Doctor's Life Magazine Vol. 6 Issue 5, 2018

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THE FLORIDA ORCHESTRA Raymond James Pops

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Look Who’s Joined BayCare Medical Group If you’re a primary care physician or a specialist, we have exciting opportunities for you. Whether you’re a new or experienced physician, if you’re looking for a new professional home, consider BayCare Medical Group. Tashrique Alam, DO Family Medicine

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To learn about employment opportunities, visit BMGPhysicians.org or contact a recruiter at (813) 586-8154. 18-537122-1018


Contents 6 8

8

Introduction to Medical Practice Valuation

12 14

Fighting Physician Burnout

The Courage to Trust Medical Care to Patients and Physicians 4

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Touring the Best Italian Wines Doctor’s Life Tampa Bay

From the Publisher Feature Introduction to Medical Practice Valuation

12

Feature Fighting Physician Burnout

14

Feature The Courage to Trust Medical Care to Patients and Physicians

16

Feature Letters of Intent in Medical Practice Transitions: A Simple Rx for Success

20

Feature Touring The Best Italian Wines Without Jumping on a Flight To Italy

Advertisers BayCare Medical Group 3 Carver Concierge 11 The Florida Orchestra 2 Jason Skeldon Artwork 5 JW Marriott 23 The Meridian Club 21 Opes Health 17 PNC Bank 24 Point Grace 19 Rebuilt Meals 9 Wine, Women & Shoes Presented by Nu Image Medical 7

Issue 5, 2018



From the Publisher

www.doctorslifetampabay.com

W

elcome to Doctor’s Life Magazine! We appreciate your readership and continued support. DLM has been in circulation since 2008. Our goal has always been to provide Tampa Bay physician’s content focused on the current medical news but primarily cover areas targeted on business, legal and lifestyle. Each issue of Doctor's Life Magazine contains a wide array of relevant information for physicians in and out of their practice. DLM publishes articles that highlight leading physicians, a variety of medical, business and legal topics with a focus on lifestyle content for after the white jacket is hung up for the day. Our issues are filled with topics in Wealth Management, Real Estate, Travel, Fitness, Food and Wine, and other areas that promote life outside of the practice.

TAMPA BAY

Published by

We are always striving to be better and to stay current on the trends. Our contributors continually search for topics, solutions, and areas of interest in lifestyle to provide articles that are relevant to our readership. The DLM success has been based on our readership feedback which assists our staff in the development of our future content direction. DLM would love your input, suggestions or ideas regarding articles of interest. DLM works with a diverse group of contributors and their opinions are not always the opinion of Doctor’s Life Magazine.

Tampa Headquarters 1208 East Kennedy Blvd. Tampa Fl, 33602 813-867-0916 Group Publisher Ed Suyak publisher@doctorslifetampabay.com

If you would like to become a contributor or receive a media kit for advertising rates, please contact our office by email or phone. (813) 867-0916 or publisher@mashedmediagroup.com

Creative Director Rob Stainback Editorial Director Danielle Topper

Be well,

Associate Publisher CJ Cooper

-Ed

Advertising Account Executive Ryan O’Neil Contributing Writers Nick Hernandez MBA, FACHE Haley Neidich, LCSW Marilyn M. Singleton, MD, JD Trisha Lotzer, JD

Ed Suyak Group Publisher publisher@doctorslifetampabay.com

Doctor’s Life Magazine’s mission is to provide physicians content and information that may assist in creating a better professional and leisure life. Our focus is to provide articles that can help to better your practice and your lifestyle outside of the white coat. We want to be your source for inspiration and content on living a good life. Doctor’s Life Magazine wants to know about extraordinary physicians and staff, upcoming events, and article ideas or contributors. Please email us if you have an event, idea or know of a doctor making a big difference. We want your suggestions and feedback. For all comments, ideas, advertising inquires or to request a media kit contact publisher@doctorslifetampabay.com. Doctor’s Life Magazine, Tampa Bay does not assume responsibility for advertisements or articles published, nor any representation made therein, nor the quality or deliverability of the products themselves. Reproduction of articles and photographs, in whole or in part, contained herein is prohibited without expressed written consent of the publisher, with the exception of reprinting for news media use. Doctor’s Life Magazine is considered a form of entertainment and should not be deemed as medical, legal or business advice without consulting the appropriate professional regarding the specific subject matter. Printed in the United States of America.

