I am please to report that editing on the 2012 Guide is completed. The May release will feature 12 New Chapters and 14 Revised Chapters.  In addition to the contributors noted in my January 8 post, Todd Sorensen and VMG have updated their chapter on Ambulatory Surgery Centers, Andrea Ferrari of HAI and Tim Smith have updated their Medical Director chapter and Mark Browne, M.D., Burl Stamp, FACHE and David McMillan, CPA of PYA have contributed a new chapter on Whole Hospital Co-Management Agreements.

The contributors and I have been working hard on the Third Edition of the Guide, the most comprehensive work on valuation in the Healthcare Industry. This update will expand that coverage exponentially, thanks to a herculean effort by Tim Smith who has contributed some 70,000 words on Physician Compensation Valuation, the first-ever detailing of this discipline!  Tim’s work is a remarkable contribution to the Body of Knowledge in valuation and represents hundreds of hours of work.

Carol Carden, Greg Anderson, Scott Safriet, Jim Pinna, Matt Jenkins, Doug Smith, Jason Ruchaber, Ann S. Brandt, Ron Finkelstein and Lydia Glatz have all updated their chapters and more of the second edition contributors are planning to do so. I have updated my own and written several new chapters, including one on the Bradford Regional case and another on physician buy-ins and buyouts, and Carol Carden and I have a significant new chapter on valuation of Accountable Care Organizations. Perhaps the most important material ever written on business valuation in healthcare, a detailed chapter on the abuses of the Cost Approach, is included with multiple authors from the nation’s leading healthcare appraisal firms.

When the new Guide is available, the details will be at this link: http://www.cpa.net/publications/bvrs-guide-to-healthcare-valuation/.  I’ll also be opening the 2012 edition of BVR’s Healthcare Symposium on January 24. You can learn more here: http://www.bvresources.com/defaulttextonly.asp?f=hcseries12.  You can subscribe to the entire series AND receive the new Guide!

MedicalPracticeValue.Com

July 24th, 2010 | Posted by Mark Dietrich in - (Comments Off on MedicalPracticeValue.Com)

Welcome to the Internet’s richest source of information about medical practice valuation, sponsored by Mark O. Dietrich, CPA P.C.. You can visit our website and explore the wealth of data on valuation as well as managed care by clicking on our name, or follow the links to the left directly to specific pages on the topics of interest to you. For information on the just re-released 2001/2002 Adobe pdf edition of The Medical Practice Valuation Guidebook, click here.

For inquiry’s on the firm’s services, call Mark Dietrich at (508) 877-1999.

BVR's Guide to Physician Practice Valuation

July 10th, 2010 | Posted by Mark Dietrich in - (Comments Off on BVR's Guide to Physician Practice Valuation)
BRV's Guide to Healthcare Valuation

The new edition of BVR’s Guide to Physician Practice Valuation available in June is the essential resource for understanding the complexities inherent in physician practice valuation, whether for sale to a hospital, private equity firm or to another physician.  The Second Edition contains nine additional chapters and revisions to six existing chapters?  Among the new chapters is one addressing traditional practice buy-ins and buyouts as well as how the presence of noncompete agreements affects value.  Another deals with the actual valuation of noncompete agreements and personal goodwill, the key to many litigation engagements as well as tax planning associated with conversion of C Corporations to S Corporations or to tax-exempt status.

Mark Dietrich and other top healthcare appraisal experts deliver current and comprehensive “how-to” guidance on valuation approaches.  Learn how the Anti-Kickback Statute and Stark Law impact your valuation in a completely updated chapter.  A related new chapter devoted to the Bradford Regional case analyzes the risks of being unfamiliar with the regulatory construct as does another new chapter on measuring intangible value in physician practices co-authored by the industry’s most experienced healthcare valuation experts.  Various chapters explore the not so subtle nuances of valuing a physician practice, including coding analysis, ancillary technical component revenue, “incident to” billing for midlevel providers, valuing accounts receivable and benchmarking and normalization of expense.

Practical guidance coupled with adherence to professional and regulatory standards define the 2012 Guide to Physician Practice Valuation.

https://www.bvresources.com/bvstore/book.asp?pid=PUB235

Medical Practice Valuation Guidebook

July 5th, 2010 | Posted by Mark Dietrich in - (Comments Off on Medical Practice Valuation Guidebook)

Sorry, the paper edition (published in 2001) is SOLD OUT, but the entire book has been scanned into Adobe pdf – see below for ordering details. We do, however, recommend purchasing the BVR 2012 Guide to Physician Practice Valuation instead because it is more current. The following quote is from the author’s introduction to the Second Edition (2001/2002), which has more than 30% new material and an Attorney’s Guide! More recent books are available elsewhere on the website.

