The BVR/AHLA Guide to Healthcare Industry Finance and Valuation, Fourth Edition

May 2016 Hardcover, PDF (1,153 pages)

Mark Dietrich

Business Valuation Resources, LLC

The landscape of the healthcare industry is dynamic and constantly evolving, especially in a time of increasing consolidation in the post-healthcare reform era. As a result, valuations in this industry are particularly challenging. We’ve brought you the best practices to valuing healthcare businesses in the past and now we bring you the latest ground breaking innovations in the approaches to healthcare valuation.

"There are wants and there are needs … and then there are musts. If you perform business valuations of healthcare entities, The BVR/AHLA Guide to Healthcare Industry Finance and Valuation should be in your professional library. 
 
– Kevin R. Yeanoplos, CPA/ABV/CFF, ASA, Brueggeman and Johnson Yeanoplos, P.C. 

The new edition of the BVR/AHLA Guide to Healthcare Industry Finance and Valuation, is the premier resource for appraisers, attorneys, and healthcare administrators involved in any healthcare valuation. Edited by renowned valuation thought leader Mark Dietrich, and co-published with the American Health Lawyers Association (AHLA), this comprehensive guide addresses all aspects of healthcare valuation. Over 30 of the top healthcare valuation experts in the country cover the best practices in valuation and how the current market is effecting valuations. The guide also includes a new approach to valuing physician compensation, along with methods to value healthcare entities for divorce and acquisitions, appraising ancillary healthcare services, and much more. This guide is a collection of tried and true methods infused with innovative approaches that will challenge the direction of the future of healthcare valuation.
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Highlights of the guide include:

 

  • Get new solutions to put to use today on heavily debated topics in the healthcare industry. Dietrich covers new ways to look at valuing compensation as well as a breakthrough valuation method for determining the FMV of compensation which challenges the conventional model for physician compensation in valuation

  • A resolution of the debate about using the cost approach in valuing physician practices. Explore four extensive chapters on the cost approach by Timothy Smith, including one that along with co-author Angie Smith, analyzes claims about valuing trained workforce using the cost approach and whether it is appropriate

  • Revolutionary analysis that sheds new light on the misuse of compensation surveys. Dietrich exposes major points about compensation surveys that have seemingly not been recognized in the past and shares his resource-based relative value scale fair market value method to assess physician compensation to use in conjunction with the historically used surveys

  • Breakdown of the regulatory risks related to transactions. Dietrich and Tim Smith also analyze six major qui tam cases in two different chapters that highlight in detail the regulatory risks of transactions and undertake an in-depth review of related expert reports and testimony

Table of Contents

About the Authors
Introduction
Acknowledgements

 

PART I. THE HEALTHCARE MARKETPLACE

  • Chapter 1. Five Years of Healthcare Reform
    • 1.0 A Brief Overview of the Healthcare Insurance Industry
    • 2.0 Medicare National Coverage Determinations (NCDs)
    • 3.0 Reform Components
    • 4.0 Conclusions
    • 5.0 Sources of Information
  • Chapter 2. Healthcare Market Structure and Its Implication for Valuation of Privately Held Provider Entities—An Empirical Analysis
    • 1.0 Results of Original Study
    • 2.0 Data Sources and Impact on Analysis
    • 3.0 Public Healthcare Insurers
    • 4.0 Market Share
    • 5.0 History of Blue Cross Plans
    • 6.0 Public Hospital Companies
    • 7.0 Medicare Part A Spending
    • 8.0 Other Hospital Market Factors
    • 9.0 Valuation Imperative
    • 10.0 Example
    • 11.0 Surgery Centers
    • 12.0 Medicare Part B Spending
    • 13.0 Prevalence of For-Profit Hospitals
    • 14.0 Valuation Imperative
    • 15.0 Radnet
    • 16.0 Acquisition Versus Same Store Growth
    • 17.0 Valuation Imperative
    • 18.0 Implications for Valuation of Private Healthcare Providers
    • 19.0 Other Uses of Market Data
    • 20.0 Valuation Imperative
    • 21.0 Regulatory Issues
    • 22.0 Conclusion
  • Chapter 3. Factors in Estimating Cost of Capital and Forecasting Cash Flow in Healthcare
    • 1.0 What Comprises the ‘Healthcare Industry’?
    • 2.0 Deriving the Discount Rate
    • 3.0 Weighted Average Cost of Capital (WACC)
    • 4.0 Government Influence
    • 5.0 Identifying Factors That Contribute to Risk
    • 6.0 Near-Term Forecasting and Risk Assessment: MedPAC, the MPFS Proposed and Final Rules, and the Market
    • 7.0 Identifying Reimbursement Trends That Are Not Sustainable
    • 8.0 The MedPAC Crystal Ball
    • 9.0 Primary Care: The Baseline for Risk in Physician Practices
    • 10.0 Understanding the Impact of Payor Relationships
    • 11.0 Using Guideline Company Data to Forecast Cash Flows and Assess Risk
    • 12.0 Conclusion
  • Chapter 4. Valuing Intangible Assets Under the Cost Approach: The Current State of the Body of Knowledge
    • 1.0 Introduction
    • 2.0 Preliminary Considerations and Clarifications
    • 3.0 Cost Approach Fundamentals in Intangible Assets Valuation
    • 4.0 The Generally Accepted Cost Approach Method
    • 5.0 Techniques for Quantifying Economic Obsolescence
    • 6.0 The Cost Approach in Tangible Asset Appraisals
    • 7.0 Conclusion