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INTRODUCTION TO

MEDICAL PRACTICE VALUATION By Nick Hernandez MBA, FACHE

At some point, there will come a time to sell your practice. It could be in part to a partner or as a whole to another group or hospital. In any case, the practice will need to undergo a valuation, which is a detailed and complicated process, oftentimes confusing because let's face it; it is not like you sell your practice every year. In general terms, the process of determining the price that a medical practice will be sold, or bought, for is referred to as valuation. You are literally putting a specific value on the business, or certain parts of it, so you can sell it. We cannot just randomly assign numbers on how much a medical practice is valued at, or how much an owner’s interest in a practice is worth. There has to be a valid basis behind the estimate of the economic value of a business. In the same vein, there is a set of procedures on how these estimates are arrived at. This is called a medical practice valuation. One thing that can help you on your path is to understand some of the basic tenants of practice valuation. CONTINUED ON PAGE 10

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CONTINUED FROM PAGE 8

Understanding Terminology If you are considering selling your practice, make sure you understand terms and appraisal definitions. Oftentimes a physician will ask their accountant to appraise the business, but the physician may be surprised to find that the "book value" given by the accountant is far different than the "Fair Market Value (FMV)" that he could actually receive at time of sale. It is not that the accountant is incorrect at all. Rather, the accountant and the physician may be operating under a different set of terms and definitions, without knowledge of each other's perspectives. Realizing that there is no absolute sales price is the essence of FMV. When determining valuation, look for a price range with a reasonable floor and ceiling.

Understanding Value For starters, value isn't an absolute number. A medical practice's tangible and intangible assets can be grouped into two broad categories: physical assets and non-physical assets. Examples of physical assets include accounts receivable, leaseholds, medical equipment and furnishings, medical records, and real estate. Examples of non-physical assets include buy/sell agreements, goodwill, managed-care contracts, restrictive covenants, and staffing. Estimates of value differ significantly, depending on the purpose of the appraisal, the acumen of the appraiser, etc. Astute appraisers will consider a host of questions. What is the value of the practice for purchase or sale? What is the value of a practice for merger? What is the value of practice assets for joint venture with a corporate partner? What is the value to establish buy-in or buy-out arrangements for partners? What is the value of practice assets for purchase or sale, apart from ongoing operations? To answer these questions, physicians must understand how practices are valuated.

Informal Terms of Valuation The "asking price" is often arbitrary and difficult to substantiate, and typically is 10

reduced by a significant percent during negotiations. The "creative price" is derived by way of creative financing. For example, the practice may provide the down payment. The "emotional price" may involve either a motivated buyer or seller, who pays an under- or overinflated price for the practice. The "friendly price" is reserved for associates, partners, or other colleagues. The "realistic price" is one that both buyer and seller believe is fair.

Formal Terms of Valuation Practice appraisers use FMV as the standard to derive a reasonable value for a practice. FMV means an arm's length transaction between an unpressured, informed buyer and an unpressured, informed seller. The "business enterprise value" of a practice equals a combination of all assets (tangible and intangible), and the working capital, of a continuing business. The value of "owner's equity" equals the combined values of all practice assets (tangible and intangible), less all practice liabilities (booked and contingent). The "working capital value" Doctor’s Life Tampa Bay

equals the excess of current assets (cash, A/R, supplies, inventory, prepaid expenses, etc.) over current liabilities (accounts payable, accrued liabilities, etc.).

The Big Picture Valuing a medical practice is more of an art than a science and you must always keep in mind that the "Asking Price" is NOT the purchase price. Quite often it does not even remotely represent what the practice is truly worth. Naturally, a buyer's valuation is usually quite different from what the seller believes their practice is worth. Sellers are emotionally attached to their medical practices. They usually factor their years of hard work into their calculation. Unfortunately, this has no business whatsoever being in the equation. Never, ever buy a practice just because the price is right; first and foremost be certain that the practice itself is right for you and that it is integral to your future strategy. Remember that valuations are not scientifically based; they're subjective!

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Burnout FIGHTING PHYSICIAN

By Haley Neidich, LCSW from ThriveTalk.com

Physicians work hard every day to ensure their patients receive the best medical care. They put in long hours and hard work to stay up-to-date with available therapies and engaged in their patients’ care. As health care continues to advance, it also puts more pressure on physicians to provide better care, in less time, and for less money. These changing conditions are putting a strain on medical practice and leading to higher rates of physician burnout.