Table of Contents is Here!
Description of New Features is Here!

“I am very excited about the second edition of the Medical Practice Valuation Guidebook, Including Comprehensive Financial Analysis and the Influence of Managed Care. The overriding goal of the second edition is to provide in-depth analysis and related problem solving tools to the financial and valuation issues confronting the medical profession now. Readers of the first edition will note the addition of extensive new material covering such diverse areas as dental practices, ambulatory surgery centers and litigation. As many who followed the PPMC industry expected, a host of lawsuits has sprung from the near collapse of that industry, and this book addresses many of the related valuation issues, such as valuing the noncompetition agreements typically included in such a transaction. Valuators engaged in Expert Witness and Divorce work will find a wealth of new information, including a point by point approach to isolating enterprise (practice) goodwill from personal (professional) goodwill, including a spreadsheet model. The Tax Planning chapter includes detailed analysis on the impact of recent tax cases such as Davis and Gross. It also includes a comprehensive description of the issues and approach to valuing a medical practice for donation to a tax-exempt entity, a surprisingly common occurrence. Valuators and physician-advisors will find a solution to the most common of all small medical practice dilemmas, solving the two-person practice buy-out. In addition, there is a complete Attorney’s Guide to the book as well as a Checklist to be used by attorneys in evaluating experts and their reports. That checklist should be invaluable to expert witnesses and valuators as well. There are numerous other additions and updates. I am certain you will find the second edition the most valuable asset in your medical practice library, whether you are a valuation expert, a consultant, industry executive, or attorney.”

Author’s Note: The print edition is sold out, BUT we have recently (July 2009) re-scanned the entire book into a single, searchable, Adobe pdf file! We are offering the scanned book along with the updated Chapter 5 on valuation methods (in searchable .pdf format with expanded coverage of valuation methods) for the price of $125 with the most recent edition of my Report on the Healthcare Economy. For prior purchasers of updated Chapter 5, a special discount is available – e-mail for details. New Chapter 5 includes critical analysis of why the market approach for valuing medical practice DOES NOT WORK due to lack of sources of comparable data. The Chapter is consistent with my peer-reviewed article appearing in the November 2005 edition of the Journal of Accountancy.In addition, to make sure purchasers have current information, the latest Report on the Healthcare Economy with more than 80 pages of detailed information industry – specific inflation, growth, reimbursement and regulatory topics – is e-mailed with your paid order. Chapter 12 of the book contains a Sample Report, which was written based upon market conditions in 1996. I still structure my reports in the same fashion, but readers should not believe that market conditions in 2009 are remotely similar to 1996 – that is why I offer the Report on the Healthcare Economy! In particular, market “data” is known to be less relevant simply because insufficient comparable data is available. I am amused when asked in cross-exam (as happened this past May, 2007) about values today based upon a report written nearly a decade ago. I have been influenced by the excellent work on the limitations of market data done by Nancy Fannon, CPA/ABV, ASA and Heidi Walker, CPA/ABV as well as my own extensive analysis. Of particular importance for medical practices is the insufficiency of Goodwill Registry data for use in the direct market method of valuation.Finally, given the importance of Revenue Ruling 59-60 in valuation, I offer the following quote from new Chapter 5: “The IRS Exempt Organizations Continuing Professional Education Technical Instruction Program Textbook for 1995 states the following in a section entitled Establishing Comparability under the Market Approach: “Factors affecting comparability include markets served; practice and specialty type; competitive position; profitability; growth prospects; risk perceptions; financial composition (capital structure); physician compensation; physician age, health and reputation; physician productivity; average revenues per physician; cost structure; and average revenue per visit or covered life to revenue to revenue mix (capitated versus fee for service): with a reference to Financial Valuation: Businesses and Business Interests. I know of no database with such information!”

Mark combines more than 20 years of experience as a medical practice consultant and tax partner with his skills as a valuation consultant accredited by the AICPA, to produce the first and only comprehensive guide applying the art and science of valuation specifically to medical practices. Templates and spreadsheets on disk are included, with a valuation model. To order the searchable .pdf version of the Book along with updated Chapter 5 in searchable .pdf format with expanded coverage of valuation methods, call (508) 877-1999.

Look for first edition reviews in:

Business Valuation Review, March, 1999

Business Valuation Update, June 1999

CPA Expert, Special Edition, Spring, 1999

Accounting Today, August/September, 1999

Health Niche Advisor, June 1999

Valuation Examiner, August, 1999

 

Reviewer quotes for the 1999/2000 Medical Practice Valuation Guidebook – Including the Influence of Managed Care, first edition

“This book is a real contribution that I recommend to anyone involved in a medical practice valuation. This is a very comprehensive and useful book with a lot of information packed into every page in an easy-to-read style. Besides the basic information, the frequent “Author’s Insights and Analysis” paragraphs translate the author’s own experiences into useful guidelines for readers. He also succinctly differentiates characteristics and appropriate valuation methodologies among different types of practices.”