PART II. REGULATORY CONSIDERATIONS IN HEALTHCARE VALUATION

  • Chapter 5. The Anti-Kickback Statute and Stark Law: Avoiding Valuation of Referrals
    • 1.0 The Anti-Kickback Statute
    • 2.0 The Stark Law
    • 3.0 Valuation Scenarios to Consider
  • Chapter 6. The Volume or Value Standard: Navigating the Stark Law’s Prohibition on ‘Taking Into Account’ Designated Health Service Referrals
    • 1.0 Stark Law Overview
    • 2.0 Navigating the Volume or Value Standard—Documenting Compliance
    • 3.0 Understanding the Volume or Value Standard—Guidance From CMS
    • 4.0 The Volume or Value Standard—Case Law Illustrations
    • 5.0 Conclusion
  • Chapter 7. The Imperative to Meeting the Stark Group Practice Definition
    • 1.0 Why the Definition Matters
    • 2.0 Single Legal Entity
    • 3.0 Physicians
    • 4.0 Range of Care
    • 5.0 Services Furnished by Group Practice Members
    • 6.0 Distribution of Expenses and Income
    • 7.0 Unified Business
    • 8.0 Volume or Value of Referrals
    • 9.0 Physician-Patient Encounters
    • 10.0 Productivity Bonuses
    • 11.0 Profit Sharing
    • 12.0 Conclusion
  • Chapter 8. Valuation Issues Affecting Tax-Exempt Healthcare Entities
    • 1.0 Introduction
    • 2.0 Valuation Issues
    • 3.0 Other Regulatory Considerations
    • 4.0 Other Medicare Fraud and Abuse Penalties
    • 5.0 Tax-Exempt Entity Definitions
    • 6.0 Tax-Exempt Organization Transactions—Private Inurement and Excess Benefits
    • 7.0 The Initial Contract Rule
    • 8.0 Section 4958 Penalty Excise Taxes
    • 9.0 Intermediate Sanctions
    • 10.0 Excess Benefit Transaction Presumption of Reasonableness
    • 11.0 Conflict of Interest
    • 12.0 Appropriate Data
    • 13.0 Adequate Documentation
    • 14.0 Analyst Considerations Regarding Private Inurement
    • 15.0 Purpose of Intermediate Sanctions
    • 16.0 Imposition of Penalty Excise Taxes
    • 17.0 Rebuttal Presumption of Reasonableness
    • 18.0 Excess Benefit Transaction
    • 19.0 Reasonableness of Tax-Exempt Entity Compensation
    • 20.0 Revocation of Tax-Exempt Status
    • 21.0 Analyst Common Misconceptions Regarding Healthcare Property and Services Valuations
    • 22.0 Summary and Conclusion
  • Chapter 9. Patient Medical Records, HIPAA, and State Medical Records Law in Valuation and Litigation
    • 1.0 Introduction
    • 2.0 The Health Insurance Portability and Accountability Act of 1996
    • 3.0 Conclusion
  • Chapter 10. By the Numbers: A Case-Based Understanding of Healthcare Valuation Fraud
    • 1.0 Introduction
    • 2.0 Principal Statutes Related to Valuation Fraud
    • 3.0 Import of Qui Tam Relators
  • Chapter 11. The Survey Games: FMV in the Tuomey and Halifax Cases
    • 1.0 FMV Methodology in Tuomey and Halifax
    • 2.0 Commercial Reasonableness Analysis in Tuomey and Halifax
    • 3.0 Review of FMV Methodology
    • 4.0 Concluding Notes
  • Chapter 12. Bradford Regional Medical Center: Lessons for the Inexperienced
    • 1.0 Introduction
    • 2.0 Court's Findings in Bradford Regional Medical Center (BMRC) Case
    • 3.0 Key Valuation Issues in BRMC Case
    • 4.0 Conclusion
  • Chapter 13. Converting Physician Practices to Tax-Exempt Status
    • 1.0 Basic Tax Consequences
    • 2.0 Valuing Intangible Assets
    • 3.0 Personal Versus Enterprise Goodwill
    • 4.0 Hypothetical Sale
    • 5.0 Current Economy Considerations
    • 6.0 Conclusion
  • Chapter 14. What Goes Around Comes Around: Derby v. Commissioner
    • 1.0 Case Summary
    • 2.0 Transaction Overview
    • 3.0 Taxpayers’ Valuation for Trial
    • 4.0 The Donation
    • 5.0 Conclusion
  • Chapter 15. What Is to Be Learned From Caracci?
    • 1.0 The Key Valuation Issue and Valuation Experts
    • 2.0 History of Sta-Home
    • 3.0 Position of the Parties
    • 4.0 Tax Court Opinion
    • 5.0 The Standard of Value
    • 6.0 Hahn’s Valuation Approaches
    • 7.0 Wilhoite’s Valuation Approaches6
    • 8.0 Appellate Court Opinion
    • 9.0 Synonymous Standard of Value?
    • 10.0 Key Regulatory Issues in Health Care
    • 11.0 Valuation Questions Raised by the Case
    • 12.0 Looking Ahead

