Presented by PYA’s Jim Lloyd (Consulting Principal) and Robert Mundy (Consulting Senior Manager), "Valuation of Dental Practices,” provide valuable insights regarding dental practice operations, merger and acquisition activity, and valuation approaches. The presentation also covers:
Key operating statistics that drive the value of dental practices.
Compensation trends for dentists.
Regulatory constraints and related issues.
Presentation Offers Valuation Strategies for Tax-Effective Practice TransactionsPYA, P.C.
PYA Principal Jim Lloyd co-presented a session at the 2013 AICPA Healthcare Industry Conference in New Orleans on “Valuation Strategies for More Tax-Effective Physician/Dentist Practice Transactions.”
An Alternative to Traditional M&A: Hospital Network AlliancesPYA, P.C.
PYA Principal David McMillan presented during The Knowledge Congress webinar, “The Impact of Healthcare Reform in M&A,” which discussed the fundamentals and significant developments related to mergers and acquisitions (M&A) and healthcare reform and was designed to help healthcare executives and professionals avoid related, common pitfalls and risk issues. The webinar also explored hospital network alliances as an alternative to traditional M&A including.
PYA Principal Carol Carden's AICPA Health Care Industry Conference presentation addressed the current hospital/physician affiliation environment and its impact on physician compensation.
Healthcare Reform and Physician Compensation— Presentation Examines What’s in...PYA, P.C.
Among the many questions facing physicians in the wake of healthcare reform—how will they get paid? PYA Principal David McMillan recently addressed this question at the PKF Healthcare Fly-In with “Current Reform Initiatives and Their Impact on Physician Compensation.”
Presentation Covers Physician Practice CompliancePYA, P.C.
PYA Consulting Manager Valerie Rock presented “Compliance in the Physician Practice.” She discussed the importance of having a compliance plan, coding and billing monitoring, audit schedules, and provider expectations.
PYA Healthcare Consulting Senior Manager Robert Mundy co-presented during, “Valuing Hospitals,” Thursday, July 31, at 1 p.m. EST. This webinar explores the changing world of hospital economics, regulations, and valuations and how appraisers can best prepare themselves for both the opportunities and challenges that lie ahead.
Accounting Update Overview with a Healthcare SlantPYA, P.C.
PYA Principal and Director of Audit Services Doug Arnold presented during East Tennessee State University’s 38th Annual Accounting, Auditing, and Tax Updating CPE conference. His presentation covered many recent Accounting Standards Updates, but leaned toward their applications in healthcare.
PYA Presentation: “Thorny Issues in FMV and Commercial Reasonableness"PYA, P.C.
PYA Principals Jim Lloyd and Lyle Oelrich presented "Thorny Issues in Fair Market Value and Commercial Reasonableness" at the Greater Kansas City Society of Healthcare Attorneys, Wednesday, April 16, 2014.
Presentation Offers Valuation Strategies for Tax-Effective Practice TransactionsPYA, P.C.
PYA Principal Jim Lloyd co-presented a session at the 2013 AICPA Healthcare Industry Conference in New Orleans on “Valuation Strategies for More Tax-Effective Physician/Dentist Practice Transactions.”
An Alternative to Traditional M&A: Hospital Network AlliancesPYA, P.C.
PYA Principal David McMillan presented during The Knowledge Congress webinar, “The Impact of Healthcare Reform in M&A,” which discussed the fundamentals and significant developments related to mergers and acquisitions (M&A) and healthcare reform and was designed to help healthcare executives and professionals avoid related, common pitfalls and risk issues. The webinar also explored hospital network alliances as an alternative to traditional M&A including.
PYA Principal Carol Carden's AICPA Health Care Industry Conference presentation addressed the current hospital/physician affiliation environment and its impact on physician compensation.
Healthcare Reform and Physician Compensation— Presentation Examines What’s in...PYA, P.C.
Among the many questions facing physicians in the wake of healthcare reform—how will they get paid? PYA Principal David McMillan recently addressed this question at the PKF Healthcare Fly-In with “Current Reform Initiatives and Their Impact on Physician Compensation.”
Presentation Covers Physician Practice CompliancePYA, P.C.
PYA Consulting Manager Valerie Rock presented “Compliance in the Physician Practice.” She discussed the importance of having a compliance plan, coding and billing monitoring, audit schedules, and provider expectations.
PYA Healthcare Consulting Senior Manager Robert Mundy co-presented during, “Valuing Hospitals,” Thursday, July 31, at 1 p.m. EST. This webinar explores the changing world of hospital economics, regulations, and valuations and how appraisers can best prepare themselves for both the opportunities and challenges that lie ahead.
Accounting Update Overview with a Healthcare SlantPYA, P.C.
PYA Principal and Director of Audit Services Doug Arnold presented during East Tennessee State University’s 38th Annual Accounting, Auditing, and Tax Updating CPE conference. His presentation covered many recent Accounting Standards Updates, but leaned toward their applications in healthcare.
PYA Presentation: “Thorny Issues in FMV and Commercial Reasonableness"PYA, P.C.
PYA Principals Jim Lloyd and Lyle Oelrich presented "Thorny Issues in Fair Market Value and Commercial Reasonableness" at the Greater Kansas City Society of Healthcare Attorneys, Wednesday, April 16, 2014.
PYA Principal Carol Carden presented on current issues in healthcare valuation at The Texas Society of Certified Public Accountants Business Valuation, Forensic, and Litigation Services Conference at the Hilton Fort Worth, October 14, 2014.
As healthcare is a language “all its own,” PYA Principal David McMillan presented “Learning the New Language of Healthcare" at the Georgia Society of CPAs' 2014 Healthcare Conference.
The Top Ten Issues in Physician Practice Acquisition and ValuationPYA, P.C.
A webinar hosted by The National Association of Certified Valuators and Analysts (NACVA) and presented by PYA Consulting Principal Darcy Devine outlines ten common, but often complex, issues that arise during the physician practice acquisition process. The webinar took place Friday, February 13, 2015. “Don’t Stumble Coming Out of the Gate—The Top Ten Issues in Physician Practice Acquisition and Valuation” is geared toward health system and physician practice financial executives as well as business valuators working with those entities.
Practice Valuation & Physician Compensation Planning ConsiderationsPYA, P.C.
PYA Principal Carol Carden and PYA Senior Consultant Katie Culver presented “Practice Valuation and Compensation Planning Considerations" at the TSCPA Southeastern Forensic & Valuation Services Conference.
PYA Thought Leader Defines Role of Radiation Oncology in Clinical IntegrationPYA, P.C.
PYA Senior Consulting Manager Chris Wilson presented “Clinically Integrated Networks (CIN) and the Role for Radiation Oncology” at the SATRO® 16 Conference, April 24-25, 2014, at the Crowne Plaza Ravinia in Atlanta, Georgia.
PYA Principal Lori Foley presented on “Hospital-Owned Orthopaedic Practices” at the Tennessee Orthopaedic Society Annual Meeting. With many providers considering hospital employment, this session focused on:
Employment activity specific to orthopaedics including some of the pros and cons that private practice physicians should consider when evaluating this option.
Other alignment arrangements taking place between hospitals and orthopaedic practices.
ICD-10 Is Really Here: What Does That Mean To Compliance Officers?PYA, P.C.
PYA Principal Denise Hall presented “ICD-10 Is REALLY Here: What Does that Mean to Compliance Officers?” at the THA 2015 Fall Compliance Conference. The presentation helps providers get “in tune” with the latest in ICD-10 compliance:
* A brief discussion of ICD-10 and its impact on healthcare.
* Compliance risks with the transition to the ICD-10 system.
* Mitigation of compliance risk and denial activities during and post-implementation.
* ICD-10’s impact on value-based purchasing and quality-based payment models.
Demystifying Commercial Reasonableness in Physician/Hospital TransactionsPYA, P.C.
PYA Principal Lyle Oelrich presented “Demystifying Commercial Reasonableness in Physician/Hospital Transactions” at the Georgia Society of Certified Public Accountants’ (GSCPA) 2016 Healthcare Conference, February 11, 2016, in Atlanta, Georgia.
Forensic and Valuation Issues in HealthcarePYA, P.C.
PYA Principal Carol Carden co-presented “Forensic and Valuation Issues in Healthcare” at the AICPA Forensic & Valuation Services Conference in New Orleans, LA, November 10, 2014.
PYA Principal Scott Clay presented “Pacing Volume-to-Value Transition” at the AlaHA Annual Meeting, June 8-11, 2016.