Shannon P. Pratt, CFA, FASA

Managing Director, Willamette Management Associates

“At last, a single source that explains all issues and details required to analyze a health care practice! This book takes the time to explain the health care analysis factors that should be considered as well as the implications of the analysis results. Should be required reading and library reference for every valuation and health care professional.”

Jim Rigby, CPA-ABV, ASA

Co-Managing Director, The Financial Valuation Group

“You can’t value what you don’t understand. Mark Dietrich offers the valuation expert – who is not already versed in the intricacies of physician practice management, the knowledge and insight in how to correctly value a medical practice. This books is three books in one: a detailed review of medical practice operations, an excellent review of valuation theory, and a nearly unlimited supply of practical “author’s insights” based on his extensive experience. If you value medical practices, you will value this book.” (Sadly, Jim passed away in January of 2009)

John Mayerhofer, FACHE, FHFMA, CPA

Mayerhofer & Associates

“Needless to say, the information in this [book] is invaluable to appraisers attempting to value a physicians’ practice or the (likely) restricted stock of a PPM company. Chapter 10, Wall Street Meets Medicine, is must-reading for any physician who is considering participating in a roll-up with a PPM. Dietrich captures the essence of the economics of PPMs both from the perspective of the physician and the PPM, as well as providing insights into the very nature of roll-ups.”

Z. Christopher Mercer, ASA, CFA

President, Mercer Capital

The Table of Contents is available (just click). The book leads the reader through the analysis and valuation of the practice. Special chapters on special valuation circumstances, regulatory concerns, physician practice management companies, common mistakes and a sample valuation report with commentary round out this complete guide to valuing a medical practice. In addition to the text, the book will include a CD-Rom with valuation spreadsheets in Lotus and Excel format, reports, correspondence and other material necessary to permit the reader to value a medical practice.

To order the revised version of Chapter 5 in searchable .pdf format with expanded coverage of valuation methods, call (508) 877-1999.

BVR/AHLA's Guide to Healthcare Valuation

July 5th, 2010 | Posted by Mark Dietrich in - (Comments Off on BVR/AHLA's Guide to Healthcare Valuation)
BRV's Guide to Healthcare Valuation

Healthcare is the single largest segment of the economy, the financial aspects of which are perhaps the least well understood and the Reform legislation promises to further complicate that understanding. The 2010 release of the Guide to Healthcare Valuation, co-published by the American Health Lawyers Association and Business Valuation Resources, was a groundbreaking contribution to healthcare valuation. The 2012 Third Edition of AHLA/BVR’s Guide to Healthcare Valuation brings together again the country’s top healthcare industry experts in an expansion of the Second Edition’s comprehensive undertaking aimed at providing both preparers and users of valuation reports with an in-depth understanding of individual industry subsectors. The Guide has been reorganized into major knowledge segments: the Healthcare Marketplace, Regulatory Considerations in Healthcare Valuation, Physician Practices, Physician Services and Hospital Relationships, and other Healthcare Enterprises and includes twelve new Chapters – five devoted to the first comprehensive approach to Compensation Valuation – and 14 revised and updated Chapters.  From physician practices to co-management agreements to home health care agencies, valuation across the continuum of medical care venues is addressed.

The 2010 Federal Healthcare Reform legislation or PPACA contributes to the quandary faced in healthcare valuation as appraisers, attorneys and industry members probe the plethora of new regulations implementing the Reform for knowledge and speculate on what yet-to-be-issued regulations will say.  Even as the PPACA seeks to impose uniform insurance regulations across an industry characterized by the uniqueness of regional and local markets, the Guide’s opening segment includes a detailed analysis of healthcare markets, updated to reflect the increasing recognition in the trade press and general media of the role that local market forces play.

Despite the significance of national trends and the federal Medicare program in the valuation of healthcare enterprises, these local differences in provider reimbursement by health insurers and individual state Medicaid programs lead to significant differences in operating results and value.  A chapter devoted to the unique challenges that local markets present to appraisers in assessing cost of capital and forecasting cashflow is included. 

Each member of the panel of valuation experts provides guidance consistent with the mandatory regulatory constraints on valuation assumptions and methodologies in the healthcare industry.  Specific risks under the Stark Law and Anti-kickback statute are addressed in a separate Chapter along with real advice on how to deal with them in a valuation engagement.  The import of the nonprofit hospital sector is addressed in another chapter on inurement and tax exemption issues.  The risks associated with valuation engagements in a unique practice area are examined in a new chapter on the Bradford Regional case, including some suggestions on the choice of valuation model assumptions where the parties are in a position to refer to one another.  A detailed analysis of the unwarranted abuse of the Cost Approach in valuing goodwill and other intangible assets written by a number of leading experts rounds out the regulatory discussion. 

