Utilizing the Income Approach to Appraise Outpatient Enterprises
Healthcare related outpatient enterprises are those that provide services that do not require hospital admission and may be performed outside the premises of a hospital. Valuation of healthcare related outpatient enterprises, similar to valuation of any business, should include consideration of the three general approaches to valuation, i.e., the income approach, the market approach and the asset/cost approach. Use of specific methods under each approach will be guided by the facts and circumstances of the engagement, e.g., availability of data, nature of the current transactional marketplace, etc. This article focuses on utilizing an income approach to value outpatient enterprises, while subsequent articles in this topic series will address the use of a market approach and an asset/cost approach to value outpatient enterprises. (Read more...)

Access to Healthcare Remains Stable Under Affordable Care Act
The U.S. may be facing a healthcare delivery and supply crisis, in which there is an insufficient amount of providers to meet the needs of the aging population, as well as the growing population insured through Medicare. The subsequent demand for additional health services, combined with an aging physician workforce entering retirement, may result in a significant supply shortage in the healthcare industry. However, recent research indicates that the U.S. has not yet reached a point at which there is insufficient access to basic healthcare services for the growing population of Medicaid beneficiaries. Although these aforementioned demographic shifts may not be controllable, the U.S. may benefit from acting quickly to address various regulatory standards regarding access to care and provisions to increase the pool of available healthcare providers, to mitigate the effects of the potential shortage of healthcare services. (Read more...)

ACOs Achieving Quality with Shared Savings
The Centers for Medicare & Medicaid Services recently found that Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) improved their mean quality scores from 71.8% in 2012, to 85.2% in 2013. Similarly, a recent study released by Avalere Health Center for Payment and Delivery Innovation found that, overall, ACOs improved their scores on the majority of quality measures over their previous year's performance. However, the most commonly achieved quality metrics were those that involved measuring survey statistics or process metrics, and the least commonly achieved quality metrics were those that involved quality outcome measures, causing concern regarding the overall purpose of the MSSP. (Read more...)

Physicians Increasingly Targeted in Fraud & Abuse Lawsuits
In the midst of growing regulatory scrutiny regarding fraud and abuse, regulatory agencies are increasingly pursuing physicians, individually, under fraud and abuse laws. In United States ex rel. Williams v. Banks-Jackson-Commerce Hosp. & Nursing Home Auth., a case stemming from the complaint of a relator (i.e., a private citizen) in the small community of Commerce, Georgia, a physician agreed to pay $200,000 to the U.S. to settle allegations regarding improper kickbacks in violation of the False Claims Act, Stark Law, and Anti-Kickback Statute. While the settlement agreement, which was executed on September 22, 2014, led to the lawsuit's dismissal, the announcement of the agreement is yet another sign of federal regulatory authorities utilizing a new tactic to boldly pursue fraud and abuse lawsuits, whereby individual physicians who receive improper payments may be liable under federal fraud and abuse laws. (Read more...)