The presentation explored volume- to value-based reimbursement, and how the pace of change is unique to each organization. The presentation introduced a strategic framework to establish and communicate a pace of change befitting various organizations, explaining:
How government policies “set the floor” on the degree of change requested.
How to determine the pace of change in your market.
How to identify your organization’s current position and culture in relation to value-based payment models.
How to set and communicate the pace of transition consistent with your market and your organization’s culture.
The many ways in which healthcare reform affects the healthcare industry are still playing out. Undoubtedly, a question for physicians and the hospitals that employ many of them is “how will physician compensation be affected?”
PYA Principal Carol Carden recently spoke at the 2013 AICPA Healthcare Industry Conference, where she addressed this question with her presentation, “Current Reform Initiatives and Their Impact on Physician Compensation.”
Presentation Zeroes in on Successful CIN PYA, P.C.
Building a clinically integrated network (CIN) that brings together a hospital and community physicians, does not have to be a long, difficult process.
In a presentation given at the 2014 AHLA Physicians and Hospitals Law Institute, PYA Principal David McMillan, Flagler Hospital Chief Operating Officer Jason Barrett, and Smith Hulsey & Busey Attorney Shareholder Charmaine T. Chiu followed one healthcare community’s journey to form a CIN in nine months.
PYA Principal Carol Carden presented “Fundamentals of Healthcare Valuation” at the American Society of Appraisers (ASA) 2015 Advanced Business Valuation Conference. The presentation explored unique characteristics of the healthcare industry, particularly those relevant to appraisers for avoiding common mistakes in assessing risk and projecting cash flow.
How to Engage Physicians in Best Practices to Respond to Healthcare Transform...PYA, P.C.
PYA Principal Kent Bottles, MD, spoke about physician engagement when it comes to value payment models during “How to Engage Physicians in Best Practices to Respond to Healthcare Transformation” at the Georgia Society of Certified Public Accountants’ (GSCPA) 2016 Healthcare Conference, February 11, 2016. Dr. Bottles discussed the difficulty of weaning physicians from fee-for-service payment models and the often-unappreciated reasoning behind the shift to value-based payment models. He also highlighted MACRA, MIPS, patient satisfaction surveys, Physician Compare, and the ProPublica Surgeon Scorecard.
Partnering for Population Health: Strategies to Promote Collaboration Among t...Conifer Health Solutions
A patient-centered approach to care delivery will bring the best health outcomes for individuals, as well as the community. While it is clear that effective population health management is integral to better health, providers can no longer be the sole proprietors of data and information. Improving a population’s health will depend on strong alliances with community stakeholders that generally have not experienced a strong history of collaboration. In the new healthcare landscape, providers, payers and employers must partner to reduce cost, boost quality and improve the health of their shared populations. These new partnerships may start with a few glitches. However a strategic plan, clear objectives and an engaged, informed patient will smooth the path to improved outcomes.
In January 2013, Catholic Health Initiatives began a multi-phase journey to develop a population health management solution across all of its regions. This presentation will describe the strategies the health system pursued for: creating a clinically integrated network as a first step in managing the health of populations and integrating care across the patient experience; aligning hospitals and physician groups to create successful clinical models; creating a data platform to share clinical measures and benchmarks; and ultimately becoming a risk-bearing shared savings ACO. Participants will hear real-world examples of best practices for how to meet FTC regulations, create an effective governance structure to manage performance, and align financial incentives. Learn how one of the nation's largest hospital systems developed a system-wide population health management solution in order to achieve the necessary transformation from fee-for-service to fee-for-value.
The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with...PYA, P.C.
PYA Principal Carol Carden co-presented “The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with Value-Based Payment Models” at the 2017 American Health Lawyers Association Physician and Hospitals Law Institute, February 1-3, 2017, in Orlando, Florida.
The presentation addressed:
Emerging alternative payment models (APMs)
The application of fraud and abuse laws and IRS rules to provider network payments
Existing market data and regulatory guidance
Considerations in determining fair market value and commercial reasonableness
PYA Principal Carol Carden presented on current issues in healthcare valuation at The Texas Society of Certified Public Accountants Business Valuation, Forensic, and Litigation Services Conference at the Hilton Fort Worth, October 14, 2014.
As healthcare is a language “all its own,” PYA Principal David McMillan presented “Learning the New Language of Healthcare" at the Georgia Society of CPAs' 2014 Healthcare Conference.
The Top Ten Issues in Physician Practice Acquisition and ValuationPYA, P.C.
A webinar hosted by The National Association of Certified Valuators and Analysts (NACVA) and presented by PYA Consulting Principal Darcy Devine outlines ten common, but often complex, issues that arise during the physician practice acquisition process. The webinar took place Friday, February 13, 2015. “Don’t Stumble Coming Out of the Gate—The Top Ten Issues in Physician Practice Acquisition and Valuation” is geared toward health system and physician practice financial executives as well as business valuators working with those entities.
Practice Valuation & Physician Compensation Planning ConsiderationsPYA, P.C.
PYA Principal Carol Carden and PYA Senior Consultant Katie Culver presented “Practice Valuation and Compensation Planning Considerations" at the TSCPA Southeastern Forensic & Valuation Services Conference.
PYA Thought Leader Defines Role of Radiation Oncology in Clinical IntegrationPYA, P.C.
PYA Senior Consulting Manager Chris Wilson presented “Clinically Integrated Networks (CIN) and the Role for Radiation Oncology” at the SATRO® 16 Conference, April 24-25, 2014, at the Crowne Plaza Ravinia in Atlanta, Georgia.
PYA Principal Lori Foley presented on “Hospital-Owned Orthopaedic Practices” at the Tennessee Orthopaedic Society Annual Meeting. With many providers considering hospital employment, this session focused on:
Employment activity specific to orthopaedics including some of the pros and cons that private practice physicians should consider when evaluating this option.
Other alignment arrangements taking place between hospitals and orthopaedic practices.
ICD-10 Is Really Here: What Does That Mean To Compliance Officers?PYA, P.C.
PYA Principal Denise Hall presented “ICD-10 Is REALLY Here: What Does that Mean to Compliance Officers?” at the THA 2015 Fall Compliance Conference. The presentation helps providers get “in tune” with the latest in ICD-10 compliance:
* A brief discussion of ICD-10 and its impact on healthcare.
* Compliance risks with the transition to the ICD-10 system.
* Mitigation of compliance risk and denial activities during and post-implementation.
* ICD-10’s impact on value-based purchasing and quality-based payment models.
Demystifying Commercial Reasonableness in Physician/Hospital TransactionsPYA, P.C.
PYA Principal Lyle Oelrich presented “Demystifying Commercial Reasonableness in Physician/Hospital Transactions” at the Georgia Society of Certified Public Accountants’ (GSCPA) 2016 Healthcare Conference, February 11, 2016, in Atlanta, Georgia.
Forensic and Valuation Issues in HealthcarePYA, P.C.
PYA Principal Carol Carden co-presented “Forensic and Valuation Issues in Healthcare” at the AICPA Forensic & Valuation Services Conference in New Orleans, LA, November 10, 2014.
PYA Principal Scott Clay presented “Pacing Volume-to-Value Transition” at the AlaHA Annual Meeting, June 8-11, 2016.
The presentation explored volume- to value-based reimbursement, and how the pace of change is unique to each organization. The presentation introduced a strategic framework to establish and communicate a pace of change befitting various organizations, explaining:
How government policies “set the floor” on the degree of change requested.
How to determine the pace of change in your market.
How to identify your organization’s current position and culture in relation to value-based payment models.
How to set and communicate the pace of transition consistent with your market and your organization’s culture.
The many ways in which healthcare reform affects the healthcare industry are still playing out. Undoubtedly, a question for physicians and the hospitals that employ many of them is “how will physician compensation be affected?”
PYA Principal Carol Carden recently spoke at the 2013 AICPA Healthcare Industry Conference, where she addressed this question with her presentation, “Current Reform Initiatives and Their Impact on Physician Compensation.”
Presentation Zeroes in on Successful CIN PYA, P.C.
Building a clinically integrated network (CIN) that brings together a hospital and community physicians, does not have to be a long, difficult process.
In a presentation given at the 2014 AHLA Physicians and Hospitals Law Institute, PYA Principal David McMillan, Flagler Hospital Chief Operating Officer Jason Barrett, and Smith Hulsey & Busey Attorney Shareholder Charmaine T. Chiu followed one healthcare community’s journey to form a CIN in nine months.