Notably, each of the valuation chapters provides keen insights on the significance of understanding the revenue cycle.  The manner in which healthcare providers – such as physicians, hospitals, imaging or ambulatory surgery centers – are paid or reimbursed for their services varies radically.  As such, an assumption about inflation or growth in per unit reimbursement appropriate for one of these sectors may be wholly inappropriate for another.

The most significant additions to the Third Edition are five chapters totaling 65,000 words representing the first comprehensive application of the general principles of business valuation to Compensation Valuation.  With the present trend of increasing physician employment by hospitals and health systems, compensation valuation is becoming the most important focus of the valuation community.  These five chapters cover the economics of physician practices along with the Income, Market and Coast approaches to value.

 The largest number of provider entities and the most frequent valuation engagement remains physician practices and the Guide reflects this.  In addition to a new chapter on physician buy-ins and buyouts and a revised and updated chapter on valuation methods for physicians, the Guide includes chapters on personal and enterprise goodwill and noncompete agreements, how to analyze CPT™ codes, damages and the use of MGMA data.  Two chapters address the tax aspects of transactions, which can have a significant affect on the manner in which a valuation method is approached. Where a medical practice valuation is the most common form of healthcare valuation, the most common reason for that valuation is a divorce.  Two chapters on the unique issues of divorce valuation are also included.  

 Physician business relationships with Hospitals and other provider entities are perhaps the major driving force in the healthcare industry today and the Guide devotes seven separate chapters to valuation engagements in this critical market segment, including a new chapter on whole-hospital co-management agreements.  I am certain the heretofore unseen scale of these comprehensive works will stand as a major contribution to the healthcare community’s Body of Knowledge. 

 The Guide’s final segment contains chapters on the valuation of Imaging Centers, Ambulatory Surgery Centers, Dialysis Centers, Hospitals, Home Health Agencies and a new chapter on valuation issues associated with Accountable Care Organizations.

 As Editor and Technical Editor for this Third Edition of the Guide and on behalf of the American Health Lawyers Association and Business Valuation Resources, our thanks to all of the contributors for their hard work on behalf of their colleagues, who we are certain, will find the Guide to Healthcare Valuation an important and valuable addition to their professional library.

 Mark O. Dietrich, CPA/ABV January, 2012

The Guide will be available April, 2012

Other Valuation Links

July 2nd, 2010 | Posted by Mark Dietrich in - (Comments Off on Other Valuation Links)

http://valuationresources.com – Perhaps the best all-around valuation site on the Internet, maintained by fellow ABV and FCG member Jerry O. Peters, CPA, ASA, ABV, CBA.

http://www.federalreserve.gov/releases/H15/update/ – A Federal Reserve Board site that is updated daily with the 20 year treasury bond rate!

http://stats.bls.gov-Bureau of Statistics

http://www.irs.ustreas.gov/prod/tax_stats/soi/corp_gen.html – IRS

http://www.census.gov – Monthly Economic Indicators

http://www.newslink.org/news.html– AJR NewsLink

http://www.asaenet.org/Gateway/OnlineAssocSlist.html– ASAE Assns

http://www.wsj.com– Dow Jones Publication Library

http://www.quote.com– Quote.com

http://www.law.cornell.edu/rules/frcp/overview.htm– Fed Rules Civil Procedure

http://www.fourmilab.ch/ustax/www/t26-APPENDIX.html– US Tax CT Rules

http://www.ustaxcourt.gov/ – US Tax Court

http://www.bizval.com– Mercer Capital

http://www.mergerstat.com– MergerStat

http://www.hlhz.com– Houlihan, Lokey, Howard & Zukin

http://www.willamette.com – Willamette Management

Healthcare and Other Useful Links

July 2nd, 2010 | Posted by Mark Dietrich in - (Comments Off on Healthcare and Other Useful Links)

Mark Dietrich’s Link Page designed especially for Valuation Consultants working on an engagement.

http://finance.yahoo.com
An under-recognized source of invaluable information about publicly traded stocks. For example, you can find the average high low and close for most public stocks going back decades — and all for free! Just click on “Download Spreadsheet” below each stock’s historical price graph. Example: IBM

http://finance.yahoo.com/q?s=IBM&D=my
The maximum period for IBM price data

http://finance.yahoo.com/d/quotes.csv?s=IBM&f=slldltlclohgv&e=.csv
The Excel spreadsheet containing the data points for the above chart.

