门诊手术中心(ASCs)一直是一个强大的合并和收购的来源&A) deal activity over the last decade. As ASC management companies, health systems, and private equity (PE) firms implement robust ASC expansion strategies, demand for ASC acquisitions is growing, 这种兴趣已经转化为溢价资产的强劲交易倍数.
That can put sellers in an advantageous position. But getting the best price for your ASC requires extensive preparation, and a significant focus on optimizing your business, in order to package your ASC as a premium asset. 以下是最大化ASC估值并促进顺利交易的三个步骤.
1. Optimize Your Managed Care Plan
精心设计的管理式护理战略可以对ASC的绩效产生深远的影响. To effectively maximize the value of your ASC, ensure:
- 了解当地市场的报销情况，并将其纳入付款人谈判. Variances by market, payer, and service line are expected, and it’s important to know where your opportunity lies.
- Contracts are professionally assessed and negotiated. 参与付款人谈判，以解决基本问题，如多年标准生活费用的增加和植入物的充分报销, 对于那些成本高或合同中费率不合理的程序，要寻求豁免. In-network centers will have access to more volume, 这通常会为ASC带来更多收入，并降低买家的风险. 评估联属公司和外派公司的语言，以确保在获得设施时提供有利的条款，并且不会有报销风险.
- An updated, adequate fee schedule is present 并正确加载到计费系统中，以实现最大的收入捕获，并避免低于合同允许金额的少付款.
- During negotiations, a business case for payer savings is developed. Discussions with payers can often extend beyond desired time frames. As an ASC operator or investor, 确保在合同终止日期前至少6个月向付款人提交一份合理的商业案例. 强调重要的指标，如ASC和医院云顶集团之间的成本比较, volume of additional cases available to migrate to an ASC, quality outcomes, and high levels of patient satisfaction. Any payer and revenue concentration should be evaluated.
Optimizing your ASC’s managed care plan will drive top-line revenue, EBITDA margin, and an increased enterprise value.
2. Improve Financial Performance with an Efficient Business Office
Maximizing ASC operations drives financial performance. This involves two central functions:
Business Office Financial Responsibility
Setting, tracking, 通过策略性的日常财务目标来推动问责制对于实现管理式医疗计划的价值至关重要. 业务办公室应进行审计，以确保按照商业付款人合同和政府付款人的允许金额支付ASC，并确定是否有任何索赔以100%的费用支付. When a claim is paid at 100% of charges, 这表明会计准则委员会的收费主管不足以从付款人那里获得应得的收入. 这为增加现金流、提高收入和EBITDA提供了一个立竿见影的机会.
同样重要的是，业务办公室拥有来自付款人的完整费用明细表和支付逻辑，并将合同加载到计费系统中. This way, 允许的金额可以根据付款进行核实，如果付款低于这些金额，则可以与付款人协商. 通常情况下，付款人没有正确加载合同，或者在索赔处理系统中更新他们的费用表，以反映每年自动扶梯的合同条款.
Finally, 为关键运营数据建立目标和指标，使中心的整体价值最大化. Standard business office metrics to monitor include but are not limited to:
- Days in accounts receivable (A/R).
- A/R over 90 days.
- Bad debt outstanding and write-off percentages.
- Denial rate.
- Days to drop a claim to measure the length of time it takes to bill payers.
Additionally, coding quality audits can be performed to improve revenue capture, coding compliance, and coding education.
ASC Operating Efficiency
In addition to billing and collections, financial performance is highly impacted by operational efficiencies. Maximizing operating performance can include:
- Measuring OR scheduling performance to ensure cases are not turned down and the appropriate time is allotted for a case; assessing OR turnover time to identify opportunities to enhance efficiency; and reviewing the effectiveness of process improvement programs.
- Evaluating staffing levels and regularly reviewing policy compliance.
- 监测首次病例准时开始(FCOTS)，以确定减少病例开始延误的机会, 评估块时间利用率和策略，以提高手术室利用率的优化.
- 回顾病人和云顶集团40011官网的满意度评分，以确定改进的机会.
优化财务绩效还包括跟踪运营成本.g., salaries and benefits, drugs, 医疗用品和植入物)和使用偏好卡来了解您的直接成本. 与云顶集团40011官网利益相关者接触将有助于确定改进的机会，并能够有效地实施将提高效率的计划, cost reduction, and overall financial performance. Showing your partners the economic impact of these savings, 这会导致额外的EBITDA，从而使你的ASC价格更高, can be effective in changing behavior.
3. Understand Key Transaction Considerations
卖方在准备ASC交易时应评估三个关键组成部分:
- Buyer pool. 在评估买家时，重要的是要考虑ASC的目标和交易后策略. 了解所选股权合作伙伴的最终价值对于建立积极的长期关系至关重要. 你的伴侣是长期的还是短暂的——你为什么要在意?
- ASC operations and expense allocations. When preparing for a transaction, 将直接的ASC费用与共享员工或管理费用分配分离开来是很重要的. During the FMV assessment, 清楚地描述费用和间接费用对预测未来的经营业绩至关重要.
- Long-term quality of earnings (QofE). QofE是指历史财务报表中报告收益的长期可持续性. 优化的管理式医疗合同和高效的业务办公室将展示谈判合同和收入获取的力量，从而推动营收增长&L performance. Stable, efficient performance over at least 12 to 24 months is optimal.
私募股权公司承诺的、未分配的资本(“干粉”)正接近创纪录的水平 $2 trillion. Coupled with aggressive M&A strategies by ASC management companies and health systems, the ASC transaction market is expected to be robust. 通过管理式护理和收入优化策略提高ASC估值，是推动健康运营和财务绩效的行之有效的方法.
Edited by: Matt Maslin
Published June 13, 2023