PYA Principal Carol Carden presented “Fundamentals of Healthcare Valuation” at the American Society of Appraisers (ASA) 2015 Advanced Business Valuation Conference. The presentation explored unique characteristics of the healthcare industry, particularly those relevant to appraisers for avoiding common mistakes in assessing risk and projecting cash flow.
How to Engage Physicians in Best Practices to Respond to Healthcare Transform...PYA, P.C.
PYA Principal Kent Bottles, MD, spoke about physician engagement when it comes to value payment models during “How to Engage Physicians in Best Practices to Respond to Healthcare Transformation” at the Georgia Society of Certified Public Accountants’ (GSCPA) 2016 Healthcare Conference, February 11, 2016. Dr. Bottles discussed the difficulty of weaning physicians from fee-for-service payment models and the often-unappreciated reasoning behind the shift to value-based payment models. He also highlighted MACRA, MIPS, patient satisfaction surveys, Physician Compare, and the ProPublica Surgeon Scorecard.
Partnering for Population Health: Strategies to Promote Collaboration Among t...Conifer Health Solutions
A patient-centered approach to care delivery will bring the best health outcomes for individuals, as well as the community. While it is clear that effective population health management is integral to better health, providers can no longer be the sole proprietors of data and information. Improving a population’s health will depend on strong alliances with community stakeholders that generally have not experienced a strong history of collaboration. In the new healthcare landscape, providers, payers and employers must partner to reduce cost, boost quality and improve the health of their shared populations. These new partnerships may start with a few glitches. However a strategic plan, clear objectives and an engaged, informed patient will smooth the path to improved outcomes.
In January 2013, Catholic Health Initiatives began a multi-phase journey to develop a population health management solution across all of its regions. This presentation will describe the strategies the health system pursued for: creating a clinically integrated network as a first step in managing the health of populations and integrating care across the patient experience; aligning hospitals and physician groups to create successful clinical models; creating a data platform to share clinical measures and benchmarks; and ultimately becoming a risk-bearing shared savings ACO. Participants will hear real-world examples of best practices for how to meet FTC regulations, create an effective governance structure to manage performance, and align financial incentives. Learn how one of the nation's largest hospital systems developed a system-wide population health management solution in order to achieve the necessary transformation from fee-for-service to fee-for-value.
The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with...PYA, P.C.
PYA Principal Carol Carden co-presented “The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with Value-Based Payment Models” at the 2017 American Health Lawyers Association Physician and Hospitals Law Institute, February 1-3, 2017, in Orlando, Florida.
The presentation addressed:
Emerging alternative payment models (APMs)
The application of fraud and abuse laws and IRS rules to provider network payments
Existing market data and regulatory guidance
Considerations in determining fair market value and commercial reasonableness
Veracap M&A International Inc. is a leading investment bank advising on acquisitions, divestitures, financing and shareholder value initiatives.
This presentation provides a overview of basic concepts and principles of business valuation and walks you through valuation methodologies, rates of return and valuation multiples, acquisitions and divestitures.
Maximising Value from Airport Investments – Adopting a Truly Active ApproachL.E.K. Consulting
Leading airports are now transforming into customer-led organizations, with real financial benefits and implications for their business models. L.E.K. experience has shown significant benefits from taking this kind of approach. This presentation looks at Australian and New Zealand airports in the context of this transformation - most have begun the journey, but there is further to go.
The basics of what business valuation is and isn't
The different approaches to valuing a business
When a business valuation is necessary
When it's a good idea
The reasons valuations can differ
How a valuation can provide you critical information to make your business stronger and more profitable.
The recent economic growth coupled with uncertainties has resulted in the stakeholder's curiosity and interest in Valuations of their respective investee Companies and also the estimated Valuations of the Targets available for Sale which has led to a greater demand for Business Valuation services.
Since as of now there are no Regulated standards for Valuation in India, numerous conceptual controversies still remain, even among the most prominent practitioners. With a view to give an overview of the Valuation concepts in general and the practical issues in particular, www.corporatevaluations.in, an online venture of Corporate Professionals Capital, SEBI Registered Merchant Banker has prepared this report on "Insight of Valuation". Hope you find it useful. Suggestions for improvement are invited @ info@corporatevaluations.in
this dental administration incorporates routine dental examinations or registration, oral wellbeing guidance, scale and cleaning, extractions, fillings, X-beams, crevice sealants and root channel medicines and looks to address all ebb and flow dental concerns.
Journal of Management Research ISSN 1941-899X 2016, Vol..docxtawnyataylor528
Journal of Management Research
ISSN 1941-899X
2016, Vol. 8, No. 4
www.macrothink.org/jmr 68
Factors Influencing Consumer Choice of Private Dental
Care Provider in Saudi Arabia
Ala'Eddin Mohammad Khalaf. Ahmad
Associate Professor of Health Marketing, Faculty of Economics and Administration
King Abdul-Aziz University, Jeddah, Kingdom of Saudi Arabia
E-mail: [email protected]; [email protected]
Received: July 26, 2016 Accepted: Sep 23, 2016 Published: October 1, 2016
doi:10.5296/jmr.v8i4.10004 URL: http://dx.doi.org/10.5296/jmr.v8i4.10004
Abstract
This research is intended to explore the factors influencing consumer choice of private dental
care providers in Saudi Arabia. The current research is descriptive analytical. A purposive
sampling technique was employed to recruit 220 consumers who visited a private dental care
provider. This research showed that factors influencing consumers' choice (information
sources, dentist attributes, dental practice attributes, and demographics) had a positive effect
on consumers' choices of the private dental providers on the one hand. On the other hand, the
demographic factor had no effect on brand. The paper contributes to previous research by
adding to existing knowledge regarding the factors influencing consumer choice of private
dental care provider in Saudi Arabia. The paper makes key recommendations towards
studying the factors influencing the consumers' choice.
Keywords: information sources, dentist attributes, dental practice attributes, consumer choice,
dental practice, Saudi Arabia
Journal of Management Research
ISSN 1941-899X
2016, Vol. 8, No. 4
www.macrothink.org/jmr 69
1. Introduction and Research Questions
A potential healthcare consumer, when looking for and deciding on a healthcare services
provider, considers his or her problems or questions (Kotler, 2001). This problem recognition
is often referred to as self-perceived need, self-assessed need, or subjective need, because it
refers to the need that the patient identifies (Lundegren, 2012). Since perceived need or
problem recognition initiates a potential healthcare consumer to actively pursue information
to choose a healthcare provider (Kotler, 2001) and the consumer behavior of choosing a
healthcare provider may differ according to perceived need, healthcare marketers and
healthcare providers who seek to promote their practice might wonder how the process by
which potential healthcare consumers’ choose their provider differs according to their
self-perceived need.
Perceived need varies from other needs such as normative need, expressed need, and relative
need. Normative need compares health indicators to asocial norm or predetermined desired
standards. Expressed need, or utilization, is worked out according to the consumer numbers
who actually used medical services. Relative need relates to the equity of services (Kuthy and
Siegal, 2003). Furthermore, perceived ne ...
Healthcare Valuations in an Era of Reform and UncertaintyPYA, P.C.
PYA Principal Jim Lloyd's AICPA Health Care Industry Conference presentation explored reform and current environment highlights, healthcare transactions and affiliations, valuation considerations, and regulatory issues.
Good oral health is essential to overall health, but dental care remains the number one unmet health need for children and low-income adults in Ohio. The consequences of not having adequate dental care can be severe, including missing work or school, living with chronic pain, or even developing life-threatening infections. Webinar speakers explore how Ohio can bring affordable, high-quality oral health care to underserved communities across the state.
Speakers include:
- David Maywhoor, Project Director, Dental Access Now!
- Dr. Edward Sterling, DDS, Diplomate, American Board of Pediatric Dentistry
- Dr. Larry Hill, DDS, MPH, President, American Association for Community Dental Programs
This challenge presents an opportunity for dental practices to increase their patient base and boost revenue by billing qualifying dental procedures to medical policies instead. Doing so not only helps patients access care to resolve complex oral health issues but also does so cost-effectively while preserving what dental benefits they might have.