http://lawyers.martindale.com/
Another source of free information. Virtually all of the nation’s lawyers are listed in Martindale-Hubble. You can find out their education, background, address, phone number and other data. Some individuals are “rated” according to a a Martindale-Hubble system. When I get a call regarding a potential engagement, I always look up the individual before returning the call, or while it is going on.

http://www.gpoaccess.gov
Main page for the Government Printing Office, including the link to the Federal register, an important source of informaiton about such things as the Fraud and Abuse regulations or changes to the Resource-based Relative Value sale (RBRVS).

http://www.gpoaccess.gov/fr/index.html
The Federal register link.

http://www.cdc.gov/nchs/fastats/Default.htm
FAQs (Frequently Asked Questions) at the Center for Disease Control’s National Center for Health Statistics, the source of much of the statistical data in the Medical Practice Valuation Guidebook.

http://www.gofcg.org
The Financial Consulting Group’s website, a nationwide organizaton of the country’s top valuation experts (including the author!).

http://www.hmodata.com
This is the company Interstudy’s site. Interstudy publishes a variety of statistical reports about HMO enrollment across the country and their findings are summarized here in periodic press releases.

http://www.managedcaremag.com
An e-mag on managed care.

http://www.medicare.gov/Choices/Overview.asp
A page for beneficiaries or consumers to understand the various Medicare options.

http://www.medicare.gov/MPHCompare/Home.asp
A site designed for consumers to compare their options under the Medicare progam, but extremely valuable to researchers and valuators who are not familiar with the program. Also a great tool for helping clients or parents understand their options.

http://oig.hhs.gov
The Office of the Inspector General of Health and Human Services home page containing links to the laws and regulations that anyone valuing a medical practice should be certain to read!

http://www.phil.frb.org
The Philadelphia Federal Reserve Board’s site

http://www.phil.frb.org/econ/liv/index.html
The Livingston Survey was started in 1946 by the late economist Joseph Livingston. It is the oldest continuous survey of economists’ expections. It summarizes the forecasts of economists from indsutry, government, banking, and academia. The Federal Reserve Bank of Philadelphia took responsibility for the survey in 1990.

The Livingston Survey’s database offers the actual releases, documentation, inflation growth rates, mean data of all the respondents as well as the individual responses from each economist.

http://www.phil.frb.org/econ/spf/index.html
Survey of Professional Forecasters on the current growth, inflation rate, and other key factors in the economy.

http://www.sec.gov/edgar.shtml
The SEC’s EDGAR site containing detailed information on public companies, such as annual 10K reports.

http://www.ustaxcourt.gov/
The US Tax Court’s website. Cases are published here as decided.

http://www.bizjournals.com/
These are exceptionally useful sites if you are doing “out of market” valuations. It lists, along with links, many of the nation’s Business Journals, weekly papers focusing on issues of interest to the business community. These Journals often publish a “Book of Lists” which show key market information for their service area.

http://www.interest.com/top100.html
This site contains links to 100 of the nation’s top newspapers.

Valuation Links

July 2nd, 2010 | Posted by Mark Dietrich in - (Comments Off on Valuation Links)

ALERT: CMS changed the location of the pages and files listed below three times in the last administration without leaving forwarding links and the pattern continues! As such, some of the CMS links below will be worthless.

Whether you are new to the business of valuing medical practices, or looking to update or develop a medical practice-specific valuation report with National Economic and Regulatory data unique to healthcare, use these links. Not enough time to do all of the research yourself? Purchase the Medical Practice Valuation Guidebook (Sorry, Sold Out! but call for options) and receive a free copy of our Report on the Healthcare Economy, including the Regulatory Environment and Medicare Program, suitable for inclusion in your own reports! (written by Mark O. Dietrich, CPA/ABV.)

Background on Healthcare

medterms.com
A Medical Dictionary search engine.

http://www.medpac.gov/document_search.cfm
If you have ever wanted to locate the “single source” to an understanding of the Medicare program’s reimbursement methods for various classes of providers, this is it: The Medicare Payment Advisory Commission (MedPAC) Annual Report to the Congress. In addition to a comprehensive explanation of the methods, it contains recommendations to Congress for increases or decreases in the payment rates to Hospitals for both inpatient and outpatient services, Physicians, Skilled Nursing Facilities (SNFs), Home Health Services, Outpatient Dialysis and Ambulatory Surgery Centers.

http://waysandmeans.house.gov/media/pdf/hr1/hr1jtexplstate.pdf
Various summaries of the new Medicare Prescription Drug, Improvement and Modernization Act, the most significant legislation since the Balanced Budget Act of 1997.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/mc86c01.pdf

A summary of the Balanced Budget Act of 1997, perhaps the single most important piece of legislation on healthcare finance since the Medicare program was adopted. A key component of any valuation report and valuator’s understanding of the healthcare reimbursement environment.

