资源, IT和电子病历系统, and group purchasing staff expenses are usually not accounted for on the financial statements, 歪曲了该bet8娱乐公司的财务状况.
The most straightforward way to account for overhead expenses is through a 管理 fee, 通常按收入的百分比收取哪些费用. This fee accounts for all 管理 services that are being provided by either employed staff or a 管理 company. 另外, the hospital can complete a full buildup of the expenses that considers the time each employee spends supporting the service line in their respective area.
相反, hospitals sometimes assign too much expense to the service line through overhead allocations, burdening the service line with overhead that would not be needed if it were a stand-alone entity. 在这些情况下应作出调整以减少费用, 从而潜在地增加bet8娱乐线的价值.
错误二:低估设备成本
Another key aspect to consider in the valuation of a hospital-based business under FMV is the facility expense. 这包括租金, 公用事业公司, 维修及保养, 以及与维护和运营空间相关的任何其他成本. 租金通常被记入整个系统的帐户, 在业务单位级别的财务中没有被捕获, and must be added to the valuation to reflect the hypothetical buyer-and-seller standard.
正确估计租金费用, hospitals may need to perform a market rent study—an analysis of the rental expense in the subject service area that considers the size and features of the actual space. This is most often needed in scenarios where the subject space is owned by the hospital and/or rent is not being charged at a level consistent with the market.
Another common area of misalignment occurs when hospitals operating 家庭健康 businesses assume that the small space means there is no rent to be considered. 在这些情况下, 然而, rent expense does need to be added to account for the facility used by the business’s administrative staff.
错误三:将价值应用于下游收益
Hospital-based businesses’ ability to bring additional patients into the health system’s core operations is one of the most important aspects of their financial value to the system. 这个收入, 称为下游收入, 是在其他bet8网站备用单位产生的,因为原来的业务线.
因为下游的收入, health systems may choose to operate certain businesses as loss leaders to generate profit elsewhere in the system. 其他bet8娱乐领域的收入, 然而, would not be available to a hypothetical buyer and so cannot be accounted for in a fair market valuation. 评估师只能考虑bet8娱乐线产生的直接收入.
错误四:考虑战略价值
如果企业表现不佳, the strategic value from the potential transaction cannot be considered to generate higher cash flow. The valuation firm would typically not use the income or market approaches in this instance and instead use the cost approach and value the assets on the balance sheet.
就其本质而言, the cost approach is less likely to result in significant value in the event of a sale, 但这并不意味着那些使用它的场景没有好处. 即使在没有大笔预付款的情况下, 医院出售表现不佳的bet8娱乐项目可能有充分的理由, 例如使他们能够简化操作, 关注核心bet8娱乐, 消除损失.
Mistake Five: Valuing the Business on a Control Basis When a Minority Interest Is Sold
Often hospital-based businesses are contributed to a joint venture rather than simply sold. 如果买方将购买少数股权投资, 在确定最终值时应该考虑到这一点. The valuator needs to understand the operating terms to arrive at a final opinion, as those will influence the level of discount that should be applied to the value. A minority owner does not have control over the business decisions of the company (unless specific governance terms are added to the operating agreement) and thus will not value the ownership interest the same as the controlling entity.
准确的估值造就可持续的期货
一个完整的, comprehensive view of a hospital’s service line is necessary to establish whether a potential divestiture makes strategic and financial sense for the health system. 一旦领导正确地记录了他们医院的费用, 包括管理费和租金, 并消除下游收入的影响, they can be certain they will have the most accurate picture of their non–core business’s performance.
这一观点, 哪些会反映在独立估值公司的意见中, will help leaders make informed decisions about how to handle underperforming service lines to support their goal of long-term success and sustained financial stability.
编辑:Emily Johnson
This article was originally published in the American Health Law Association Journal in March 2024.
出版于2024年3月28日