Problem 1Pro Forma Income Statement and Balance SheetBelow is the .docxChantellPantoja184
Problem 1Pro Forma Income Statement and Balance SheetBelow is the income statement and balance sheet for Blue Bill Corporation for 2013. Based on the historical statements and theadditional information provided, construct the firm's pro forma income statement and balance sheet for 2014.Blue Bill CorporationIncome StatementFor the year ended 2013Projected201220132014Revenue$60,000$63,000Cost of goods sold42,00044,100Gross margin18,00018,900SG&A expense6,0006,300Depreciation expense1,8002,000Earnings Before Interest and Taxes (EBIT)10,20010,600Interest expense1,5001,800Taxable income8,7008,800Income Tax Expense3,0453,080Net income5,6555,720Dividends750800To retained earnings$4,905$4,920Additional income statement information:Sales will increase by 5% in 2014 from 2013 levels.COGS and SG&A will be the average percent of sales for the last 2 years.Depreciation expense will increase to $2,200.Interest expense will be $1,900.The tax rate is 35%.Dividend payout will increase to $850.Blue Bill CorporationBalance SheetDecember 31, 2013Projected20132014Current assetsCash$8,000Accounts receivable3,150Inventory9,450Total current assets20,600Property, plant, and equipment (PP&E)28,500Accumulated depreciation16,400Net PP&E12,100Total assets$32,700Current liabilitesAccounts payable$3,780Bank loan (10%)3,200Other current liabilities1,250Total current liabilities8,230Long-term debt (12%)4,800Common stock1,250Retained earnings18,420Total liabilities and equity$32,700Additional balance sheet information:The minimum cash balance is 12% of sales.Working capital accounts (accounts receivable, accounts payable, and inventory) will be the same percent of sales in 2014 as they were in 2013.$8,350 of new PP&E will be purchased in 2014.Other current liabilities will be 3% of sales in 2014.There will be no changes in the common stock or long-term debt accounts.The plug figure (the last number entered that makes the balance sheet balance) is bank loan.
1
Rough Draft
Rough Draft
Rasmussen College
Metro Dental Care is a dental office that provides affordable, convenient, and high quality of care to patients. As a patient at Metro, I personally believe that Metro Dental Care is one of the best dental clinics around, and that’s why I have chosen this company. Metro Dental Care measures their results by recording patient satisfaction.
Managing financial reports, and the quality of service they provide to their customers. Furthermore, the dentists and staff at Metro Dental Care know how important your smile is. Their mission statement states “We pride ourselves in making your smile look great so you not only look good, but feel confident with your smile.”
Metro Dental Care offers convenience for their patients with more than 40 offices throughout the Minneapolis and St. Paul metro area offering flexible hours including early morning, evening and Saturday appointments. Whether you work or live Metro Dental Care has a location near you. Metro Dental .
This challenge presents an opportunity for dental practices to increase their patient base and boost revenue by billing qualifying dental procedures to medical policies instead. Doing so not only helps patients access care to resolve complex oral health issues but also does so cost-effectively while preserving what dental benefits they might have.
USA Podiatry Market High Level OverviewNiraj Singhvi
This report is prepared by Maple Growth Partners, an investment research and strategic advisory firm.
The primary purpose of this quick-turnaround project was to provide a high-level market overview of podiatry practices’ growth prospects and market dynamics in the US. Our client, a US-based healthcare private equity investment professional, was largely interested in understanding the prevailing market trends, growth drivers, and podiatry economics.
Major pointers we highlighted for podiatry industry investment consideration:
- While podiatry overhead expenses has increased significantly, podiatrists are able to pass on the incremental cost to the patient/payer with a year in lag
- Current supply of ~13,000 podiatrists are most likely meeting sufficient portion of the unmet demand and this supply-demand gap will likely diminish going forward
- High student debt will likely inhibit incoming podiatrists to start their own practice and will likely compel them to join a group practice
- Podiatry is a local/regional play as opposed to other limited practitioners such as dentists which is truly a national play
Following trends were presented that influenced the economics of a podiatry practice:
- Gross income and net income for overall types of US podiatry practices have increased in recent years
- Contrary to the market perception, gross income for solo practices in the US has shown signs of decent growth in recent years
- On an overall basis (both solo and group practices) for net income, recently-formed group practices have been driving up the net income range for practices that are less than 10 years old
- They are utilizing new tech to differentiate themselves and to improve the diagnosis and treatment quality
- Podiatrists are looking to utilize assistance of nurse practitioners and physician assistants
- Share of older practices (>30 years) and aging podiatrists (>61 years) has been increasing in recent years
We had also included podiatry transactions in the previous 10 years; one-pager profiles of major competitors; and regulations by states.
Improving Oral Health Access Migrant and Seasonal WorkersMPCA
Dental disease ranks as one of the top 5 health problems for farmworkers aged 5 - 29 and among the top 20 health problems for farmworkers of other ages,
A Qualitative Research Factors Affecting Patient Satisfaction and Loyalty A C...YogeshIJTSRD
This study aims to identify factors affecting patient satisfaction and loyalty in private dental practice using Smile Family Dental Clinic as a case study Convenience Sampling . The researcher identified the factors dental practice related factors which affect patient satisfaction and loyalty regarding their efforts to increase dental practice quality to respond to patients demands and needs, influencing patient satisfaction and loyalty. The literature review indicated that previous studies in the healthcare sector confirmed the relationship mainly are from the quantitative design. Still, few support the dental care services private dental practice sector in the qualitative approach. The researcher developed the theoretical framework from high valid sources of previous research and the consumer behavior model of Kotler and Keller 2016 . The elements of dental practice related factors include Prices, Facilities, Dentist Services, and Staff Services, whic based on Kim et al. 2012 , patient satisfaction and patient loyalty were based on previous research. Purposive Sampling in a total of 10 respondents from 3,689 cases of the clinics population was in a data collection process through online Semi structured interviews and content analysis adopting NVivo software. The results showed that patients perceptions of dentist services are essentially the most, followed by staff services, prices, and facilities. Satisfaction on factors effect on patient loyalty Revisit and Recommendation Intention . Recommendation from peers or relatives influencing them to choose a clinic. A dentists reputation is the most recommendation. Patients are satisfied with dentist and staff services responding to their needs and expectations. The reasonable price and the costs are not high, influencing their satisfaction. Facilities are the least important factor. Further research may help the decision manager develop a marketing plan and strategies in the private dental healthcare sector. The results could be applied to improve quality management and increasing customer satisfaction and loyalty in any company services sector. Supaprawat Siripipatthanakul | Dr. Mamata Bhandar "A Qualitative Research Factors Affecting Patient Satisfaction and Loyalty: A Case Study of Smile Family Dental Clinic" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd44975.pdf Paper URL: https://www.ijtsrd.com/management/marketing/44975/a-qualitative-research-factors-affecting-patient-satisfaction-and-loyalty-a-case-study-of-smile-family-dental-clinic/supaprawat-siripipatthanakul
“CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting”PYA, P.C.
PYA Principal Martie Ross spoke at the virtual North Carolina Healthcare Association Critical Access Hospital Statewide Meeting. The two-day event, “Quality Focus is a Finance Focus,” provided critical access hospital leaders with the opportunity to network and review data-informed strategies as well as updates to the Medicare Flexibility Program Project. It also provided guidance on federal compliance and tracking of Provider Relief Funds.
In “CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting,” Martie gave an overview of the history of distribution of those funds as well as regulations and guidelines including:
Statutory Language
Reporting Requirements
Use of Funds Calculation
Expenses
Risk Management
Martie presented Thursday, March 4, 2021.
If you would like guidance related to Provider Relief Fund regulations, or for assistance with any matter related to strategy and integration, compliance, or valuation, contact one of our PYA executives at (800) 270-9629.
PYA Presented on 2021 E/M Changes and a CARES Act Update During GHA Complianc...PYA, P.C.
The Georgia Hospital Association (GHA) Compliance Officers Roundtable, an active GHA group that meets quarterly and includes educational sessions featuring government representatives, industry experts, and other thought leaders speaking about compliance-related issues, conducted their latest meeting virtually. PYA Principals Lori Foley, Tynan Kugler, and Valerie Rock were among the presenters at this quarter’s event. In their session, they:
Described key elements associated with 2021 E/M changes, and strategies for preparation and implementation.
Explained the impact of 2021 E/M changes on physician compensation and contracting, including potential mitigation approaches.
Presented key components of Stark Law and Anti-Kickback Statute final rules.
Provided an update on the CARES Act.
The Compliance Certification Board offered CEUs for this event, which took place on Friday, December 4, 2020.
Webinar: “Trick or Treat? October 22nd Revisions to Provider Relief Fund Repo...PYA, P.C.