PART III. VALUING PHYSICIAN PRACTICE

  • Chapter 16. Choosing and Using the Right Valuation Methods for Physician Practices
    • 1.0 The Market in 2015-2016
    • 2.0 Introduction
    • 3.0 Alleged Comparative Practice Sales Method
    • 4.0 Understanding Physician Practice Discount and Capitalization Rates
    • 5.0 Discounted Cash Flow (DCF)
    • 6.0 Using the MGMA Compensation and Cost Data
    • 7.0 Accounts Receivable
    • 8.0 Terms Make the Deal
    • 9.0 An In-Depth Review of the Correct Use of the Excess Earnings Method
    • 10.0 The Use of the Capitalization of Cash Flows in Conjunction With the Excess Earnings Method
    • 11.0 Control Adjustments to the Excess Earnings Valuation Model?
    • 12.0 Chapter Summary
    • The Thornton Letter
  • Chapter 17. Using Work RVUs and ‘Particular Market’ Rates to Establish Fair Market Value Physician Compensation
    • 1.0 Executive Summary
    • 2.0 Introduction.
    • 3.0 Failings of the Surveys
    • 4.0 The RVU Method
    • 5.0 Regulatory Impact and Conclusion
  • Chapter 18. Evaluating RVU-Based Compensation Arrangements
    • 1.0 Limitations of Resource-Based Relative Value Scale (RBRVS)
    • 2.0 Impact of Contract Rates and Payor Mix on Physician Compensation
    • 3.0 Income-Based Approach to Analyzing Compensation Value vs. Sole Reliance on Survey Data
    • 4.0 Conclusion
  • Chapter 19. Reasonable Compensation for Physicians Under the Internal Revenue Code
    • 1.0 Overview
    • 2.0 General Factor in Assessing Reasonable Compensation
    • 3.0 Independent Investor Standard of Exacto Spring
    • 4.0 Mulcahy, Pauritsch, Salvador
    • 5.0 Who Owns the Intangible Assets?
    • 6.0 Specific Intangible Assets
    • 7.0 Norwalk v. Commissioner
    • 8.0 Larry E. Howard
    • 9.0 IRS Technical Advice Memo 200244009
    • 10.0 Specific Case Law Involving Physician Compensation
    • 11.0 Factors Specific to Tax-Exempt Entities
    • 12.0 Schedule J .
    • 13.0 Excess Benefit Transaction Rules
    • 14.0 The IRS Exempt Organization Division Continuing Professional Education Texts
    • 15.0 The Derby Case
    • 16.0 Physician-Specific Factors in Assessing Reasonable Compensation
    • 17.0 Physician Supervision of Midlevel Providers
    • 18.0 Local Market Factors and Payor Rates per RVU
    • 19.0 Impact of Noncompete Agreements
    • 20.0 Trade Secrets and Similar Provisions
    • 21.0 Applying the Independent Investor Test to Physician Practices
    • 22.0 Net Working Capital
    • 23.0 Fixed Assets
    • 24.0 Trained Workforce
    • 25.0 Ancillary Technical Component Profits in Detail
    • 26.0 Some Common Mistakes
    • 27.0 Example
    • 28.0 Transactions
    • 29.0 Individual Market Idiosyncrasies
    • 30.0 Contract Rights
    • 31.0 Patient Charts
    • 32.0 Payor Contracts
    • 33.0 Goodwill
    • 34.0 Understanding and Documenting the Reasonable Compensation Analysis
    • 35.0 Determination of Midlevel Profits
    • 36.0 Massachusetts Medical Study
