The volume of physician practice mergers and acquisition (M&A) transactions is on pace to increase by approximately 37% in 2018 as compared to prior year1.

As these physician practice transactions continue to become more prevalent, 重要的是要了解在大多数实践中常见的关键财务问题, 无论专业. 从财务尽职调查的角度来看，这些医师执业交易可能具有挑战性，因为在实践中普遍缺乏财务/会计功能，而且许多实践财务的现金基础性质.

Key items to consider when evaluating physician practice transactions

  • 现金与权责发生制转换 – As the majority of physician practices typically operate on a cash basis of accounting, 收益分析质量的一个标准组成部分包括将公司的帐簿从现金制转换为权责发生制. This conversion would consider items such as: accounts receivable, 物资库存, 应计未付薪金, 和应付账款. 而现金与权责发生制转换最重要的部分与应收账款和应计供应商补偿有关(两者将在下面的章节中讨论), it is also important to understand the historical 物资库存 balances, unaccrued non-provider补偿, and other operating payables when evaluating the working capital necessary to operate the practice.
  • 收益分析质量 – In order to estimate historical accounts receivable, 需要利用Target的历史索赔和支付数据进行现金瀑布分析. This analysis will present historical cash collections by date of service, which will allow you to analyze collections trends over time and anticipate any future collections. Performing this analysis at a disaggregated level (e.g., by location, provider, payor, procedure, etc.)可以让你识别趋势和异常，否则在综合分析现金瀑布时可能不会很明显. 在分解级别上分析瀑布时可能会变得明显的物品可能包括在冲锋仪上的变化, 付款人费率的变化, and periods of disruptions in service/billing. If anomalies such as these are identified, the cash waterfall analysis may need to be adjusted to normalize the impact of these outliers. When analyzing the results of the cash waterfall analysis, it is important to understand the trending of charges and payments over the historical period (e.g., increases in volume of charges typically result in a positive cash to accrual EBITDA adjustment).
  • 供应商赔偿 – It is common practice for providers to be compensated based on a production basis (i.e., based on a percentage of collections for services rendered). 基于提供商分解瀑布分析的结果和提供商雇佣协议的条款, 这种以生产为基础的薪酬可以在权责发生制基础上重新计算，作为盈余质量分析的一部分. It is important to understand the Target’s historical production-based payment schedule. If there is a significant lag between when the compensation is earned (i.e., when the service is performed) and when the compensation is paid to the provider, there could be a significant exposure related to earned but unpaid provider compensation.
  • 所有者补偿 – The terms of owner compensation are typically renegotiated as part of a potential transaction. 因为所有者可以通过股权分配获得他们历史上的大部分补偿(i.e., 对损益表没有影响), 所有者补偿的重估(如上文所讨论的以生产为基础的安排)通常会显著降低医生执业的历史报告EBITDA. Conversely, if the owners’ historical compensation has been through payroll (i.e., 对损益表的影响), 交易后关闭所有者补偿的重估可能会导致工资支出显著减少，并增加医生执业的预估EBITDA.  在建立你的投资模型时，考虑与业主的关闭后就业安排的条款和形式补偿的影响是很重要的.

整体, 鉴于一般现金基础会计的性质，对医师执业的财务尽职调查可能具有挑战性. 然而, 理解解决这些问题所需的关键问题和分析将有助于确保交易的成功.

需要对你的医疗保健M有信心&一个过程? 问以下10个问题.

考虑到大多数医疗保健组织不断变化的会计复杂性和会计资源限制, 不幸的是，买家不能把报告的财务信息的表面价值的未来预期收益将是收盘后. As part of the financial due diligence process, 买方至少应考虑以下关键项目，以确定收入的可持续性, 如果EBITDA(息前收益), 税, 折旧和摊销)是一个足够的度量来确定卖方产生现金流的能力.

收入

  1. 银行对账单上的现金收入是否支持财务报表上的净收入，是否支持病人账单/会计系统上的收款?
  2. How are charges and collections trending by payor during the historical period (e.g., are collection rates increasing or decreasing)?
  3. Have there been any recent contract changes that will impact earnings post-close (e.g., payor / managed care contracts, professional services agreements, outsourced billing/collections)?
  4. Is there a shift in payor mix that will impact reimbursement trends post-close (e.g., 自费病人增加, increase in self-pay after insurance amounts for deductibles and co-payments, 改变政府付款人组合)?
  5. Has there been a change in service mix (e.g., 实验室费用的增加或辅助服务的增长)掩盖了传统业务的表现?

费用

  1. Are there any non-recurring expenses recorded in the historical financial statements (e.g., owner compensation or rent expense not reported at fair market value, start-up costs / de novo costs) or changes in cost structure?
  2. 所有的经营成本是否准确地反映在财务报告中(e.g., is a cash-to-accrual conversion required)?
  3. 临床医生和其他关键员工的历史薪酬和福利结构(包括承包商使用的考虑)与这些员工(和承包商)关闭后的预期薪酬和福利计划相比如何?
  4. 是否有即将到来的资本支出或其他投资需要继续增长的业务?
  5. Have there been any significant medical malpractice claims against the seller or its clinicians?

整体, 收入和收益分析的质量是收购过程中的关键步骤，它将允许买家更好地评估业务的每一个报告方面. 以及这个收益分析, 对资产负债表账户的深入了解将使买方对被收购企业的未来预期收益和现金流有信心.

For more information, contact 布莱恩Marynowitz at 布莱恩.marynowitz@sepon-boutique-resort.com or . 了解更多有关明升体育app下载 事务咨询服务.

1Source: According to an article published in Q3 2018 from Irving Levin Associates, Inc., 截至2018年8月，私人股本公司共进行了153宗医生业务收购，而2017年全年则为168宗. 我们将2018年前8个月的153笔交易按年计算，以估计该年的总增长. http://healthcare.levinassociates.com/2018/08/31/pmg-deals-set-for-new-record/

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