On October 22nd, the Department of Health and Human Services released revised Provider Relief Fund (PRF) reporting requirements. Under HHS’ September 19 directive, “lost revenue” was defined narrowly as a negative change in year-over-year patient care operating net income. Now, HHS will permit providers to use PRF funds to cover the difference between their 2019 and 2020 actual patient care revenue with some adjustments for COVID-related expenses. The October 22nd notice is available here.
PYA Principals Martie Ross and Michael Ramey hosted a complimentary 30-minute webinar, “Trick or Treat? October 22nd Revisions to Provider Relief Fund Reporting Requirements” on Thursday, October 29th.
“Regulatory Compliance Enforcement Update: Getting Results from the Guidance” PYA, P.C.
PYA Principal and Chief Compliance Officer Shannon Sumner and Consulting Senior Manager Susan Thomas presented “Regulatory Compliance Enforcement Update: Getting Results from the Guidance” at the virtual 2020 Montana Healthcare Conference. They reviewed the sources of regulatory enforcement and investigation information—guidelines, statutory updates, best practices, settlements, case studies, etc.—available to healthcare organizations. They will also discuss how to interpret and implement the guidance in order to strengthen the compliance function and protect the organization. The presentation covered:
Compliance regulatory requirements for healthcare organizations.
Guidance available for consideration in organizational compliance programs.
Internal and external reporting to ensure regulatory requirements are met.
Best practices for implementation of guidance.
Case studies for illustration of guidance implementation.
“Federal Legislative and Regulatory Update,” Webinar at DFWHCPYA, P.C.
The Dallas Fort Worth Hospital Council (DFWHC) and PYA co-hosted an exclusive complimentary webinar, “Federal Legislative and Regulatory Update,” on Wednesday, September 23.
DFWHC President/CEO Stephen Love hosted a discussion with PYA Senior Manager Kathy Reep about concerns that have dropped from the radar during the last four months of COVID-19, addressing issues for which hospitals must prepare in approaching 2021. This session focused on these key areas:
Appropriate use criteria
Transparency
Site neutral payments
The future of the Medicare Trust Fund
The federal budget
Key provisions of the final rule for the inpatient prospective payment system for FY2021 and the proposed outpatient rule for CY2021
On-Demand Webinar: Compliance With New Provider Relief Funds Reporting Requir...PYA, P.C.
On September 19, the Department of Health and Human Services (HHS) published its Post-Payment Notice of Reporting Requirements. The Notice details the reporting requirements for all Provider Relief Fund (PRF) recipients that have received $10,000 or more in aggregate payments.
Under the PRF Terms and Conditions, a recipient may use the funds only for healthcare-related expenses and lost revenue attributable to coronavirus. The Notice provides the clearest direction to date regarding permissible uses of PRF funds.
PYA offered a 45-minute complimentary webinar that explained the new reporting requirements and delved into permissible uses. While many questions remain, we provided practical advice on the next steps in the reporting process.
The webinar took place Monday, October 5 at 11 a.m. EDT.
Webinar: “While You Were Sleeping…Proposed Rule Positioned to Significantly I...PYA, P.C.
You likely know from the headlines that the 2021 Medicare Physician Fee Schedule (MPFS) Proposed Rule slashes payments for surgical specialists. But the impact of the Proposed Rule is far broader, reflecting a fundamental realignment driven by the transition to value-based payments. In our webinar, “While You Were Sleeping…Proposed Rule Positioned to Significantly Impact Physician Compensation,” PYA experts addressed these proposals, helping you understand and prepare for the changes ahead.
Following this presentation, attendees were able to:
Understand how a handful of wRVU changes would alter Medicare reimbursement for nearly all physicians.
Appreciate the operational impact of these changes.
Recognize the challenges to existing physician compensation models.
Identify strategies and tactics to prepare for and manage these impacts.
Presenters include PYA Principals Angie Caldwell, Martie Ross, and Valerie Rock. The webinar took place Thursday, September 10 and was hosted in conjunction with the Florida Hospital Association.
If you have additional questions about the MPFS Proposed Rule and its impact on physician compensation or need assistance with any matter involving physician compensation, valuation, strategy and integration, or compliance, contact a PYA executive below at (800) 270-9629.
Webinar: “Cybersecurity During COVID-19: A Look Behind the ScenesPYA, P.C.
Cybersecurity breaches have been in the news almost daily for some time now. COVID-19 has amplified the problem, as “bad actors” seize upon the opportunity to take advantage of hospitals at their most vulnerable time. Given this climate and an aging HIPAA rule, it is difficult to anticipate and prepare for the future.
PYA Principal Barry Mathis presented “Cybersecurity During COVID-19: A Look Behind the Scenes,” on Wednesday, August 12, 2020. This one-hour, complimentary webinar was hosted by PYA in conjunction with the Montana Hospital Association as Part 2 of the Frontier States Town Hall Meeting.
Barry covered information related to HIPAA, cybersecurity, and a special behind-the-scenes view into the tradecraft of bad actors. This unique presentation included:
Recent enforcement trends by the Office for Civil Rights.
The current environment for ransomware.
An opportunity to watch as Barry logs onto the Dark Web and shows you first-hand how bad actors operate.
Ideas for managing cybersecurity threats.
On Friday, August 21, 2020, a webinar co-hosted by PYA prepared hospitals for a new rule taking effect on January 1, 2021, to address price transparency in healthcare. The Centers for Medicare & Medicaid Services published a rule in November 2019 requiring hospitals to establish, update, and make public a list of their standard charges for items and services they provide. In addition to the current requirement to post standard charges on their websites, the Final Rule requires hospitals to publish online, in a machine-readable format, their payer-specific negotiated rates for 300 “shoppable” services and their standard charges for all items and services provided, defined as the gross charge, payer-specific negotiated charges, discounted cash price, and the de-identified minimum and maximum charges.
As we approach January 2021, it is vital that hospitals understand the requirements of the pricing transparency rule and options for compliance. It is unlikely that this rule will “go away”–court decisions are always subject to appeal, and there is even concern that Congress is considering action that would transform these requirements from regulation to legislation.
During the complimentary webinar, PYA Senior Manager Kathy Reep discussed hospital requirements related to pricing transparency, and Chris Kenny, Partner in the Washington, D.C., office of King & Spalding, addressed concerns related to compliance and the legal challenges associated with the final transparency rule.
This webinar was presented in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Georgia Hospital Association
Kansas Hospital Association
Louisiana Hospital Association
Montana Hospital Association
Not a surprise to most — healthcare is making headlines on an international level. Though not front and center, still of importance to the hospital community are issues working their way through government agencies and the legislature.
As one of the keynote speakers of this year’s virtual Florida Institute of CPAs Health Care Industry Conference, PYA Senior Manager Kathy Reep presented a “Federal Legislative and Regulatory Update.” She covered a number of current issues affecting healthcare providers, including:
Price transparency.
Congressional action on surprise billing.
The Administration’s budget for 2021.
Medicare proposed rules related to hospital inpatient payments and post-acute care for FY2021.
The virtual event took place June 23-24, 2020.
Webinar: Post-Pandemic Provider Realignment — Navigating An Uncertain MarketPYA, P.C.
The COVID-19 pandemic will materially affect U.S. provider industry structure, as financial weaknesses are exposed, risk tolerances are tested, and uncertainties persist. As a result, provider mergers-and-acquisitions (M&A) activities across industry sectors will likely spike in the short- to medium-term future. Providers of all types need to be aware of, and prepared for, the changes they will face.
In this 45-minute joint webinar, PYA Principal Brian Fuller and Juniper Advisory Managing Director Jordan Shields provided a real-time assessment of the COVID-19 pandemic, as well as shared predictions for what the extending crisis means in coming years for M&A activity in the provider space.
The webinar took place Thursday, August 6, 2020, at 11 a.m. EDT.
Since March, PYA experts have closely tracked and carefully evaluated the pandemic’s impact on employed physician compensation. During this complimentary one-hour webinar, PYA Principals Angie Caldwell and Martie Ross highlighted five immediate considerations for hospitals and health systems to manage the storm. They also explored five longer-term considerations impacting future planning.
This webinar took place Friday, July 24, 2020, at 11 a.m. EDT, and was held in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Kansas Hospital Association
Montana Hospital Association
The COVID-19 pandemic has exposed organizational and industry weaknesses. To build a more resilient delivery system, leaders now must engage their governing boards in re-calibrating strategic plans, re-evaluating investments, and re-imagining hospitals’ and health systems’ roles in their communities.