Getting Specific About Physician Burnout Developments in medical research and advances in technology continue to improve health care and patient outcomes. With these rapidly changing treatment options and patient expectations, physicians are being challenged more than ever. These challenges along with other stressors can contribute to physician burnout. Physicians who experience burnout often show signs of emotional detachment and exhaustion, doubting their impact and quality of work, and cynicism. While physician burnout does not impact every provider, it does affect a high percentage of physicians. Studies report 40-55% of surveyed physicians report symptoms of burnout. Burnout can 12

impact physicians at different points in their career and can affect them to different degrees. For some, working in a stressful environment for many years can weigh them down and eventually cause symptoms of burnout. Others experience acute events at work or in their personal life that make them question their impact at work.

What Causes Physician Burnout Increasing demands on health care facilities and providers put physicians at risk for burnout. Physician burnout can be complex and have a variety of causes. Some physicians feel burnout because the nature of their job is stressful. Patients come to them for help when they are feeling their worst. Providers are under a lot of pressure to ensure each patient an accurate diagnosis, appropriate medications and other therapies, and timely follow up. Errors in health care can directly impact Doctor’s Life Tampa Bay

a patient’s health, and in some cases can be the difference between life and death. The pressure physicians often put on themselves to be perfect can drive them to burnout. On top of these daily stressors, hospitals and clinics are feeling the pressure of tight budgets and focus on patient satisfaction. Unfortunately, these demands are often creating stressful work conditions for providers. Higher workloads with less available time and lower reimbursements for services provided contribute to physician burnout. Burnout can also be caused by overwhelming amounts of charting and administrative work required for insurance companies and liability purposes; these tasks take away from their available time for patient care.

The Costs of Physician Burnout Physician burnout does not only impact the Issue 5, 2018


mental and physical health of physicians. It can also greatly impact those close to them, and in some cases can affect the quality of the patient care they provide.

Doctors and Their Families Physicians enter their careers with the understanding they will be expected to work some long hours and provide coverage for on-call times. Although families are often aware of these responsibilities, it can be stressful to work around the demanding schedule of a doctor. As this demanding schedule continues to weigh on physicians and signs of burnout begin, they often feel exhausted and emotionally drained. These feelings often follow them home and can isolate them from their families.

Patients Surprisingly there has been research done that has shown burnout can actually have a negative impact on patient care. As burnout sets in, physicians find themselves easily distracted and detached when interacting with patients and their families. When their energy levels drop it can be harder to evaluate information and make good decisions; sometimes this results in significant errors. Patient satisfaction and quality of care can suffer, and expenses can rise when doctors cannot fully engage in their patients’ therapy due to burnout. Higher incidence of burnout can also lead to turnover, which prevents patients from establishing strong relationships with their health care providers.

Mental Health Problems In addition to the costs to patients and physicians’ families, there has been a discouraging increase in mental health conditions reported by physicians over the years. In the MDVIP Physician Health Survey, physicians reported high rates of stress that impacted their health. A shocking 41% said they have contemplated leaving the field of medicine and 48% would not choose medicine if they were starting their career over again, all related to the stress of their job. The Medscape National Physician Burnout & Depression Report released this year revealed 15% of physicians report being depressed, either clinically diagnosed (3%) or having feelings of being sad or down (12%). These mental health problems contribute to substance abuse among some physicians, and in severe Issue 5, 2018

cases, burnout and stress can contribute to physician suicide.

Managing Burnout Many physicians may feel like burnout is inevitable and out of their control. Fortunately, there are things physicians can do to reduce their risk of burnout.

Practicing Self Care Recognizing feelings of stress and taking a step-back can be an important practice for physicians. Without taking some time to take care of themselves, both physically and emotionally, physicians can easily lose their energy and motivation. Throughout the day, small breaks can help physicians overcome challenging encounters and stay engaged with their future patients. Finding time to exercise can help shake off the stress of the day and also build physical fitness which can contribute to better energy levels. Getting adequate sleep at night and taking time to eat healthy meals also improve energy levels. Physicians are often very busy, those in need of support may consider talking to an online mental health professional

Learn to Say No Doctors are often some of the highest achieving individuals in the country. They are driven by a need to help others and trained to work extremely hard to accomplish their goals. This has led to advances in medical treatment, successes in patient care, and life-saving interventions for those who are suffering. Unfortunately, this drive to not only succeed, but to also never fail, can cause doctors to feel like they have to take on every challenge they are presented; this can lead directly to burnout. Recognizing when they have enough responsibilities and being able to say no to new opportunities can prevent physicians from becoming overwhelmed and feeling overworked.