    • 37.0 Center for Studying Health System Change
    • 38.0 Massachusetts Attorney General’s Report
  • Chapter 20. Assessing Intangible Value in a Physician Practice Acquisition
    • 1.0 Key Concepts and Definitions
    • 2.0 The Context for Valuing Physician Workforce
    • 3.0 Example
    • 4.0 A Review of the Significant Issues
    • 5.0 Conclusion
  • Chapter 21. Valuing Trained and Assembled Workforce in Healthcare Provider Entities Using the Cost Approach
    • 1.0 Introduction
    • 2.0 Overview of Job Types in Healthcare Provider Entities
    • 3.0 Types and Levels of Training Within a Healthcare Provider Entity
    • 4.0 Assembling a Workforce for a Healthcare Provider Entity
    • 5.0 Applying the Generally Accepted Cost Approach Method
    • 6.0 Calculating Replacement Cost New
    • 7.0 Estimating the Forms of Depreciation in RCNLD
    • 8.0 Confirming the Cost Approach Value Indication for TAWF
    • 9.0 Specific Liabilities Accompanying TAWF
    • 10.0 Due Diligence and Data Gathering
    • 11.0 Specific Areas of Consideration for Valuing TAWF in Physician Practices
    • 12.0 Conclusion
  • Chapter 22. Examining the Valuation of Trained and Assembled Workforce Under a Liquidation Premise of Value
    • 1.0 Introduction
    • 2.0 Premise of Value for Intangible Assets
    • 3.0 The Bankruptcy Case Law Thesis
    • 4.0 Examining the Attributes and Conveyance of TAWF
    • 5.0 Valuation of TAWF Under a Liquidation or In-Exchange Premise of Value
    • 6.0 Conclusion
  • Chapter 23. Resolving the Debate About the Value of Physician Practices: A Comprehensive Analysis
    • 1.0 Introduction
    • 2.0 Clarifying the Issues in the Debate
    • 3.0 Physician Compensation: The 300-Pound Gorilla in the Room
    • 4.0 Use of Post-Transaction Compensation in the Valuation
    • 5.0 Application of the Income Approach
    • 6.0 Application of the Cost Approach in Valuing Intangible Asset
    • 7.0 Application of the Asset-Based Approach
    • 8.0 Application of the Market Approach
    • 9.0 Reconciling Value Indications From the Approaches to Value
    • 10.0 Application of the Appropriate Premise of Value
    • 11.0 Arriving at a Conclusion of Value
    • 12.0 Conclusion
  • Chapter 24. Critical Condition—A Coding Analysis for a Physician Practice Valuation
    • 1.0 Established Patient Office Visits
    • 2.0 Other Examples
    • 3.0 Sources Of Data
    • 4.0 Identifying Problematic Coding
    • 5.0 Analysis
    • 6.0 Modifiers
    • 7.0 Utilization of Tests
    • 8.0 Surgical Practices
    • 9.0 Beware Changes in the Value of Codes
    • 10.0 Conclusion
  • Chapter 25. Understanding and Using the Technical and Professional Components of Ancillary Revenue When Valuing Medical Practices
    • 1.0 Some Common Mistakes
    • 2.0 Jurisdictional Issues
    • 3.0 Transactions
    • 4.0 Individual Market Idiosyncrasies
    • 5.0 Conclusion
  • Chapter 26. Identifying and Measuring Personal Goodwill in a Professional Practice: Part I—Basic Concepts