In this 45-minute webinar, PYA Principals Martie Ross and Brian Fuller provided a framework for these critical discussions including root-cause analysis, market assessment, new realities, guiding principles, and strategic and operational priorities.
This webinar originally took place on Wednesday, June 24, 2020.
Webinar: Free Money with Strings Attached – Cares Act Considerations for Fron...PYA, P.C.
PYA, in conjunction with the Montana Hospital Association, recently co-hosted a Frontier States Town Hall Meeting webinar, “Free Money With Strings Attached: CARES Act Considerations for Frontier States’ Healthcare Provider Organizations.” Principals Lori Foley, Martie Ross, and David McMillan introduced the CARES Act Provider Relief Fund including distribution formulas, the attestation process, the verification and application process, and ongoing recordkeeping requirement. They also answered attendees’ numerous questions regarding these matters.
Webinar: “Got a Payroll? Don’t Leave Money on the Table”PYA, P.C.
Under the CARES Act, every employer with a payroll has an opportunity to retain cash–whether they have a PPP loan or not. What employers need to know right now.
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) along with the Payroll Protection Program (PPP) offer all business owners relief, but the details can be confusing or overlooked.
Perhaps you don’t fully understand how the deferral of the employer’s share of Social Security taxes works. Maybe you wonder if the deferral even applies to you—good news, it does if you have a payroll!
Failure to fully understand your options could cost you money, at a time when “cash is king.”
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined issues and opportunities within the CARES Act, and answered questions during a one-hour webinar that originally aired on Wednesday, May 20, 2020.
Webinar: So You Have a PPP Loan. Now What?PYA, P.C.
The CARES Act provides relief to small businesses through Paycheck Protection Program (PPP) loans, but receiving the loan is only the first part of the equation. PYA discussed what businesses need to know and do next.
Failure to fully understand the requirements for PPP loan forgiveness could cost employers money, at a time when every penny counts. Employers need to stay up-to-date on recent activities regarding the PPP loan forgiveness application, necessary documentation, and other best practices to ensure they are well-prepared for the next steps under the PPP.
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined PPP loan forgiveness requirements and answered questions during a one-hour webinar on Wednesday, June 3, 2020.
Webinar: “Making It Work—Physician Compensation During the COVID-19 Pandemic”PYA, P.C.
What to do with your physician compensation plan in the face of the COVID-19 pandemic? It’s a question that leaves administrators searching for answers.
PYA Principal Angie Caldwell and Senior Manager Katie Culver introduced several key considerations for provider compensation during and after the COVID-19 pandemic. In PYA’s complimentary webinar, they:
Summarized the current environment impacting physician compensation associated with the pandemic.
Provided an overview of the Stark Blanket Waivers and opportunities created for physician compensation.
Described restoration and recovery strategies for physician resources.
PYA hosted this one-hour webinar Tuesday, April 28, 2020, at 11 a.m. EDT in conjunction with the Florida Hospital Association.
Webinar: “Provider Relief Fund Payments – What We Know, What We Don’t Know, W...PYA, P.C.
The federal government is now making CARES Act Relief Fund payments to Medicare providers. These payments are not loans—they do not have to be repaid or forgiven. However, this money comes with strings attached.
During PYA’s 30-minute webinar, Provider Relief Fund Payments—What We Know, What We Don’t Know, What To Do Now, PYA Principals Martie Ross and Lori Foley discussed:
The source of the funds.
The required attestation process.
Compliance, tax, and audit concerns.
The webinar took place Friday April 17, 2020.
Webinar: “Hospitals, Capital, and Cashflow Under COVID-19”PYA, P.C.
Hospitals and providers need to think creatively, strategically, and long-term about capital and cashflow under the pressures of the COVID-19 pandemic. A one-hour webinar hosted by PYA discussed the current state of capital markets for non-profit healthcare systems, and considerations for capital management, including the role of real estate assets.
PYA Principal Michael Ramey joined Realty Trust Group Senior Vice-President Michael Honeycutt and Ponder & Company Managing Director Jeffrey B. Sahrbeck to present “Hospitals, Capital, and Cashflow, Under COVID-19” In this webinar, they covered:
Hospital industry capital market updates and trends, including how the capital markets are responding to the crisis.
Access to capital under recent regulations.
Cash preservation techniques for hospitals considering real estate operations and assets.
The webinar took place Thursday, April 9, 2020, at 11 a.m. EDT.
PYA Webinar: “Additional Expansion of Medicare Telehealth Coverage During COV...PYA, P.C.
Late on March 30, CMS released an interim rule which, among other things, significantly expands Medicare telehealth coverage, even beyond the initial Section 1135 waivers. PYA’s complimentary one-hour webinar explained these changes and how they make telehealth an even more attractive option in response to the COVID-19 pandemic.
PYA Principals Martie Ross and Valerie Rock addressed the latest developments, including:
New reimbursement for telephone-only services.
Broader coverage for remote patient monitoring.
New payments for rural health clinics and federally qualified health centers.
Use of telehealth to meet supervision requirements.
New rules regarding coding and billing as well as the changed payment rates for telehealth services.
The webinar took place Friday April 3, 2020, at 11 a.m. EDT.
This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
Harm Reduction Strategies: Safe use practices, medication-assisted treatment, and naloxone availability aim to reduce harm.
Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
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ALKAMAGIC PLAN 1350.pdf plan based of door to door delivery of alkaline water...rowala30
Alka magic plan 1350 -we deliver alkaline water at your door step and you can make handsome money by referral programme
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TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
Rate Controlled Drug Delivery Systems, Activation Modulated Drug Delivery Systems, Mechanically activated, pH activated, Enzyme activated, Osmotic activated Drug Delivery Systems, Feedback regulated Drug Delivery Systems systems are discussed here.
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...The Lifesciences Magazine
Cold Sores, medically known as herpes labialis, are caused by the herpes simplex virus (HSV). HSV-1 is primarily responsible for cold sores, although HSV-2 can also contribute in some cases.
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PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
- Urological tumors.
- The role of FDG PET in NET.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
2. Forensic and Valuation Services Section 1
Speaker Biography
W. James Lloyd
W. James (Jim) Lloyd, CPA/ABV, ASA, CFE is a Principal with Pershing
Yoakley & Associates (PYA), an accounting and consulting firm
specializing in the healthcare industry. Primary areas of focus include
valuation, transaction advisory, and dispute related services.
Healthcare industry experience includes: ambulatory surgery centers,
cancer centers, dental practices, dialysis facilities, imaging centers,
hospice, hospitals, long-term care facilities, managed care, pharmacies,
pharmaceutical manufacturers, physician practices, and physician
compensation arrangements among others.
Frequent speaker at national and regional conferences on valuation and
dispute related topics.
Past chair: American Institute of CPAs' ABV Credential Committee. Past
member: American Society of Appraisers' Board of Examiners.
3. Forensic and Valuation Services Section 2
Speaker Biography
Robert M. Mundy
Robert M. Mundy, CPA/ABV, CVA, is a Senior Manager with Pershing
Yoakley & Associates (PYA), an accounting and consulting firm
specializing in the healthcare industry. Primary areas of focus include
valuation, transaction advisory, and dispute-related services.
Healthcare industry experience includes: general acute care and
specialty hospitals, diagnostic imaging centers, ambulatory surgery
centers, skilled nursing facilities, assisted living centers, cancer
treatment centers, and a variety of physician practices.
Co-authored “The Valuation of Hospitals” chapter in Business Valuation
Resources’ Guide to Healthcare Valuation.
4. Forensic and Valuation Services Section
Agenda
1
2
3
4
5
Overview of the dental industry
Valuation and compensation trends
Current trends affecting dental practices
Overview of regulations affecting healthcare and dental industry
Key operating benchmarks and data resources
www.aicpa.org/fvs 2
5. Forensic and Valuation Services Section
Overview of Dental Industry
Over 195,000 professionally active dentists in the U.S. as of
2012
Segments of the dental provider industry:
• General dentistry
• Oral and maxillofacial surgery
• Prosthodontics
• Orthodontics
• Pediatric dentistry
• Endodontics
• Periodontics
www.aicpa.org/fvs 3
6. Forensic and Valuation Services Section
Overview of Dental Industry
General dentists comprise the vast majority of dental providers
in the U.S.