important to make a deliberate effort to leave work at work and give your mind the opportunity to recharge before taking on the next day’s challenges. For many physicians, these tips can help them get started on recovering their motivation and energy. For some though, these techniques may not be enough. In cases where these efforts feel fruitless, or where you feel too far gone, it can be helpful to seek help from a qualified clinician. Physician burnout is a problem that should be taken seriously by physicians and health care facilities as numbers of physicians who report symptoms of burnout rises. Burnout can impact the quality of patient care and can contribute to an already large problem with physician shortages. Taking steps to reduce stress levels and encourage self-care can lead to better physician health and patient outcomes. Resources: https://www.aafp.org/fpm/2015/0900/p42.html https://www.kevinmd.com/blog/2016/09/6-steps-overcomingphysician-burnout.html https://www.health.harvard.edu/blog/physician-burnout-canaffect-your-health-2018062214093 https://www.mdmag.com/medical-news/beating-physicianburnout https://www.mdvip.com/about-mdvip/press-room/strainedhealthcare-system-hurts-doctors-affects-patient-care https://www.nimh.nih.gov/health/statistics/major-depression. shtml https://www.ahrq.gov/professionals/clinicians-providers/ahrqworks/burnout/index.html https://www.medscape.com/slideshow/2018-lifestyleburnout-depression-6009235#25 https://wire.ama-assn.org/life-career/physician-burnout-it-snot-you-it-s-your-medical-specialty

Leaving Work at Work Being able to walk away from the stress of each day in health care is an essential skill for avoiding burnout. Health care is a high stress environment, and physicians are presented with serious problems they need to solve every day. These problems can consume physicians’ thoughts until they are solved. However, leaving work at work and being able to disconnect from those stressors is extremely important to the mental health of these providers. It is Doctor’s Life Tampa Bay

Haley Neidich, LCSW has her masters degree from Columbia University and is licensed psychotherapist who has been in the mental health field for over 10 years. Haley is the Director of Clinical Development ThriveTalk. com (please link to the website), an online therapy company that instantly connects you with highly trained and empathic therapists who help you to craft a plan for powerful change in your life. 13


The Courage to Trust Medical Care to

Patients and Physicians

T

By Marilyn M. Singleton, MD, JD

he days of trusting your legislators to have your best interests at heart are in the rear view mirror. Apparently, their main interest is parroting the buzzwords of the moment to get elected and then being too busy banking lobbying money to listen to the voters. Our legislators have become spectators who wait for the perfect moment to pounce on their political “enemy” and then go on cable news shows to boast about it. The “us against them” attitude, punctuated by hyperbolic, apocalyptic rhetoric closes the door to finding solutions. Our interests would be better served by having town hall meetings where voters could state their concerns, air their differences, and learn what legislators are doing about their issues. Caution: meetings at 9 a.m. on Wednesday when paid activists are guaranteed to outflank the working general public are prohibited. There are strong differences of opinion on how to attain a healthy citizenry.

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Educating potential patients about what drives up medical care expenditures can start the conversation. Well-informed patients would demand solutions based not on corporate interests or government or political agendas, but on a fair, competitive market that maximizes choices and achieves lower costs. Eight years of the Affordable Care Act have borne out Congressional Budget Office predictions that abandoning basic principles of insurance—which compensates only for events beyond the insured’s control and is priced according to the degree of risk—would lead to higher and higher premiums, fewer participating insurers, and unsustainable government expenditures to subsidize insurance premiums. The data in three recent Centers for Medicare and Medicaid reports on ACA exchanges show “individual market erosion and increasing taxpayer liability.” The average monthly premium for coverage purchased through the exchanges rose 27 percent in 2018, and federal premium Doctor’s Life Tampa Bay

subsidies increased 39 percent from 2017 to 2018. A less frequently discussed cost driver is the disturbing trend of private doctors’ offices being scooped up by hospitals, health insurance companies, and venture capital groups. Prices tend to rise when health systems merge, because of decreased competition. And not only do hospitals and health systems generally charge more than private physicians’ offices, the government compounds this problem by paying more to hospitals than independent offices for the same service. A review of 2015 Medicare payments showed that Medicare paid $1.6 billion more for basic visits at hospital outpatient clinics than for visits to private offices. Patients are the biggest losers: they paid $400 million more out of pocket and had their tax dollars wasted. The study also found hospital-employed physicians’ practice patterns in cardiology, orthopedic, and gastroenterology services led to a 27 percent increase in Medicare costs. This Issue 5, 2018


