医师执业的加速趋势
超过100,000 physicians moved from independent practice to employment by 医院 and other corporations between 2019 and 2021,[1] 在加速医师实践收购的持续趋势. 到2021年底, 74%的bet8网站备用受雇于bet8网站备用, 医院, 或者公司实体, 22%的bet8网站备用受雇于公司实体.[2]
几乎所有专业都受到了影响, primary care practices have been in high demand—especially as health systems and other buyers have been able to realize significant value in shifting from fee-for-service contracts, 提供者按所执行的每项bet8娱乐付费(例如, 办公室访问和测试), 以价值为基础的合同. 基于价值的合同, physicians are incentivized to better manage patients’ treatment plans and eliminate unnecessary services, 这样可以降低医疗成本, and this reduction in cost is then shared with the physician’s practice through risk-sharing arrangements.
高初级保健实践采购价格
35岁以上[3] physician practice transactions with publicly available data have closed in the last five years and transacted with an EBITDA—earnings before interest, 税, 折旧, 摊销,乘以10x或更高. 在这些交易中,有12笔涉及初级保健,没有一个买家是bet8网站备用. Many had significant purchase prices; the chart below lists some recent transactions.
作者们亲眼目睹了大倍数. 在他们所重视的最近25种初级保健实践中, 这些交易中有一半以上的EBITDA倍数超过10倍.
Many non–health system buyers are not required to follow fair market value (FMV) standards: “the price at which the property would change hands between a willing buyer and a willing seller, neither being under any compulsion to buy or to sell and both having reasonable knowledge of relevant facts.”[4] Thus, they can offer more competitive bids for physician practices than health systems are able to. Health systems will need to match these bids while staying within FMV if they are to have a chance of acquiring primary care groups, 包括只有少数提供者的实践.
医师实践的三种评估方法
医师执业的估价从三种方法开始:收入法, 成本法, 市场方法.
- The income approach estimates the value of a business or arrangement based on the present value of the cash flows that are expected to be generated in the future.
- The market approach estimates the value of a business by considering the prices of comparable businesses or the prices at which similar businesses have transacted. 这种方法还包括对过去交易的分析, 根据主题业务和市场数据之间的差异进行调整.
- The cost approach seeks to identify replacement costs and typically is performed through an analysis of the relevant assets and liabilities in a business valuation. 在这种方法中, the tangible and intangible assets are individually appraised and then aggregated to estimate value. The cost approach entails estimating the cost of reproducing the benefits to be derived from the business or arrangement. 这种方法对投资控股公司的估值最有用, asset-intensive公司, 以及考虑或正在进行清算的企业.
The income and market approaches require the practice’s EBITDA to be greater than zero; this value is unusual in smaller physician practices, 在哪里,bet8网站备用所有者获得所有的收入作为分配. To support a purchase price, the owners would have to reduce their salaries after the transaction.
在不减薪的情况下,这种做法将按照费用法加以估价. Because physician practices have small asset bases—this is especially true of primary care practices—valuing the practice under 成本法 would result in a low valuation and a low incentive for physicians to consider selling their practice.
然而, the income approach allows health systems to quantify the opportunity of entering into risk-sharing arrangements. 有效地管理病人的生命具有重要的价值, 特别是医疗保险优惠患者, 考虑到管理这群人的高成本. Health systems and larger practices are putting a greater emphasis on value-based contracts and can take advantage of this additional income stream, 然而,很少有bet8网站备用能够自己做到这一点.
如何使医师执业采购价格最大化
The FMV standard requires the consideration of a hypothetical buyer and hypothetical seller; meaning, the additional value of transitioning patients 以价值为基础的合同 can be considered when the valuation uses market data and is not specific to a particular buyer. 而非bet8网站备用的购买者可能要支付高达12美元的费用,每个医疗保险优惠期, health systems cannot directly value a practice by the number of lives without running afoul of Stark law and Anti-Kickback Statute regulations. 而不是, they need to work with skilled advisers who can appropriately forecast the future cash flow a hypothetical buyer could achieve from risk-based contracts.
为了准确地反映一旦一个假设的买家拥有了这家公司会发生什么, a portion of these incremental cash flows should be paid to the physicians as an incentive to continue seeing fewer patients per day when those patients need more of a provider’s time. Another portion of the incremental cash flow is for infrastructure and care management costs. The rest of the cash flow is then available to either reinvest in the company or make payable as distributions to the practice owners. 现金流越大,估值越高, in the same way as excess cash flow is quantified in the income approach and market approach, and makes it possible for health systems to offer purchase prices that are competitive with corporate entities.
成本法与收益法的比较
下面的例子列出了最近由一位bet8网站备用和三个应用程序进行的评估. It shows a traditional cost approach as well as an income approach that quantifies the value-based arrangement opportunity.
另外,下面的图表包含了一些例子 医师实践之间的盈利差异 按bet8娱乐收费的方式和签订双边风险安排的方式 在高成本地区成功管理患者群体.
量化基于价值的安排机会的好处
随着越来越多的初级保健bet8网站备用意识到他们实践的价值, 他们将不再接受固定资产购买价格. A valuator who has a deep understanding of managed care and value-based arrangements can help by:
- 对转向基于风险的合同的潜在价值进行详细的预测.
- 支持bet8网站备用在快速变化的环境中提供有竞争力的报价.
A valuation expert can help a health system quantify the value-based arrangement opportunity while ensuring the analysis is competitive and meets FMV standards.
您的组织是否准备好在快速变化的环境中提供有竞争力的报价?
Health systems should make sure their appraisers appropriately consider the value that primary care practices generate when they successfully manage populations.
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编辑: 苏做饭
脚注
- 1.
“PAI-Avalere Report on Physician Employment 趋势 and Practice Acquisitions in 2019–2021: Key Research Findings,bet8网站备用倡导协会.
- 2.
同前.
- 3.
Scope Research, http://www.scoperesearch.co/.
- 4.
出版于2023年2月22日