80.2%
3.5%
2.5%
5.1%
3.2% 2.8% 2.7%
Number of Active Dentists by Specialty
General dentist
Oral surgeon
Endodontist
Orthodontist
Pediatric dentist
Periodontist
Other
Source: American Dental Association, Dental Data, November 2012
www.aicpa.org/fvs 4
7. Forensic and Valuation Services Section
Overview of Dental Industry
Restorative, preventative, and diagnostic services comprised
the majority of dental services in 2013
6.90%
22.20%
15.60%8.80%
9.80%
14.90%
5.40%
2013 Services Distribution
OMFS
Restorative dental services
Preventative services
Fixed prosthodontics
Orthodontics
Diagnostic services
Non-surgical endodontic
services
Source: IBISWorld, Dentists in the U.S. Industry Report, December 2013
www.aicpa.org/fvs 5
8. Forensic and Valuation Services Section
Current Trends in Dental Industry
Positive Trends for the Dental Industry
Aging population
Profitability still high for the industry, even during economic downturn
Improved economic conditions
• Increased access to employer-sponsored health insurance; however, many
employer-sponsored plans do not include dental benefits
• Increases in disposable income should lead to more dental procedures
Greater awareness and focus on oral health
Increasing access to coverage through healthcare insurance exchanges
Trend toward more cosmetic procedures
According to Centers for Medicare & Medicaid Services, dental
spending is projected to increase from $110.9 billion in 2012 to $191.3
billion in 2022, representing a 5.6% compound annual growth rate
www.aicpa.org/fvs 6
9. Forensic and Valuation Services Section
Current Trends in Dental Industry
Challenges Facing the Industry
Rapid advancements in technology
Rising costs of operations
Volatile prices for nonferrous metals
Better preventive care by patients leads to fewer patient visits
Only 60% of U.S. has some form of dental benefits1
Shift from private insurance to more public coverage and out of
pocket payments
Potential cuts to Medicaid for adult dental coverage
Changing demographics among dental providers
1 2013 National Association of Dental Plans / Delta Dental Plans Association Joint Dental Benefits Report on Enrollment
www.aicpa.org/fvs 7
10. Forensic and Valuation Services Section
Current Trends in Dental Industry
Trend Toward Consolidation
Shift from solo practitioners to group practices
• Rising operating costs and capital requirements
• Economies of scale
• High costs of dental education and student loans make solo practice less
attractive
Growing interest with private equity and dental practice
management companies (DPMCs)
• Potential for high-profit margins with sufficient volume
www.aicpa.org/fvs 8
11. Forensic and Valuation Services Section
Dental Practice Management Companies
Publicly traded company
Birner Dental Management Services, Inc. (BDMS)
• 66 offices throughout Colorado, New Mexico, and Arizona
• Revenues in excess of $64 million in 2013
• Market value of invested capital (MVIC) to Revenue = 0.65x
• MVIC to EBITDA = 11.75x
www.aicpa.org/fvs 9
12. Forensic and Valuation Services Section
Dental Practice Management Companies
Privately held companies
American Dental Partners, Inc.
• Acquired for $398 million in 2011 by private equity firm JLL Partners
InterDent, Inc.
• Provides support services to over 150 affiliated dental offices
• Employs over 450 dentists
Smile Brands Group, Inc.
• Provides support services to over 400 dental offices
• Employs over 1,300 dentists
Pacific Dental Services, Inc.
• Provides support services to over 275 dental offices
www.aicpa.org/fvs 10
13. Forensic and Valuation Services Section
Dental Practice Key Statistics
Practice Gross Billings
Gross Billings per Practice Hour by Number of Chairside Assistants
Source: American Dental Association, 2010 Survey of Dental Practices, median values
All Independent
Dentists
No Non-Owner
Dentists
Includes Non-Owner
Dentists
General Practitioners $700,000 $650,000 $1,163,250
Percent Collected 95.6% 95.9% 94.4%
Specialists $1,000,000 $900,000 $1,700,000
Percent Collected 96.0% 96.0% 95.6%
1 Chairside Assistant 2 Chairside Assistants 3+ Chairside Assistants
General Practitioners $299 $377 $510
Specialists $326 $430 $624
www.aicpa.org/fvs 11
14. Forensic and Valuation Services Section
Dental Practice Key Statistics
Percentage of Practices Employing Non-Dentist Staff
Average Number of Non-Dentist Staff per Dentist
Source: American Dental Association, 2010 Survey of Dental Practices
Dental Hygienists Chairside Assistants
General Practitioners 76.0% 94.3%
Specialists 28.6% 97.0%
Dental Hygienists Chairside
Assistants
Total Non-Dentist
Staff
General Practitioners 1.8 1.6 4.5
Specialists 1.6 2.5 5.1
www.aicpa.org/fvs 12
15. Forensic and Valuation Services Section
Dental Practice Key Statistics
Staffing Expenses as a % of Gross Billings for General Practitioners
Source: American Dental Association, 2009 Survey of Dental Practices
1Q Median 3Q
Salaries for shareholder dentists 18.8% 25.6% 35.8%
Salaries for employed dentists 3.9% 8.0% 13.7%
Salaries for non-dentist staff 17.5% 22.7% 26.8%
Payroll taxes for all staff 2.4% 3.5% 6.5%
Employee benefits for all staff 2.3% 4.5% 8.4%
Total staffing expenses 44.9% 64.3% 91.2%
www.aicpa.org/fvs 13
16. Forensic and Valuation Services Section
Dental Practice Key Statistics
Staffing Expenses as a % of Gross Billings for Specialists
Source: American Dental Association, 2009 Survey of Dental Practices
1Q Median 3Q
Salaries for shareholder dentists 21.6% 31.2% 43.8%
Salaries for non-dentist staff 14.0% 19.5% 25.7%
Payroll taxes for all staff 2.2% 3.1% 6.7%
Employee benefits for all staff 2.9% 5.0% 7.9%
Total staffing expenses 40.7% 58.8% 84.1%
www.aicpa.org/fvs 14
17. Forensic and Valuation Services Section
Dental Practice Benchmark Resources
American Dental Association
• Survey of Dental Practice Fees
• Survey of Dental Practice Expenses
• Survey of Dental Practice Employment
• Survey of Dental Practice Income
Rosen & Associates
• “See How You Compare” Survey
Dental Economics – www.dentaleconomics.com
www.aicpa.org/fvs 15
18. Forensic and Valuation Services Section
Overview of Healthcare Reform
Patient Protection and Affordable Care Act of 2010 (PPACA)
• Signed into law on March 23, 2010.
• Primary goals:
- Provide healthcare coverage for many uninsured.
- Reform healthcare system to improve quality.
- Reduce overall healthcare costs.
Health Care and Education Reconciliation Act of 2010
• Signed into law on March 30, 2010.
• Includes several amendments to PPACA.
www.aicpa.org/fvs 16
19. Forensic and Valuation Services Section
Key Healthcare Reform Provisions
Affecting Dental Practices
• Individual insurance mandate
- Tax penalty for non-compliance beginning in 2014.
- Each state must establish healthcare insurance exchange by 2014.
- Stand-alone dental plans must offer pediatric oral essential benefits
without annual and lifetime limits
• Expansion of Medicaid
- Expands eligibility to cover individuals up to 138% of the federal
poverty level.
- Extended funding of Children’s Health Insurance Program (CHIP)
- States that provide CHIP coverage through the Medicaid expansion
are required to cover basic dental services
- Supreme Court ruling allowed states to opt out of expansion.
www.aicpa.org/fvs 17
20. Forensic and Valuation Services Section
State Adoption of Medicaid Expansion
www.aicpa.org/fvs 18
21. Forensic and Valuation Services Section
Key Healthcare Regulations
Healthcare
Regulations
Stark Law
Anti-Kickback
Statute
Stark Law
False Claims Act
IRS 501 (c)(3)
Anti-Inurement
Rules
www.aicpa.org/fvs 19
22. Forensic and Valuation Services Section
Stark Law
• Also called the “physician self-referral law.”
• Prohibits a physician from making referrals for designated health
services to entities in which the physician (or a family member)
has a financial relationship.
• Designated Health Services (DHS):
- Currently 12 health services.
- Includes hospital inpatient and outpatient services, as well as
clinical lab, physical and occupational therapy, radiology,
certain imaging, DME, home health, and various other
services and supplies.
• Is a “strict liability” law.
• Contains various “safe harbors.”