    • 1.0 Illustrative Examples
    • 2.0 Enforceability of Noncompetes
    • 3.0 Reasonable Compensation
    • 4.0 Categories of Intangibles
    • 5.0 Mechanics of Valuation
  • Chapter 27. Identifying and Measuring Personal Goodwill in a Professional Practice: Part II—Using the Single Period Capitalization Model
    • 1.0 Probability of Competition
    • 2.0 Key Conclusions
  • Chapter 28. Valuation Solutions for Special Situations With Medical Practices
    • 1.0 A Series of Group Practice Buy-In Considerations
    • 2.0 Reality Checks
    • 3.0 Solving the Two-Person Practice Buyout Dilemma
    • 4.0 Strategies for Creating Merger Value
    • 5.0 Structures for Successful Mergers
    • 6.0 Divorce
    • 7.0 Valuing Independent Practice Associations (IPAs)
    • 8.0 Defending Against Unwarranted Damage Claims in a Practice Dissolution
    • 9.0 Chapter Summary
  • Chapter 29. Why Transaction Structure and Taxes Affect Value and Other Nuances of Valuing Medical Practices
    • 1.0 A Review of Complex Tax Issues
    • 2.0 Fair Market Value?
    • 3.0 Stock and Asset Transactions
    • 4.0 Healthcare Transactions, in Particular
    • 5.0 Conclusion
  • Chapter 30. A Healthcare Appraiser Reviews a Judge-Appraiser’s ‘Report’
    • 1.0 Time Line of the Case
    • 2.0 History of MedPAC’s Identification of High-Tech Imaging Expense Trends
    • 3.0 The Medicare Conversion Factor
    • 4.0 Reduction in the Relative Value of MRI Services
    • 5.0 A Quantitative Analysis of the Court’s Excessive Terminal Growth Rate
    • 6.0 The Broader Revenue Picture in the Healthcare Industry
    • 7.0 Amount of Medically Unnecessary PT Services
    • 8.0 An Observation on the Industry Risk Premium
    • 9.0 Conclusions
  • Chapter 31. The CPA’s Role in Mergers and Acquisitions Due Diligence Assistance to PPMCs and Private Equity Firms
    • 1.0 Introduction
    • 2.0 Professional Reporting Standards
    • 3.0 Engagement Planning
    • 4.0 Operating Statistics
    • 5.0 Patient Volume
    • 6.0 Charges and Collections
    • 7.0 Payor Mix
    • 8.0 CPT Code Analysis
    • 9.0 Accounts Receivable
    • 10.0 Financial Information
    • 11.0 Tax Matters
    • 12.0 Conclusion
  • Chapter 32. When the Marriage Is Over, What Is the Practice Worth?
    • 1.0 Standard of Value
    • 2.0 Premise of Value
    • 3.0 Valuation Date
    • 4.0 Appreciation
    • 5.0 Buy/Sell Agreements
    • 6.0 Goodwill
    • 7.0 Double Dip
    • 8.0 Summation
  • Chapter 33. Jurisdictional Issues in Physician Practice Divorce Valuation: California (A Community Property State)
    • 1.0 Family Code §771, Earnings and Accumulations After Date of Separation Are Separate Property
    • 2.0 Family Code §2552, Valuation Date of Assets and Liabilities
    • 3.0 Premise of Value
    • 4.0 Status of the ‘Double Dip’
    • 5.0 Property Can Be Characterized as Separate, Community, Quasi-Community, or a Combination
    • 6.0 Current Professional Practice Case Analysis
    • 7.0 Conclusion