translated to a 21 percent increase in outof-pocket costs for patients. Similarly, a U.C. Berkeley School of Public Health study of consolidation of California's hospital, physician, and insurance markets from 2010 to 2016 concluded “highly concentrated markets are associated with higher prices for a number of hospital and physician services and Affordable Care Act (ACA) premiums.” In consolidated markets (defined by the Federal Trade Commission’s Horizontal Merger Guidelines), prices for inpatient procedures were 79 percent higher and outpatient physician prices ranged from 35 percent to 63 percent higher (depending on the physician specialty) than less concentrated markets. Big medicine and third-party financing are taking the cost curve in the wrong direction. This speaks to the urgency of encouraging cash friendly practices that bypass insurance and direct primary care (DPC) practices. With DPC, all primary care services and access to lowpriced commonly used medications are included in an affordable upfront price. Importantly, DPC’s time-intensive and individualized management of chronic diseases decreases hospital admissions, paring down Medicare’s $17 billion spent on avoidable readmissions. Why corporations want to marginalize private practice seems clear; the government’s motive is open to debate. Surveys consistently find that patients overwhelmingly want “personalized provider interactions.” Thus, herding patients into government-directed programs is not the solution. One core problem with government systems is their reliance on the goodwill of politicians. As President Ford said, “a government big enough to give you everything you want is a government big enough to take everything you have.” It’s time for Congress to scrutinize anti-competitive health system mergers. It’s time to bring to the floor over a dozen bills to expand and improve Health Savings Accounts (HSAs) to give patients more control over all facets of their medical care. Congress, the clock is ticking on this legislative session. Stand up for patients. Or did the dog eat your courage?

Issue 5, 2018

Dr. Singleton is a board-certified anesthesiologist. She is also a Board-of-Directors member and President-elect of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.

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LETTERS OF INTENT IN MEDICAL PRACTICE TRANSITIONS:

A Simple Rx for Success

O

By Trisha Lotzer, JD

ne of the most powerful tools in the successful purchase and sale of a medical practice is the letter of intent (or “LOI”). A well drafted and properly timed LOI accomplishes four things:

1. Serves as a formal, written offer; 2. C learly sets forth all major substantive terms that the parties have agreed on or agree to agree on in the closing documents; 3. E stablishes “to-do” lists and a corresponding timeline for the parties and their advisors during the pre-closing period; and 4. S aves the parties time and resources by not drafting the purchase agreement until key terms have been agreed to in writing in the LOI. A good LOI clarifies terms, obligations and expectations and serves as a playbook for running the transaction smoothly throughout the closing process. It’s generally short, less than ten pages including timelines and checklists, and mostly in plain English.

“In my experience, deals with LOIs close faster and prevent undue friction between the parties and their advisors. Deals where the parties rush past the opportunity to get clear on the essential points and set a timeline in an simple LOI often end up lost for months, or eternity, in the mire of a sixty or seventy page purchase and sale agreement. Skipping an LOI does not save time in the long run; LOIs save time, prevent headaches and preserve resources.” The proper timing of the LOI is after an appraisal but before the purchase and sale agreement. The optimal timing of key documents and events in medical and dental practice transitions is as follows:

Practice Listing The offering price is published by the seller or broker and the practice is listed for sale. Note: Few brokers prepare actual appraisals or have the credentials to do so. And, because they are usually paid on commission and represent the seller, they have an built-in incentive to list the practice for a much higher price than most independent appraisals. But all prices are negotiable except for quick “fire sales” that occur for various reasons and there should be an appropriate, deep discount built into the non-negotiable selling price and pressure to close quickly. LOI’s are especially important in these “fire sale” deals. CONTINUED ON PAGE 18

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Non-disclosure agreement (NDA) NDAs are optional but serve to protect the buyer and seller’s confidential information, including financial records and that the parties are discussing a potential purchase and sale. Basic NDAs are often provided by the broker representing the seller, if there is one, and may be required by the seller before showing a potential purchaser the practice and sharing practice financial data. If there are specific privacy concerns to be addressed, the “boilerplate” NDA from the broker is probably useless and the NDA should be drafted by an attorney.