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/se0432.pdf
A summary of the Balanced Budget Refinement Act of 1999

http://www.mwe.com/index.cfm/fuseaction/publications.nldetail/object_id/A9EAA7E2-C6C5-48A2-9BC5-A385C79D3356
The law firm McDermott, Will & Emery’s summary of the Benefits Improvement and Protection Act of 2000.

http://www.cms.hhs.gov/QuarterlyProviderUpdates/
The location of CMS’ What’s New page.

http://www.cms.hhs.gov/
The Centers for Medicare and Medicaid website index.

http://www.cms.hhs.gov/MedicareProgramRatesStats/03_HlthCrInds.asp
This is the location of the Health Care Indicators providing the most recent CMS data on Hospital, Employment, and Price Indicators for the Health Care Industry. Included are various tables displaying the current trend in days per 1000, admits per 1000 and medical price CPI, as well as many others. This is an excellent source of data for preparing that section of your valuation report that deals with current trends in the healthcare segment of the economy. Downloads are available in html and Adobe format.

http://www.cms.hhs.gov/home/regsguidance.asp
Links to regulations relating to the Medicare program. Find our what the current state of the law is and make sure you demonstrate an understanding of it in your valuation report.

http://www.hmodata.com/
This is the company Interstudy’s site. Interstudy publishes a variety of statistical reports about HMO enrollment across the country and their findings are summarized here in periodic press releases. An invaluable source on what is going on in the HMO industry across the country and regionally.

http://www.healthleaders.com
An e-newspaper with a broad variety of healthcare news items and articles, submitted to us by pediatrician Dr. Jeff Lasker.

http://www.cdc.gov/nchs/products/nhsr.htm
The Advance Data reports at the Center for Disease Control’s National Center for Health Statistics have been renamed National Health Statistics Reports and, of course, relocated(!) Much of the statistical data in the Medical Practice Valuation Guidebook came from CDC. You can quickly locate data such as Hospital Discharges or Ambulatory Surgery that may influence your valuation conclusion.

Example
http://www.cdc.gov/nchs/data/nhsr/nhsr029.pdf
The most recently available Hospital Discharge Summary (2006). “The discharge rate per 10,000 population ranged from 940.2 in the West to 1,330.7 in the Northeast region. The average length of stay ranged from 4.2 days in the Midwest to 5.3 days in the Northeast region.” This tells you that utilization of hospital services in the Northeast is much higher than any other part of the country.

http://www.cms.hhs.gov/MedicareFeeforSvcPartsAB/03_MEDPAR.asp#TopOfPage
The location of many of the Medicare’s program statistical summaries of hospital utilization and costs. MEDPAR files contain information for 100% of Medicare beneficiaries using hospital inpatient services. Data is provided by state and then by DRG for all short stay and inpatient hospitals. As of this update (August 2009), the most recent data is 2007.

http://oig.hhs.gov
The Office of the Inspector General of Health and Human Services home page containing links to the laws and regulations that anyone valuing a medical practice should be certain to read! Get the latest information on changes in the volatile regulatory environment.

http://www.justice.gov/opa/pr/2012/November/
The Civil Division of the Department of Justice (DOJ) press release page where you can find the latest news about fines levied against healthcare providers in connection with the False Claims Act and qui tam cases, among others.

http://www.access.gpo.gov/su_docs/fedreg/a010104c.html
The location of the final Stark II regulations – don’t value a medical practice without reading them (or, at least, the summary of the regulations in the current edition of the Medical Practice Valuation Guidebook). To find the correct link, go down the page to “Health Care Financing Administration” (hint: use the ‘find’ command of your browser) and click on each of the three links for different portions of the regulations. Each link contains 50 pages of material.

http://www.gpo.gov/fdsys/pkg/FR-2007-09-05/pdf/07-4252.pdf
This is the third ‘set’ of Stark II regulations, containing 11 pages. Pages 9 through 11 contain a list of Stark services by CPT code enabling you to identify those codes that present a potential problem area. For example, you may encounter a group practice compensation system where the income from those Stark services is allocated to the physician who ordered the test and no exception is available. The most recent listing of CPT and HCPCS codes (2012) covered by Stark is located here http://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/Downloads/2012Addendum.zip

https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/index.asp
If the government is concerned about the arrangements listed here, you should be too! This is the Fraud Alert page that lists to specific areas the Office of the Inspector General is looking for potential fraud. Be on the look out for these when conducting a valuation.

http://oig.hhs.gov/fraud/docs/alertsandbulletins/consultants.pdf
The link to the Office of the Inspector General’s WARNING to consultants, including valuation consultants, about practices which may violate federal civil and criminal statutes. Pay careful attention to page 4.