• Provisions enforced by the Centers for Medicare & Medicaid
Services (CMS), although Department of Justice adjudicates
false claims arising from violations of the Stark Law.
www.aicpa.org/fvs 20
23. Forensic and Valuation Services Section
Stark Law
Stark Law Definition of Fair Market Value:
The value in arm’s-length transactions, consistent with the general market
value. “General market value” means the price that an asset would bring
as a result of bona fide bargaining between well-informed parties to the
agreement who are not otherwise in a position to generate business for
the other party, on the date of acquisition of the asset or at the time of the
service agreement. Usually, the fair market price is the price at which bona
fide sales have been consummated for assets of like type, quality, and
quantity in a particular market at the time of acquisition, or the
compensation that has been included in bona fide service agreements
with comparable terms at the time of the agreement, where the price or
compensation has not been determined in any manner that takes into
account the volume or value of anticipated referrals.
www.aicpa.org/fvs 21
24. Forensic and Valuation Services Section
Anti-Kickback Statute
1 2 3 4
Prohibits the
payment or
receipt of
remuneration
to induce or
reward
referrals for
Medicare or
Medicaid
services.
Criminal
statute that
requires proof
of “intent,” i.e.,
knowingly and
willfully paying
for referrals.
Contains
various “safe
harbors.”
5
Enforced by
the Office of
Inspector
General (OIG)
and the
Department of
Justice (DOJ).
If one purpose
of the payment
is to induce
referrals, then
the Anti-
Kickback
Statute (AKS)
is violated,
even if there
are other
legitimate
business
reasons for the
payment.
www.aicpa.org/fvs 22
25. Forensic and Valuation Services Section
False Claims Act
Imposes liability on any person who
submits a claim to the federal
government that the person knows
(or should know) is false.
Civil statute.
Often “piggy-backed” with the AKS
and Stark.
Subject to qui tam (“whistle-blower”)
suits.
www.aicpa.org/fvs 23
26. Forensic and Valuation Services Section
Penalties for Violations of
Stark & AKS
Penalties for violation can include:
1. Denial of payments.
2. Refund of payments.
3. Civil monetary penalty up to $15,000 per claim.
4. Civil monetary penalty up to $100,000 for each “scheme”
designed to circumvent the law.
5. Civil monetary penalty of up to 3 times the amount of
claims.
6. Possible criminal penalties, including jail time.
7. Exclusion from the Medicare or Medicaid program.
www.aicpa.org/fvs 24
27. Forensic and Valuation Services Section
IRS 501(c)(3) Anti-Inurement Rules
501(c)(3) tax exempt
entities must avoid “excess
benefit” transactions.
Transactions must be at
FMV and be consistent
with the entity’s charitable
mission.
Violations can result in loss
of tax exempt status
Rules
www.aicpa.org/fvs 25
28. Forensic and Valuation Services Section
Valuation Approaches
Asset
Approach
Income
Approach
Market
Approach
Provides an indication of value based
upon market date derived from other
similar businesses.
Provides an indication of value based on
the anticipated future economic benefits of
ownership.
Provides an indication of value based on
the cost to replace or replicate the tangible
and intangible net assets of the business.
www.aicpa.org/fvs 26
29. Forensic and Valuation Services Section
Valuation Methods for
Each Approach
Asset Approach Income Approach Market Approach
• Adjusted Net
Asset Value
Method
• Excess
Earnings
Method
• Discounted
Cash Flow
Method
• Capitalized
Net Cash
Flow Method
• Guideline
Public
Company
Method
• Comparable
Transactions
Method
www.aicpa.org/fvs 27
30. Forensic and Valuation Services Section
Asset Approach
Cash and accounts receivable are often excluded unless the
transaction is structured as a stock purchase.
Fixed assets (equipment, real estate/improvements), and
supplies must be adjusted to their current value.
Intangible assets must be identified and valued. Common
examples include:
• Workforce-in-place
• Non-compete agreements
• Trade name/trademarks
As a general rule, intangible asset values should be supported
by an appropriate level of economic benefit (i.e. cash flow).
www.aicpa.org/fvs 28
31. Forensic and Valuation Services Section
Income Approach
Discounted Cash
Flow (DCF)
Method or
Capitalized
Income (CapInc)
Method.
CapInc Method
utilizes a
constant growth
rate and is
normally more
appropriate for
mature entities
with stable
operations.
DCF Method
requires cash
flow projections
and is normally
more appropriate
for growth
companies.
www.aicpa.org/fvs 29
32. Forensic and Valuation Services Section
Discounted Cash Flow Method
3
2
1
Step #3: Develop appropriate discount rate and
determine present value of the projected cash flow.
Step #2: Prepare or review cash flow projections
(revenue, expenses, working capital, cap-ex).
Step #1: Analyze historical financials and operations. Make
normalization adjustments as necessary to develop
baseline for future years.
4
Step #4: Adjust as applicable for any non-operating
assets or liabilities.
www.aicpa.org/fvs 30
33. Forensic and Valuation Services Section
Normalization of Earnings
Historical financials often require some level of
normalization to be used as a basis for projecting future
cash flow.
• Common examples of normalization adjustments for dental practices:
Overstaffing and/or excess salaries to family members
Above or below market rate rent expense
Discretionary/personal expenses
Non-recurring or non-operating income or expenses
Billing or coding issues (past errors anticipated to be corrected)
• Purpose is to restate earnings to a level that can be expected to continue
in the future and/or improvements that a hypothetical buyer could
effectuate
• Owner dentist compensation should be normalized to fair market value
• Caution regarding synergistic type adjustments that may be applicable to
a specific potential buyer (if FMV is the standard of value)
www.aicpa.org/fvs 31
34. Forensic and Valuation Services Section
Revenue & Expense Projections
Cash flow (i.e. revenue, expenses, working capital, cap-ex, etc.)
must be projected until a stabilized level of operations is
reached which can then be capitalized (terminal period).
For revenue projections, consider the following:
• Dentist(s) age and historical productivity
• Local demographics
• Competition (current and anticipated future)
• Capacity issues (dentists and facilities)
• Ancillary services
• Historical trends and benchmarks
Revenue should generally be projected utilizing two growth
metrics – patient volume and net revenue per applicable unit.
For operating expenses, segregate between fixed and variable.
www.aicpa.org/fvs 32
35. Forensic and Valuation Services Section
General Dentist Compensation Trends
$156,850
$158,770
$161,750
$163,240
$164,570
$152,000
$154,000
$156,000
$158,000
$160,000
$162,000
$164,000
$166,000
2009 2010 2011 2012 2013
National Annual Mean Compensation
Compound Annual Growth Rate = 1.2%
Source: Bureau of Labor Statistics
www.aicpa.org/fvs 33
36. Forensic and Valuation Services Section
Oral & Maxillofacial Surgeon
Compensation Trends
$210,710
$214,120
$217,380
$216,440
$218,960
$206,000
$208,000
$210,000
$212,000
$214,000
$216,000
$218,000
$220,000
2009 2010 2011 2012 2013
National Annual Mean Compensation
Compound Annual Growth Rate = 1.0%
Source: Bureau of Labor Statistics
www.aicpa.org/fvs 34
37. Forensic and Valuation Services Section
Orthodontist Compensation Trends
$206,190
$200,290
$204,670
$186,320
$196,270
$175,000
$180,000
$185,000
$190,000
$195,000
$200,000
$205,000
$210,000
2009 2010 2011 2012 2013
National Annual Mean Compensation
Compound Annual Growth Rate = -1.2%
Source: Bureau of Labor Statistics
www.aicpa.org/fvs 35
38. Forensic and Valuation Services Section
Discount Rate
• Discount rates utilized in connection with the
Income Approach should reflect the risk of the
projected cash flows.
• Most common method for developing an equity
discount rate for small- to medium-sized dental
practices is the “Build-Up Method”:
- Starts with a risk-free rate (usually 20-year U.S.
Treasury bond).
- Adds various risk premiums: Equity Risk
Premium, Small Size Risk Premium, Industry
and Company-Specific Risk Premiums.
www.aicpa.org/fvs 36
39. Forensic and Valuation Services Section
Market Approach
www.aicpa.org/fvs 37
Guideline Public Company Method
• Difficult to apply for most small/medium-sized dental practices due to
significant size and operating differences
Comparable Transactions Method
• Multiple databases available that include dental practice transactions
such as: Pratt’s Stats and BIZCOMPS®
• Often difficult to apply due to lack of transaction details such as:
- Dentist’s age, qualifications, and historical productivity
- Use of mid-level providers
- Competition, demographics, and local economic conditions
- Ancillary services, cosmetic procedures/products, etc.
- Post-transaction compensation terms
Often utilized as a “sanity check” to other valuation
approaches