Appraisal An independent appraisal provides both parties the security of knowing that the purchase price they negotiated is a fair one. Or, each party can have their own appraisal prepared and keep it private for negotiation purposes. Either way, nothing is worse than finding out too late that you paid too much or sold for too little and that it could have been avoided by a simple appraisal. Not having an appraisal would be like buying or selling a car without checking the Kelly Blue Book value–except that the difference in price could be hundreds of thousands. Want to sleep well at night and give your attorney an advantage at the negotiating table? Get an appraisal from someone with AICPA, ABV, AM&AA, USPAP or CPA credentials. A valuation is not the same thing as an appraisal and very few brokers and CPAs are qualified to prepare them. Any broker’s “valuation” is most likely a guestimate or rule of thumb that has been rounded up and padded with an extra 10-25% on top of the practice’s actual value.

Letter of Intent When the purchaser decides to make an offer, an LOI is drafted, including all major terms and the offering price. The seller either accepts the offer and signs the LOI or sends back an edited LOI as a counter offer. All major deal terms and price are being negotiated at this stage between the parties and their attorneys. At the same time, the purchaser has begun due diligence and is seeking financing.

Closing Documents After the key terms have been agreed to in a LOI then the purchase agreement is drafted. The purchase agreement is part

of a larger set of agreements called the “closing documents.” The closing documents include any leases, employment agreements, promissory notes or other agreements to be incorporated into the purchase transaction. Some fine-tuning might occur here but the major points have already been negotiated in the LOI and there shouldn’t be any big surprises or deal changes at this stage… unless something unexpected turned up in due diligence.

Escrow As the parties get closer to a closing date and are almost ready to sign the closing documents then the deal moves to escrow. An escrow agent helps collect signatures on legal documents, oversee details such as the lien search and coordinate the funding of the purchase price. Some attorneys may be willing to perform the duties of an escrow agent but it is generally more cost effective to use an escrow agent or the seller’s broker to coordinate escrow details.

Closing When the purchase documents have been executed, closing obligations satisfied and escrow completed then the deal has “closed” and ownership transfers on the effective date per the date and terms set in the purchase agreement. While LOIs are optional and can be provided at different stages during different deals, generally speaking, deals that close faster and most efficiently follow this standard and optimal timeline.

How does an LOI save time and money? The LOI is a short document, mostly in plain English, that gets all the parties literally “on the same page” before the comprehensive (and more expensive) closing documents are drawn up. If the parties cannot agree on the terms in an LOI it’s time to call it quits before investing in the closing documents. For example, imagine that a potential buyer offers to purchase a medical practice for $550,000 and the offer is accepted. Great right; or perhaps not so great. But what if the buyer thinks that includes supplies, the domain name and accounts receivable (just to name a few things) and the seller thinks it includes only the patient charts and practice debt? Then you’ve got a problem that could have been avoided by an LOI. And, chances are, the problem doesn’t become apparent until the lawyers are five to twenty five hours deep into the closing documents. Then you have an expensive problem. Worst of all, if the buyer and seller cannot reach another agreement about what the $550,000 includes then the deal falls off the table and both parties still owe their advisors fees for working on the purchase agreement.

What if I’m too late and the deal is already off-track? If your deal is off track because you did not execute an LOI that includes key terms, a checklist and a closing timeline the good news is that it can be done at any time prior to closing. In fact, many side-tracked deals have been salvaged and quickly put back on track after the parties stepped back and described the forest in an LOI before getting lost in the trees of a sixty page purchase agreement. The moral of this story… Always do an LOI.

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Alta Mora Etna Bianco Travel south to Sicily, the largest island in the Mediterranean Sea, where these grapes are grown and harvested on the slopes of the active volcano, Mount Etna. The soil is black, fertile and dynamic, and the name Alta Mora translates to "tall, black," representing the great heights of the vineyards on the mountain and the dark, black volcanic soil. This wine is a slight nod to Sauvignon Blanc in style.

Doctor’s Life Tampa Bay

Feudi di San Gregorio Falanghina This vineyard is in Sorbo Serpico, a tiny village in Campania's Irpinia region, near Mount Vesuvius. The area, with its numerous castles and fortresses, has ancient roots, and has been a transit land between the Tyrrhenian and Adriatic seas. Named after the method of vine cultivation in Sannio at the end of the Roman Era called Falangs ("poles"), this Falanghina is ideal as an aperitif. It can also accompany appetizers, plates of simple fish and vegetables as well as fresh cheeses. Let these wines bring the beauty of Italy to your table.

Issue 5, 2018


AFRICA

ASIA

EUROPE

LATIN AMERICA

MIDDLE EAST

NORTH AMERICA

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