21 November 2016

Lease Satisfaction Scores Tougher than CMS’




How FASB and debt markets will grade healthcare organizations’ leases

  • Because of the prevalence of capital leasing for many companies, FASB and IASB have amended accounting guidance (ASC 842) to provide more reporting on lease transactions.
  • IASB and FASB differ on how operating leases will be disclosed and valued on the financial statements. For this purpose, we will focus on the FASB guidelines.
  • The new accounting standards require organizations to recognize all lease obligations (over 12-months) on their balance sheets, to ensure greater transparency in financial reporting.
  • Healthcare providers will need to begin monitoring the potential effect of these changes on their debt-to-capital ratio and related debt covenants.
  • Regulations take effect in 2019 and 2020, but back reporting begins in 2017 (for public companies) and 2018 (for private, non-profit and government organizations), so time is short to understand and manage implementation.
  • Hospitals and health systems will be particularly affected by the new reporting standards due to the capital-intensive nature of healthcare service delivery.
  • Missteps in managing this change can result in loan covenant defaults, souring investor sentiment and/or failure to meet benchmarks.
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8 November 2016

Imagine Atlanta Without a Net




How do you kill three birds with one stone? It doesn’t happen often, but in 2016, DTSpade helped two of the city’s most critical organizations to execute a plan that helped one of Atlanta’s most vital hospitals expand its campus, secure more parking and ensure a long term future for a critical community program. In the same transaction, DTSpade helped Fulton County to lower its operating expenses and provide a better delivery of care to its HIV, STD and Hep-B patient populations. And that’s just the beginning of the story…

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18 July 2016

More Doctors Signing Fewer Checks




Georgia gains on shifts in physician employment models

  • Inelasticity in demand, an aging population and changes in healthcare policy have led to steady and continued growth in healthcare employment—outpacing total non-farm job numbers and wage growth through 2024 for most industries.
  • Georgia will be an acute winner due to availability of workforce and a growing population.
  • Physician demand is strong, but lack of supply will require technology implementation and improved employment models.
  • This will increase the need for physician assistants or nurse practitioners to fill the gap.
    Capital seeking healthcare consolidation provides physicians security of employment, if they want it.
  • Factors to watch carefully are:

1. Lifting of uncertainty within the market,
2. Flow of capital toward and away from healthcare consolidation,
3. Technologies that remove the complication from medical billing,
4. Compression of physician pay and/or improving hospital profitability.

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16 May 2016

The Regulator: The State of Healthcare in Georgia




On March 18, 2016, the Georgia Association of Healthcare Executives sponsored a closed door session for C-Level Executives throughout the state to hear perspectives from two insiders: Harold Kirtz, Senior Litigator for the Federal Trade Commission, and Mr. Will Melson, President of the Broadwell Group. The discussion went long, but here’s half of what was shared from a regulator’s perspective. Please note that any comments by Harold Kirtz are not necessarily the views of any individual Commissioner or of the Commission as a whole.

Q: What things does the FTC look for in its jurisdiction over mergers and acquisitions?

A:  We look for whether the merger or acquisition will substantially lessen competition in a particular market.  We have to determine what the product or service market is, what the geographic market is, what concentration is there among the current players in the market, and whether there is the likelihood of substantial entry by new or expanding players in the market. 

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2 May 2016

The Dealmaker: The State of Healthcare in Georgia




On March 18, 2016, the Georgia Association of Healthcare Executives sponsored a closed-door session for C-Level Executives throughout the state to hear perspectives from two insiders:  Harold Kirtz, Senior Litigator for the Federal Trade Commission, and Mr. Will Melson, President of the Broadwell Group. The discussion went long, but here’s one half of the story from a dealmaker’s perspective.

Q: What is the actual “state” of Mergers & Acquisitions?

A: While none of us have unlimited funds, healthcare professionals struggle with the idea there’s a lot of things I “could” do, but what “should” I do? When it comes to mergers & acquisitions, you’re probably presented with a lot of opportunities to consider – should we join? Should we buy? Should we merge? Should we integrate?

I think we’re in the middle of it. And when you’re in the middle of all this change, it’s sometimes a little hard to figure out. Should we go with a population health management? Should we do something with a payer plan?   We see a lot of health systems that will dabble in something that looks like a plan.

You would have thought that in 2010, M&A was on a huge tear. And even up to 2014, you’re thinking there’s no way it can be any bigger. Last year was a 66% increase of M&A activity in Healthcare. Even nationwide – Wall Street Journal reported there were over $2 Trillion of mergers.

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18 April 2016

Prada-fication of Healthcare: The Patient Will See You Now




Cash Payments, Deductibles and the Patient Experience

Executive Summary

  • Macro changes in healthcare mean that more patients are directly trading currency for care.
  • When patients pay more, their expectations of care change.
  • The Wall Street Journal is reporting a return to cash discounting for patients.
  • Patients’ disconnection to invoicing drives non-payment.
  • Coordination and thoughtfulness in invoice delivery increases percentage of payment revenue.
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21 March 2016

Beijing Setting MRI Rates in Dunwoody




Global volatility and its effect on local healthcare supply in the southeast

  • Global economic indicators do not universally support a national contraction.
  • Emerging market declines and a stronger U.S. dollar are weakening demand, but the weakening is disproportionately borne by energy and heavy industrials like Exxon.
  • Georgia realized a net gain of 92,900 new jobs in 2015 and is outpacing the U.S. in population and employment growth.
  • Non-elective medical procedures comprise significant revenue in healthcare organizations, but most of the profitability is based on consumer spending and choice.
  • Removing consumer confidence, whether through institutional shortcomings or macroeconomic volatility, typically leads to deficiencies in local delivery models.

Executive Summary

Recent events in global markets have led to speculation that the expansion of the US economy has ended. But indicators do not universally support a national contraction. China’s growth continues to decline (along with other emerging markets) and with a strong U.S. dollar, weaker economies are dampening the demand for U.S. exports and hindering businesses bottom lines. However, much of this damage to reported profits is contained and disproportionately borne by energy and heavy industrials like Exxon.

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