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Healthcare Appraisers General Overview . Founded in 2000 Two offices (in Florida and Colorado) Hundreds of clients across the country; thousands of completed projects “Founded” in providing FMV analysis for the hospital sector ( e.g., HCA’s CIA)
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Healthcare AppraisersGeneral Overview • Founded in 2000 • Two offices (in Florida and Colorado) • Hundreds of clients across the country; thousands of completed projects • “Founded” in providing FMV analysis for the hospital sector (e.g., HCA’s CIA) • Currently, clients include the entire healthcare constituency • HAI’s staff includes a heavy emphasis on valuation and financial credentials (e.g., ASA, AVA, CFA, CPA) and healthcare and health law experience • We actively develop and contribute to the healthcare valuation body of knowledge (through articles, surveys, presentations)
HAI’s Professional Staff Principals: Daryl P. Johnson, MAcc, AVA Todd J. Mello, ASA, AVA, MBA Fred M. Lara, CFA, AVA Scott M. Safriet, MBA, AVA Professional Staff: Curtis H. Bernstein, CPA/ABV, CVA, MBA Albert D. Hutzler, J.D., MBA Paul E. Risner, J.D. Karen Bairstow, MBA Ann S. Brandt, Ph.D. Jim D. Carr, MBA Richard E. Chasinoff, MBA, MHA Christopher W. David, CPA/ABV, ASA, MBA Andrea Ferrari, J.D., MHA Melissa R. Keehn, MPA. Barbara Landy, MBA, MHA, FACHE Adam S. Polsky, MBA Terika L. Haynes, MHA Kyle M. Tormoehlen , MBA
Valuation Approach • Our projects are tailored to client-specific engagements. • Engagements may address (i) selected compensation arrangements or (ii) systematic programs for establishing FMV. • We do not publish or provide “canned” FMV guidance. • We apply traditional valuation methodologies, modified as required to comply with applicable healthcare regulations. • Our approaches insure that conclusions are not based upon “tainted” market values and that other common healthcare valuation pitfalls are avoided.
The Healthcare Valuation Risk Continuum More Risk Less Risk • Use of independent, credentialed appraiser • Strict compliance with the FMV definition • Formal documentation process • Use of accepted valuation approaches • Applicable market data is free from bias • Logical, defensible, reproducible conclusions • No formal valuation process • Payment rates are based upon: • Market surveys • Physician “demands”
Implications of the FMV Standard • FMV involves a hypothetical scenario • FMV is distinctly different from investment value (which considers synergies among the parties) • FMV is not established through… • Earnest negotiations • An amount that is requested • Opportunity cost • Reliance upon “tainted” market values
Relevant Arrangements Payments to physicians for personally performed services • Thought Leader / Medical Director / Promotional Presentations / Educational Programs • Physician participation in clinical studies (e.g., principal investigator, etc.) • Licensure / royalty payments • Payments involving intellectual property
Our Mantra A reliable and comprehensive valuation approach should provide: • An evaluation methodology that analyzes each parameter in an objective, consistent and repeatable way. • Adherence to accepted valuation theory, as modified to comport with healthcare regulations. • A FMV outcome that can be supported via independent market data. • A comprehensive written work product that documents the valuation approach(es) and the FMV findings.
Example: Determining The FMV of Thought Leader Compensation • Determine extent of the services (i.e., how many hours). • The nature of the specialty. • Credentials/qualifications of the thought leader. • The specific services contemplated by the arrangement.
A Cost Approach: The Thought Leader Compensation Algorithm • Utilizes survey benchmark compensation data, by medical specialty, as the starting point. • Considers multi-year data. • Compensation data is adjusted for taxes/benefits. • Makes a series of adjustments to the benchmark data based on: • The extent of thought leader time required. • Specific requirements of the position. • The skills/experience of the specific thought leader.
Considers Specific Duties and Responsibilities • Number of hours associated with each duty and/or responsibility. • The specific duties & responsibilities of the position. • The complexity of each duty and/or responsibility. • Level of leadership required. • Specific objectives and deliverables. • Potential impact of thought leader/consultant on organizational and/or product success.
Considers Thought Leader Qualifications • Educational credentials and specialized training. • Professional certifications. • Leadership experience. • Academic appointments. • Research experience and funding history. • Invited presentations. • Publication history. • Other professional leadership activities / recognition in the healthcare community.
How We “Score” the Thought Leader Algorithm • Establish relative weightings for the pertinent factors. • Identify interdependencies among the factors (e.g., extent of time requirement vs. qualifications of thought leader). • Consider potential redundancy of qualifications.
The Market Approach • Places reliance upon “non-tainted” data. • Considers physician compensation arrangements that are free from referral bias. • “Crosswalks” the arrangement to non-healthcare settings.
Our Approach To Non-Tainted Market Data • Fees paid to physicians who are not in a position to refer: • Expert witness fees • Physician consultants • Fees paid to comparably qualified non-physicians: • Consultants • Attorneys
75 NW 1st Avenue, Suite 201 Delray Beach, FL 33444 561-330-3488 858 Happy Canyon Road, Suite 240 Castle Rock, CO 80108 303-688-0700 www.healthcareappraisers.com Daryl Johnson djohnson@hcfmv.com Ann Brandt abrandt@hcfmv.com 15