PART IV. GUIDE TO THE VALUATION OF HEALTHCARE INDUSTRY ENTERPRISES

  • Chapter 34. Valuation Considerations Specific to Diagnostic Imaging Entities
    • 1.0 The Unique Structure of Diagnostic Imaging Services Requiring Analysis
    • 2.0 Diagnostic Imaging: Influences on Revenue, Historical Performance Analysis, and Revenue Forecasting
    • 3.0 Regulatory Impacts Specific to Diagnostic Imaging Entities and Their Influence on Forecasting Revenue Streams
    • 4.0 The Primary Influences and Considerations Required When Analyzing and Forecasting Infrastructure Expense Unique to Diagnostic Imaging Entities
    • 5.0 Potential Land Mines and Valuation Considerations That Can Come Back to Haunt You
  • Chapter 35. Ambulatory Surgery Centers
    • 1.0 Introduction
    • 2.0 Segment Overview
    • 3.0 History of ASCs
    • 4.0 Certificate of Need Requirements
    • 5.0 ASC Growth
    • 6.0 Changes in Medicare Payment System for ASCs
    • 7.0 Discrepancy in Payments
    • 8.0 CY 2015 Final Ruling
    • 9.0 2015 Sequestration
    • 10.0 Typical ASC Legal Structures
    • 11.0 Typical ASC Financial Structure and Performance
    • 12.0 Income Statement Observations
    • 13.0 Balance Sheet Observations
    • 14.0 Does the Past Tell Us Anything About the Future?
    • 15.0 ASC Risk-Assessment Matrix
    • 16.0 Purchase or Sale of Controlling Equity Interest
    • 17.0 Purchase or Sale of Noncontrolling Equity Interests
    • 18.0 Conversion of an HOPD
    • 19.0 Data Request
    • 20.0 Conclusion
    • 21.0 Bibliography
  • Chapter 36. Valuing Dialysis Clinics: Reasons for Valuation
    • 1.0 Regulatory Considerations
    • 2.0 Reimbursement Models
    • 3.0 Valuation Approaches
    • 4.0 Value Drivers
    • 5.0 Government Enforcement Environment
    • 6.0 Conclusion
  • Chapter 37. The Valuation of Pathology Services
    • 1.0 Clinical and Anatomic Pathology Background
    • 2.0 Clinical Pathology Services
    • 3.0 Anatomic Pathology Services
    • 4.0 Market for Professional Pathology Services
    • 5.0 Pathology Services Agreements
    • 6.0 Summary
  • Chapter 38. The Valuation of Hospitals
    • 1.0 Overview of the Hospital Industry
    • 2.0 Hospital Value Drivers
    • 3.0 Healthcare Reform Law
    • 4.0 Current Challenges Facing Hospitals
    • 5.0 Hospital Reimbursement
    • 6.0 Valuation Process
    • 7.0 Conclusion
    • 8.0 Resource Materials
  • Chapter 39. Home Healthcare Services
    • 1.0 The Industry
    • 2.0 Funding of Home Health Products and Services
    • 3.0 Home Health Funding
    • 4.0 Hospice Funding
    • 5.0 Private Duty Funding
    • 6.0 Home Medical Equipment Funding (HME)
    • 7.0 Home Infusion Therapy (HIT) Funding
    • 8.0 Home Health Industry Information
    • 9.0 Valuing Home Healthcare Businesses
    • 10.0 Special Situations Affecting Home Healthcare Value
    • 11.0 Conclusion
  • Chapter 40. Valuing Joint Ventures and Other Physician Alignment Initiatives
    • 1.0 Reasons for Valuation
    • 2.0 Regulatory Considerations
    • 3.0 Key Features and Typical Valuation Methodologies
    • 4.0 Types of Information Utilized and Testing Assumptions
  • Chapter 41. Urgent Care Centers: Valuation Overview
    • 1.0 Retail Healthcare
    • 2.0 Value Proposition—Patients
    • 3.0 Value Proposition—Payors
    • 4.0 Payor Mix
    • 5.0 Medicare FFS Program
    • 6.0 Industry Growth
    • 7.0 Market Participants
    • 8.0 Private Equity and Urgent Care
    • 9.0 Hospitals and Urgent Care
    • 10.0 Physician Entrepreneurs
    • 11.0 Typical Urgent Care Income Statements
    • 12.0 Transaction Market Defined
    • 13.0 Valuation Characteristics and Methodology
    • 14.0 Cost Approach
    • 15.0 Market Approach
    • 16.0 Income Approach
    • 17.0 Conclusion
  • Chapter 42. Valuing CINs, ACOs, PHOs, and IPAs
    • 1.0 Shifting Focus From Volume to Value
    • 2.0 Bringing Providers Together
    • 3.0 Transactions Involving MPNs
    • 4.0 Example 1: Income Approach
    • 5.0 Income Approach Analysis
    • 6.0 Working Capital and Cash Flows
    • 7.0 Summary Financials
    • 8.0 Accounting for the Risk of Shared Savings Revenue
    • 9.0 Residual Value
    • 10.0 Sensitivity Analysis—Multiple Cash Flow Scenarios
    • 11.0 Venture Capital Discount Rate
    • 12.0 Exit Event Assumed on Dec. 31, 2018
    • 13.0 Other Considerations
    • 14.0 Example 2: Market and Cost Approaches
    • 15.0 Conclusion

Index
Index of Court Cases Cited Within This Guide