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/downloads/cms-1533-fc.pdf/
CMS’ periodic reports on various segments if the healthcare provider industry with invaluable summaries of market research.

Regional Data

Valuators generally want to review in their reports the state of the economy in the region in which the valuation subject operates. The links in this section provide access to government sites where this data is maintained.

http://www.census.gov/population/www/estimates/popest.html
This is the Census Bureaus entry point for population statistics, available by state and in various levels of detail.

Example
http://www.census.gov/population/estimates/state/st-99-08.txt contains the population broken down by five year age groups for each state in the nation.

http://www.census.gov/econ/census07// contains the Summary Statistics for the United States from the 2007 Economic Census by Major Industry (NAICS – North American Industry Classification System) Grouping. There are links to get the same data by state, county and metropolitan area!

http://www.census.gov/econ/census07/
This is the Census Bureau’s entry point for when detailed information from the 2007 Survey on conditions in the various segments of the economy will be released.
Example
http://www.census.gov/epcd/ec97/us/US000_54.HTM contains detailed information on Professional, Scientific, and Technical Services by Subsector.

http://www.bls.gov/
Bureau of Labor Statistics home page with links to the various offices that maintain regional CPI statistics.

http://www.bls.gov/eag/home.htm
The Bureau of Labor Statistics’ Economy at a Glance page. Using a map of the United States, you can click on the valuation subject’s state and instantly locate current and historical employment, unemployment, and other employment stats.

http://stats.bls.gov/iag/iaghome.htm
The Bureau of Labor Statistics’ Industry at a Glance page with current information on each of the major sectors of the economy.

http://www.census.gov/hhes/www/hlthins/ Census Bureau’s 2006 report on the health insurance status of the country.

Quantitative Data

One of the most challenging tasks is finding the necessary quantitative data to use in the valuation model. The links below enable you to quickly obtain the risk-free rate and the rate of inflation for use in developing your discount and capitalization rates, as well as detailed physician reimbursement data of the type described in the Medical Practice Valuation Guidebook, Including Comprehensive Financial Analysis and the Influence of Managed Care.

http://www.phc4.org/reports/fin/06/Default.htm
Pennsylvania Health Care Cost Containment Council report page containing detailed data on hospitals and Ambulatory Surgery Centers in Pennsylvania, an excellent source of (free) data on revenues and profitability.

http://www.healthaffairs.org/
Health Affairs, The Policy Journal of the Health Sphere Owned and published by Project HOPE – The People-to-People Health Foundation, Inc.

http://www.cms.hhs.gov/NationalHealthExpendData/03_NationalHealthAccountsProjected.asp
The National Health Expenditure Projections presented here are based on the 2006 version of the National Health Expenditures released in February 2008. The Projections are estimates of spending for health care in the U.S. for the years 2007-2017. The Projections are presented by type of service delivered (hospital care, physician services, nursing home care, etc.) and by source of funding for those services (private health insurance, Medicare, Medicaid, out-of-pocket spending, etc.).

CMS Statistics

http://www.cms.hhs.gov/ActuarialStudies/ The location of the following links:

Medicare Trust Funds

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2012.pdf

Medicare Rates

http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/RSD/list.asp#TopOfPage: Medicare Advantage capitation payment rates and information
http://www.cms.hhs.gov/SustainableGRatesConFact/01_overview.asp Estimated Sustainable Growth Rate and Conversion Factor for Medicare Payments to Physicians
http://www.cms.hhs.gov/ActuarialStudies/02_PhysicianResponse.asp#TopOfPage: Analysis of physician response to changes in Medicare payment rates
http://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html: Medicare premiums, deductibles, and coinsurance

Medicare and Medicaid

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProgramRatesStats/downloads/MedicareMedicaidSummaries2010.pdf A brief overview of the Medicare and Medicaid programs
http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/HealthPlanRepFileData/Monthly.html Monthly Trend Report for Medicare & Medicaid

Health Accounts

Health Expenditures and Sources of Funds — historical and projected national health expenditures and historical estimates by state.
Health Care Indicators — contains data and analysis of recent trends in health care spending, employment and prices.

http://www.statehealthfacts.kff.org/
The Kaiser Family Foundation’s State Health Facts Online, a comprehensive aggregation of spending data on all types of healthcare. Perhaps the best site of its kind imaginable!
http://www.statehealthfacts.kff.org/profile.jsp
The direct link to individual state profiles. Click Health Costs & Budgets for statistical data.

Other

http://www.federalreserve.gov/releases/H15/update/ – A Federal Reserve Board site that is updated daily with the 20 year treasury bond rate! Contains historical information sufficient to get data for virtually any valuation date.

http://www.phil.frb.org/research-and-data/real-time-center/survey-of-professional-forecasters/
Survey of Professional Forecasters on the current growth, inflation rate, and other key factors in the economy.

http://www.bls.gov/cpi/
The Bureau of Labor Statistics Consumer Price Index page. An inflation calculator is located here that enables you to calculate the value of a dollar based on inflation since 1980.

http://www.cms.hhs.gov/MedicareFeeforSvcPartsAB/04_MedicareUtilizationforPartB.asp#TopOfPage
With the changes to the CMS website, only certain utilization data seems to be readily available at the link above. The mother lode of free data: the file containing physician utilization by CPT code for 2004 http://www.cms.hhs.gov/PhysicianFeeSched/01_Overview.asp#TopOfPage is back: Utilization File [ZIP, 1.3MB]! This database can be opened using Microsoft Access. You can then sort the data, for example, by medical subspecialty (e.g., internal medicine, cardiology, etc.) and CPT Code sequence to obtain the “normal” coding pattern. You can then compare this coding pattern to the practice you are valuing. The most important codes to analyze for a medical (as opposed to surgical) specialty are the established patient visit codes, 99211-99215. For the consultative specialties, such as cardiology and gastroenterology, you should also look at 99242-99245. This type of analysis is explained in the Medical Practice Valuation Guidebook, Including Comprehensive Financial Analysis and the Influence of Managed Care . It is the key to a properly conducted valuation. (See the following link as well)

physpec.xls
I have had many inquiries from users of this site about where to find the cross-reference to physician specialties listed by number in the physician utilization data above, and here it is. (See the previous link as well)

http://www.cms.hhs.gov/PhysicianFeeSched/PFSCSF/list.asp#TopOfPage
This page contains the state by state detail of the Medicare Physician Fee schedule for the years 1998 through 2008. This data can be used to evaluate the collectibility of Medicare charges in a physician practice. For example, you may compute the average collected fee for key CPT codes in a practice and compare it to this fee schedule using a vertical lookup table.

E-Newsletters

The following links give you the opportunity to sign up for e-mail newsletters from a variety of organizations that we at Dietrich & Wilson have found valuable in our healthcare practice.

Atlantic Information Services (AIS) main link to sign-up for one or more of their e-newsletters listed below.

http://www.aishealth.com/GovernmentNews.html

AIS Health’s Government News of the Week. Just what it says, a weekly newsletter that tracks announcements by the Centers for Medicare and Medicaid(CMS), the OIG, the Department of Justice and various state regulatory authorities.

http://www.aishealth.com/MDPracticeAlert.html

AIS Health’s MD Practice Alert. In addition to news relevant to physicians from CMS, this newsletter tracks such diverse items as the malpractice insurance crisis and news releases about physician recruitment and compensation.

http://www.AISHealth.com/BusinessNews.html

AIS Health’s Business News of the Week. This weekly newsletter (Tuesday) tracks such things as trends in health insurance coverage, conversions of Blue Cross plans to for-profit status, and other items of note in the healthcare industry.

Other E-Newsletters

Modern Healthcare, a weekly industry magazine, offers a free daily newsletter. The topics are varied, including government action as well as the introduction of new pharmaceuticals, purchases and sales of hospitals, and anti-trust action.

http://www.healthaffairs.org/1260_opt_in.php

Health Affairs, The Policy Journal of the Health Sphere, is a bi-monthly academic research publication sponsored by Project Hope. The e-mail newsletter offers summaries of select articles form the current issue, which is available online for free.

Need to acquire statistical data for benchmarking or excess earnings calculations?

Medical Group Management Association

Cost Survey; 2012 Report Based On 2011 Data (updated annually)
http://www.mgma.com/store/Surveys-and-Benchmarking/Cost-Survey-2012-Interactive-Report-Based-on-2011-Data-CD-Single-User/

Physician Compensation And Production Survey: 2007 Report Based On 2006 Data (updated annually)
http://www.mgma.com/physcomp/

104 Inverness Terrace East
Englewood, CO 80122-5306
# (303) 799-1111

American Medical Group Association

http://www.amga.org/Research/2011ExecSummary.pdf

1422 Duke Street
Alexandria, Virginia 22314-3430
# (703) 838-0033

American Medical Association

Medicare RBRVS: The Physician’s Guide
Capitation: The Physician’s Guide – Highly Recommended (may be out of print)
Physician Practice Management Companies: What You Need To Know
Physicians’ Current Procedural Terminology-CPT 05

515 North Street
Chicago, Illinois 60610
# (312) 464-4332

Links

July 2nd, 2010 | Posted by Mark Dietrich in - (Comments Off on Links)

Mark Dietrich’s selected links for all aspects of valuation and healthcare: