Med Monthly July 2017 by MedMedia9

PHYSICIAN SOLUTIONS PRESENTS

Med Monthly MAGAZINE

July 2017

First Steps:

What You Need to Do Before You Put Your Medical Practice on the Market pg. 18

SELLING YOUR MEDICAL PRACTICE: Steps for Success pg. 22

STRATEGIC DILIGENCE OF PHYSICIAN PRACTICE MERGERS pg. 28

5 Points to Contemplate When Selling Your Practice pg. 26

the

Do Your Homework When Selling Your Practice pg. 30

Selling Your Practice issue

contents

PUTTING PATIENTS FIRST: Think Before You Speak

features

18 FIRST STEPS: What You Need to Do Before You Put Your Medical Practice on the Market

22 SELLING YOUR MEDICAL PRACTICE: Steps for Success 26 5 POINTS TO CONTEMPLATE WHEN SELLING YOUR PRACTICE 28 STRATEGIC DILIGENCE OF PHYSICIAN PRACTICE MERGERS 30 DO YOUR HOMEWORK WHEN SELLING YOUR PRACTICE

28 STRATEGIC DILIGENCE OF PHYSICIAN PRACTICE MERGERS

practice tips 6

PUTTING PATIENTS FIRST: Think Before You Speak

HOW TO GET YOUR FIRST THOUSAND FACEBOOK FOLLOWERS

10 TREATMENT GAP IN PATIENTS WITH AN IRREGULAR HEARTBEAT INCREASES RISK OF STROKE

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THINKING ABOUT SELLING YOUR PRACTICE?

Medical Practice Listings can help you sell your practice online! Now offering two types of listings to better serve all practice specialties and budgets. For Sale by Owner Listing The For Sale by Owner Listing offers you the opportunity to gain national exposure by posting your listing on our website which is viewed daily by a network of qualified professionals. This option includes a brief practice consultation to explain the benefits of marketing through the Medical Practice Listings website. Our special rate for the For Sale by Owner listing through the end of 2017 is only $29.95 per month.

Professional Listing In addition to the benefits in the standard listing our Professional Listing affords you access to services provided by our expert legal and marketing team and a Bizscore Practice Valuation. This valuation compares your practice with other practices in your area, provides projections and determines what your practice is worth.

Visit us today at www.medicalpracticelistings.com to learn more.

919.848.4202 | medicalpracticelistings.com

is now hiring MD’s, PA’s, NP’s and DDS’s, in North Carolina, Florida, Georgia, Kentucky, South Carolina, Tennessee and Virginia

Ongoing and intermittent shifts are available for physicians, physician assistants, nurse practitioners, and dentists as well as permanent placement. Find out why providers choose Physician Solutions. P.O. Box 98313, Raleigh, NC 27624 Scan this QR code with your smartphone to learn more.

phone: 919.845.0054 fax: 919.845.1947 e-mail: physiciansolutions@gmail.com www.physiciansolutions.com

Med Monthly July 2017 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Naren Arulrajah Kaci Durbin, M.D., FACOG Vishal Gandhi, BSEE, MBA Barbara Hales, M.D. Thomas Hibbard Nick Hernandez, MBA, FACHE Denise Price Thomas

contributors Kaci Durbin, M.D., FACOG is a board certified obstetrician and MBA candidate. Since leaving private practice last year, she has served as obstetrical hospitalist director at St Anthony’s Medical Center in St. Louis.

Vishal Gandhi, BSEE, MBA is the founder and CEO ClinicSpectrum Inc. He is a well-known and widely respected authority on the “nitty-gritty” of medical practice workflow and technology. His Hybrid Workflow Model is quickly becoming a new healthcare industry standard model for combining human and computer workflow, to maximize revenue and minimize cost and he has appeared in prominent health IT publications.

Barbara Hales, M.D.

Med Monthly is a national monthly magazine committed to providing insights about the health care profession focusing on practical advice for physicians and practices. We are currently accepting articles to be considered for publication. For more information on writing for Med Monthly, please email us at medmedia9@gmail.com.

P.O. Box 99488 Raleigh, NC 27624 medmedia9@gmail.com Online 24/7 at medmonthly.com

is a skilled expert in promoting your health services. As seen on NBC, CBS,ABC and FOX network affiliates as well as Newsweek, Dr. Hales writes all the content you need to promote your medical services. Her latest book is on the best seller list and she can do the same for you. Check out her site at www.TheMedicalStrategist.com. For a free marketing assessment, call 561-325-9664.

Nick Hernandez, MBA, FACHE is the CEO and founder of ABISA, a consultancy specializing in solo and small group practice management. He has consulted with clients in multiple countries and has over 20 years of leadership and operations experience. Visit www.abisallc.com for more information.

Denise Price Thomas retired in 2009 as a surgical practice administrator where she was employed for 32 years. She is certified in healthcare management through Pfeiffer College. Speaking invitations have taken her from NC to SC, Georgia, Florida, Chicago, Alaska and more. Website: www.denisepricethomas.com MED MONTHLY MAGAZINE |5

practice tips

Putting Patients First: Think Before You Speak By Denise Price Thomas Owner, DPT Consulting & Training Speaker, Author & Healthcare Humorist Being an “Undercover Patient” can certainly shed some light on the true patient experience. With each assessment, I enjoy discovering the good, by finding out what is working well. And in other areas, adding some polish where it is needed. Sometimes when I am contacted, leadership may be anxious to “clue me in” on certain personality types. However, I ask that they hold off until after my assessment. You see, it’s important my experience is that of a true patient. That’s how we learn. I understand that we all know a few “characters” who do not always put patients first. It’s always important to make sure that these “characters” are not in direct contact with the patients. They may be very suitable in a behind the scenes role as support staff. Like a puzzle, it’s always interesting to fit those pieces together. I’ve witnessed a few healthcare professionals that should really LISTEN more and SPEAK less. Let me explain with the following examples:

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Appointment Scheduler for a Physician’s Practice: Me: “I need to reschedule my appointment. We have had a death in the family.” Appointment scheduler: “When do you want to schedule it?” Patient-centered Alternative: ”I am so sorry, I know you have a lot going on right now, do you need to call us back or did you want to reschedule it now?” Receptionist for a Physician’s Practice: Upon entering a physician’s practice, preparing to checkin, I witnessed three staff members enjoying a conversation with each other. They were all smiles and it was great to see that they got along so well. When they realized a patient had walked up to be checked in, their smiles were instantly replaced with “shucks, back to work” expressions on their faces. In fact, one left the area completely, one looked down

at what seemed to be an urgent issue all of a sudden. The other one, I guess, was given the task to check me in and I obviously was NOT a welcomed part of their conversation. Patient-centered Alternative: “Good morning! What is your name please? OK, I have your information right here. Let’s review a few things to get you ready to see the doctor today. Clinical Assistant: Clinical Assistant: “Well good morning, how are you today?” (With that, I am thinking we are off to a great start. I begin to explain the reason for my being there…) Me: “Well, I have been better. Yesterday, I awoke to a scratchy throat and today it is much worse!” (It must be contagious because she picks it right up and adds to the conversation which goes like this) Clinical Assistant: “Oh my, the very same thing happened to me last weekend and then I got this horrible cough. My daughter got it after I did and I feel like it’s coming back on me again. We’re just passing it around! OK, I’ll let the doctor know and she’ll be with you in a few minutes.” Patient-centered Alternative: “I am so sorry! You are certainly in the right place and hopefully, you will feel better very soon. Now, let’s check that blood pressure and temp so we can get the doctor in here and get you on the path to feeling better!” Home Health Caregiver: Upon arrival to the patient’s home

Caregiver: “I am EXHAUSTED! I have this patient who demands so much of my time. I have to feed her, she wants me to brush her hair while I’m there and then fix her lunch. You guys are so low maintenance, I couldn’t wait to get here! Whew! I just need to sit down a few minutes!” Patient-centered Alternative: “Good afternoon, I am so happy to see you all! I was thinking on my way over here just how happy I would be when I saw your smiling face. You are truly a treasure.” Our thoughts and our words set the tone for the entire day. When we look for the good, we will discover it. We can choose positive words which help to lead to a more positive day for your patients and everyone around you. Even when we see it through the eyes of humor,

sometimes it’s fun to look for the positive. We have that choice. Recently, I have been told by leadership in several hospitals and physician practices that they open training sessions and staff meetings with YouTube videos of my alter ego, “Gladys Friday” Healthcare Comedian. She helps to address some difficult issues in healthcare. These videos add some healthcare humor, opening the door to brainstorming, inviting the opinions of others to share in just how we can “Shine Brighter.” 

It’s simple. When we work in healthcare, if we do not care, we should work elsewhere. “CARE” means Compassion And Respect for Everyone

“Training Wheels in Heels” Denise Price Thomas Trainer for Health Care Professionals Focusing on Exceptional Customer Service, Effective Communication & Exemplary Compassion 34+ year career in health care and certified in health care management Undercover Patient Providing Insight to Your Practice Through the “Eyes of a Patient” Conference Speaker Presenting also as “Gladys Friday”, Health Care Comedienne

Home Grown/Nationally Known www.denisepricethomas.com denisepricethomas@gmail.com 704-747-8699 MED MONTHLY MAGAZINE

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practice tips

How to Get Your First Thousand Facebook Followers

By Barbara Hales, M.D. www.TheMedicalStrategist.com

acebook offers a tremendous opportunity to create a page for your medical or dental practice providing a vast level of information and detailed content. With the addition of graphics and logos, it also makes a perfect place for brand recognition. Maintain colors on the cover that are consistent with your website. Many practices or businesses even rely on their Facebook Page as the main website! The problem is, only followers will get to see your posts. So, the typical question is “How do I get more Followers?”

7 Easy Steps to Get More Followers 1. Focus on Your Profile Complete your profile with a professional picture that shows eyes looking out to greet the viewer and a welcoming expression. Forget about that photo taken with the family or pets when it comes to uploading your profile image. Also forget about that funny photo with the Halloween costume taken at last year’s party. This 8

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needs to convey an air of professionalism. If the practice is a multi-group office, consider having a photograph of the office and building instead, saving your personal profile picture for the ‘About’ section. Have a description that conveys your services and how you help others. Most importantly, have a link to your website. When viewers are deciding whether or not to follow you, they look at your profile first. They want to know that you are someone they want to know, someone who has relevance to them, someone who can help them, educate them or entertain them. To increase your chances of acquiring fans, fill out your profile as meticulously as possible. Note - Filling a complete profile on each of the social media sites is one of the most effective means of marketing and it doesn’t cost anything! 2. Complete an About Section Include: • Photographs of yourself and your staff (with a

description of their function in the office under the photo of each staff member) • Office Telephone number • Office address • Mission statement • Participating insurance plans • Covering physicians • Hospital affiliations 3. Invite Your Friends and Patients (whose email addresses you have been collecting) Let everyone you know that you have a new FaceBook Page up and invite those who you think would be most interested in it. After you have received 25 fans, you can obtain a vanity URL for the page (i.e. facebook.com/yourbrandname), which will appear more professional when you then share the URL. 4. Link Link your profile via email and other social networks. Tweet your new URL and ask members of your Twibe to follow you on your new Facebook Page. Let people in your LinkedIn account or Instagram to check out the new site. 5. Call to Action As with everything else you do, don’t forget to add the call to action on your Facebook profile and on the various posts. This can be to refer someone to your website, to make an appointment, enter a contest or to get a premium that you are offering. (E.g. whitepaper, FAQ sheet, etc.) Consider a call-to-action on some blog posts to check out the Facebook Page. 6. Add Buttons and Boxes Adding a like button and like box are two great features that you can add to your website and Fan page. This will garner more fans. Enter your Facebook page URL for the like button. For the like button, insert your Facebook page URL, and edit options for a feed of your posts. Facebook provides a large selection of widgets and buttons that you can add to your site, catering to your style and website personality. 7. Respond, Respond, and Respond Like a lot of other people’s posts in your genre. According to the law of reciprocity, a certain percentage of people that you like will like you in return. Comment on images or videos that are in

your niche and where you can have helpful input or where you can provide solutions. Comments get noticed even more than likes and often viewers will reciprocate. When you get comments, always comment or respond back - at least put a like for the effort that they put out in commenting. The best comments are on sites where there are few others so that you really stand out. Remember, the purpose of social media is in building relationships. Keeping conversations going when people initiate them or answer your questions best does this. Have at least 7 images or posts prior to promoting your site. No one wants to follow a blank page! If you want to add followers even faster, consider a few targeted ads to your specific audience. Investing a bit for the extended reach can really ramp up the fan base. Now that you have taken the seven steps above, it’s time to go live! Don’t have the time for this? No worries. Contact Barbara@TheMedicalStrategist for help or a free consultation. We’ll get you up and running! 

The Write Treatment

Ezines and NewslettersCost Effective Powerful Tools • Drive traffic to your business website • Build relationships between yourself and patients • Get new patients • Announce a new service or product • Give great impact Have you got a newsletter yet or want to spread a message? Contact Barbara Hales, M.D. for a free consultation. Barbara@TheWriteTreatment.com 516-647-3002

MED MONTHLY MAGAZINE

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practice tips

STUDY REVEALS TREATMENT GAP IN PATIENTS SUFFERING FROM AN IRREGULAR HEARTBEAT LEAVING THEM AT AN INCREASED RISK OF STROKE

A study by the University of Birmingham has revealed a treatment gap in patients suffering from a heart condition that causes an irregular or abnormally fast heartbeat. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major global public health problem. It is associated with a five-fold increase in risk of stroke. There are three types of AF – paroxysmal, persistent or permanent. In paroxysmal AF, episodes come and go, and usually stop without any treatment.

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With persistent AF episodes can last for periods of more than seven days and are treated with medication or a medical procedure called cardioversion. In permanent AF, the irregular heartbeat is present all the time and cardioversion has failed to restore a normal heart rhythm. All patients with AF, including paroxysmal AF, are at an increased risk of stroke. UK guidelines recommend anticoagulant treatment, such as the blood-thinning drug warfarin, for patients with all types of AF in order to reduce the risk of stroke. Now a study, carried out by the University of Birmingham’s Institute of Applied Health Research and published in Heart, has discovered that patients with paroxysmal AF are significantly less likely to receive anticoagulants for stroke prevention than patients with persistent or permanent AF. Corresponding author Dr Nicola Adderley said: “Our team of researchers analysed the records of 14 million patients from 648 GP surgeries from across the country, looking specifically at records covering a 15-year period between 2000 and 2015. “We found that patients with paroxysmal AF were consistently less likely to be prescribed anticoagulants than those with persistent or permanent AF. “Although the proportion of AF patients prescribed anticoagulants increased considerably, in 2015 fewer paroxysmal AF patients were prescribed anticoagulants - a treatment gap of 13%. “While the anticoagulant treatment gap has narrowed over the years, from 15% in 2000 to 13% in 2015, over the same period a diagnosis of paroxysmal AF became three times more common. This means that the number of paroxysmal AF patients missing out on anticoagulants is greater now than 16 years ago. “Underuse of anticoagulants in patients with paroxysmal AF is likely to result in preventable strokes among this group, leading to greater levels of avoidable death and disability.” “Although the gap is narrowing, we need to remind ourselves that all patients with AF are at increased risk of stroke. Paroxysmal AF patients should be given the same priority for stroke prevention as other AF patients.”  Source: http://www.pressreleasepoint.com/studyreveals-treatment-gap-patients-suffering-irregularheartbeat-leaving-them-increased-risk-strok

Physician Solutions, Inc. Medical & Dental Staffing

The fastest way to be $200K in debt is to open your own practice The fastest way to make $100K is to choose

Physician Solutions

THE DECISION IS YOURS Physician Solutions, Inc. P.O. Box 98313 Raleigh, NC 27624 Scan this QR code with your smartphone to learn more.

phone: 919-845-0054 fax: 919-845-1947 www.physiciansolutions.com physiciansolutions@gmail.com

What’s your practice worth? When most doctors are asked what their practice is worth, the answer is usually, “I don’t know.” Doctors can tell you what their practices made or lost last year, but few actually know what it’s worth. In today’s world, expenses are rising and profits are being squeezed. A BizScore Performance Review will provide details regarding liquidity, profits & profit margins, sales, borrowing and assets. Our three signature sections include:  Performance review  Valuation  Projections

Scan this QR code with your smart phone to learn more.

919.846.4747 bizscorevaluation.com

U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 http://www.commerce.state.ak.us/dnn/ cbpl/ProfessionalLicensing/DispensingOpticians.aspx Arizona 1400 W. Washington, Rm. 230 Phoenix, AZ 85007 (602)542-3095 http://www.do.az.gov Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847 California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 http://www.optometry.ca.gov/ Colorado 1560 Broadway St. #1310 Denver, CO 80202 (303)894-7750 http://www.dora.state.co.us/optometry/ Connecticut 410 Capitol Ave., MS #12APP P.O. Box 340308 Hartford, CT 06134 (860)509-7603 ext. 4 http://www.ct.gov/dph/cwp/view. asp?a=3121&q=427586 Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 http://www.pof.org/opticianry-board/ Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 http://sos.ga.gov/index.php/licensing/ plb/20 Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704 http://hawaii.gov/dcca/pvl/programs/ dispensingoptician/

Idaho 450 W. State St., 10th Floor Boise , ID 83720 (208)334-5500 http://www.ironforidaho.net/

Oregon 3218 Pringle Rd. SE Ste. 270 Salem, OR 97302 (503)373-7721 http://www.oregonobo.org/optque.htm

Kentucky P.O. Box 1360 Frankfurt, KY 40602 (502)564-3296 http://www.opticiantraining.org/optician-training-kentucky/

Rhode Island 3 Capitol Hill, Rm 104 Providence, RI 02908 (401)222-7883 http://sos.ri.gov/govdirectory/index. php? page=DetailDeptAgency&eid=260

Massachusetts 239 Causeway St. Boston, MA 02114 (617)727-5339 http://1.usa.gov/zbJVt7

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4665 www.llr.state.sc.us

Nevada P.O. Box 70503 Reno, NV 89570 (775)853-1421 http://nvbdo.state.nv.us/

Tennessee Heritage Place Metro Center 227 French Landing, Ste. 300 Nashville, TN 37243 (615)253-6061 http://tn.gov/health

New Hampshire 129 Pleasant St. Concord, NH 03301 (603)271-5590 www.state.nh.us New Jersey P.O. Box 45011 Newark, NJ 07101 (973)504-6435 http://www.njsop.org/aws/NJSOP/pt/sp/ home_page New York 89 Washington Ave., 2nd Floor W. Albany, NY 12234 (518)402-5944 http://www.op.nysed.gov/prof/od/ North Carolina P.O. Box 25336 Raleigh, NC 27611 (919)733-9321 http://www.ncoptometry.org/ Ohio 77 S. High St. Columbus, OH 43266 (614)466-9707 http://optical.ohio.gov/

Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661 http://www.tob.state.tx.us/ Vermont National Life Bldg N FL. 2 Montpelier, VT 05620 (802)828-2191 http://vtprofessionals.org/opr1/ opticians/ Virginia 3600 W. Broad St. Richmond, VA 23230 (804)367-8500 http://www.dpor.virginia.gov/Boards/ HAS-Opticians/ Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 http://www.doh.wa.gov/LicensesPermitsandCertificates/MedicalCommission. aspx

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U.S. DENTAL BOARDS Alabama Alabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244 (205) 985-7267 http://www.dentalboard.org/ Alaska P.O. Box 110806 Juneau, AK 99811-0806 (907)465-2542 https://www.commerce.alaska.gov/web/ cbpl/ProfessionalLicensing/BoardofDentalExaminers.aspx Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 http://azdentalboard.us/ Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 http://www.asbde.org/ California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789 http://www.dbc.ca.gov/

Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 http://cca.hawaii.gov/pvl/boards/dentist/ Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 http://isbd.idaho.gov/ Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 http://www.isds.org/LawsLegislation/ boardOfDentistry.asp Indiana 402 W. Washington St., Room W072 Indianapolis, IN 46204 (317)232-2980 http://www.in.gov/pla/dental.htm

Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 https://www.colorado.gov/pacific/dora/ Dental_Board

Iowa 400 SW 8th St. Suite D Des Moines, IA 50309 (515)281-5157 http://www.state.ia.us/dentalboard/

Connecticut 410 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/cwp/view. asp?a=3143&q=388884

Kansas 900 SW Jackson Room 564-S Topeka, KS 66612 (785)296-6400 http://www.dental.ks.gov/

Delaware Cannon Building, Suite 203 861 Solver Lake Blvd. Dover, DE 19904 (302)744-4500 http://1.usa.gov/t0mbWZ

Kentucky 312 Whittington Parkway, Suite 101 Louisville, KY 40222 (502)429-7280 http://dentistry.ky.gov/

Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://floridasdentistry.gov/ 14

Georgia 237 Coliseum Drive Macon, GA 31217 (478)207-2440 https://gbd.georgia.gov/

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Louisiana 365 Canal St., Suite 2680 New Orleans, LA 70130 (504)568-8574 http://dentistry.ky.gov/

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 http://www.mainedental.org/ Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 http://dhmh.state.md.us/dental/ Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/ dentist/about/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 http://www.michigan.gov/lara/0,4601,7154-72600_72603_27529_27533---,00. html Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 http://www.dentalboard.state.mn.us/ Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 http://bit.ly/uuXKxl Missouri 3605 Missouri Blvd. P.O. Box 1367 Jefferson City, MO 65102 (573)751-0040 http://pr.mo.gov/dental.asp Montana P.O. Box 200113 Helena, MT 59620 (406)444-2511 http://bsd.dli.mt.gov/license/bsd_ boards/den_board/board_page.asp

Nebraska 301 Centennial Mall South Lincoln, NE 68509 (402)471-3121 http://dhhs.ne.gov/publichealth/Pages/ crl_medical_dent_hygiene_board.aspx

Ohio Riffe Center 77 S. High St.,17th Floor Columbus, OH 43215 (614)466-2580 http://www.dental.ohio.gov/

Nevada 6010 S. Rainbow Blvd. Suite A-1 Las Vegas, NV 89118 (702)486-7044 http://www.nvdentalboard.nv.gov/

Oklahoma 201 N.E. 38th Terr., #2 Oklahoma City, OK 73105 (405)524-9037 http://www.ok.gov/dentistry/

New Hampshire 2 Industrial Park Dr. Concord, NH 03301 (603)271-4561 http://www.nh.gov/dental/

Oregon 1600 SW 4th Ave. Suite 770 Portland, OR 97201 (971)673-3200 http://www.oregon.gov/Dentistry/

New Jersey P.O Box 45005 Newark, NJ 07101 (973)504-6405 http://njpublicsafety.com/ca/dentistry/

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)783-7162 http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Dentistry/ Pages/default.aspx#.VbkfjPlPVYU

New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680 http://www.rld.state.nm.us/boards/Dental_Health_Care.aspx New York 89 Washington Ave. Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/prof/dent/ North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223 http://www.ncdentalboard.org/ North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600 http://www.nddentalboard.org/

Rhode Island Dept. of Health Three Capitol Hill, Room 104 Providence, RI 02908 (401)222-2828 http://1.usa.gov/u66MaB South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4599 http://www.llr.state.sc.us/POL/Dentistry/ South Dakota P.O. Box 1079 105. S. Euclid Ave. Suite C Pierre, SC 57501 (605)224-1282 https://www.sdboardofdentistry.com/ Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202 http://tn.gov/health

Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 http://www.tsbde.state.tx.us/ Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 http://1.usa.gov/xMVXWm Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://governor.vermont.gov/boards_ and_commissions/dental_examiners Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.virginia.gov/dentistry Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Dentist.aspx West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 http://www.wvdentalboard.org/ Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 http://dsps.wi.gov/Default. aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp

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U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://www.medlicense.com/alaskamedical-license.html Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.docjungle.com/medicalboards/colorado-physician-licensing/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/cwp/view. asp?a=3143&q=388902 Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://doh.dc.gov/bomed 16

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Florida 2585 Merchants Row Blvd. Tallahassee, FL 32399 (850)245-4444 http://www.stateofflorida.com/Portal/ DesktopDefault.aspx?tabid=115

Louisiana LSBME P.O. Box 30250 New Orleans, LA 70190 (504)568-6820 http://www.lsbme.la.gov/

Georgia 2 Peachtree Street NW, 36th Floor Atlanta, GA 30303 (404)656-3913 http://bit.ly/vPJQyG

Maine 161 Capitol Street 137 State House Station Augusta, ME 04333 (207)287-3601 http://www.maine.gov/md/

Hawaii DCCA-PVL P.O. Box 3469 Honolulu, HI 96801 (808)587-3295 http://hawaii.gov/dcca/pvl/boards/medical/

Maryland 4201 Patterson Ave. Baltimore, MD 21215 (410)764-4777 http://www.mbp.state.md.us/

Idaho Idaho Board of Medicine P.O. Box 83720 Boise, Idaho 83720 (208)327-7000 http://bit.ly/orPmFU

Massachusetts 200 Harvard Mill Sq., Suite 330 Wakefield, MA 01880 (781)876-8200 http://www.mass.gov/eohhs/gov/departments/borim/

Illinois 320 West Washington St. Springfield, IL 62786 (217)785 -0820 http://www.idfpr.com/

Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918 http://michigan.gov/lara/0,4601,7-15472600_72603_27529_27541-58914--,00. html

Indiana 402 W. Washington St. #W072 Indianapolis, IN 46204 (317)233-0800 http://www.in.gov/pla/ Iowa 400 SW 8th St., Suite C Des Moines, IA 50309 (515)281-6641 http://medicalboard.iowa.gov/ Kansas 800 SW Jackson, Lower Level, Suite A Topeka, KS 66612 (785)296-7413 http://www.ksbha.org/ Kentucky 310 Whittington Pkwy., Suite 1B Louisville, KY 40222 (502)429-7150 http://kbml.ky.gov/Pages/index.aspx

Minnesota University Park Plaza 2829 University Ave. SE, Suite 500 Minneapolis, MN 55414 (612)617-2130 http://bit.ly/pAFXGq Mississippi 1867 Crane Ridge Drive, Suite 200-B Jackson, MS 39216 (601)987-3079 http://www.msbml.state.ms.us/ Missouri Missouri Division of Professional Registration 3605 Missouri Blvd. P.O. Box 1335 Jefferson City, MO 65102 (573)751-0293 http://pr.mo.gov/healingarts.asp

Montana 301 S. Park Ave. #430 Helena, MT 59601 (406)841-2300 http://bsd.dli.mt.gov/license/bsd_ boards/med_board/board_page.asp Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 https://www.nebraska.gov/LISSearch/ search.cgi Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 http://www.medboard.nv.gov/ New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 http://www.nh.gov/medicine/ New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 http://www.medlicense.com/new-jerseymedical-license.html New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220 http://www.nmmb.state.nm.us/ New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/ North Carolina P.O. Box 20007 Raleigh, NC 27619 (919)326-1100 http://www.ncmedboard.org/

North Dakota 418 E. Broadway Ave., Suite 12 Bismarck, ND 58501 (701)328-6500 http://www.ndbomex.com/

Texas P.O. Box 2018 Austin, TX 78768 (512)305-7010 http://www.tmb.state.tx.us/

Ohio 30 E. Broad St., 3rd Floor Columbus, OH 43215 (614)466-3934 http://med.ohio.gov/

Utah P.O. Box 146741 Salt Lake City, UT 84114 (801)530-6628 http://www.dopl.utah.gov/licensing/physician_surgeon.html

Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400 http://www.okmedicalboard.org/ Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700 http://www.oregon.gov/OMB/ Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)787-8503 http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/ Pages/default.aspx#.Vbkgf_lPVYU Rhode Island 3 Capitol Hill Providence, RI 02908 (401)222-5960 http://1.usa.gov/xgocXV South Carolina P.O. Box 11289 Columbia, SC 29211 (803)896-4500 http://www.llr.state.sc.us/pol/medical/ South Dakota 101 N. Main Ave. Suite 301 Sioux Falls, SD 57104 (605)367-7781 http://www.sdbmoe.gov/ Tennessee 425 5th Ave. North Cordell Hull Bldg. 3rd Floor Nashville, TN 37243 (615)741-3111 http://tn.gov/health

Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220 http://1.usa.gov/wMdnxh Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400 http://1.usa.gov/xjfJXK Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 (360)236-4085 http://www.medlicense.com/washingtonmedicallicense.html West Virginia 101 Dee Dr., Suite 103 Charleston, WV 25311 (304)558-2921 http://www.wvbom.wv.gov/ Wisconsin P.O. Box 8935 Madison, WI 53708 (877)617-1565 http://dsps.wi.gov/Boards-Councils/ Board-Pages/Medical-Examining-BoardMain-Page/ Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053 http://wyomedboard.state.wy.us/

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features

First Steps: What You Need to Do Before You Put Your Medical Practice on the Market

ome doctors open a practice with the intention of keeping it until retirement, while others plan to sell within a few years. In either case, they have a relatively clear idea of when they will sell. Yet, all too often, they do not begin working towards the sale until they are ready to put it on the market. Rushing into a sale unprepared is a serious mistake for several reasons. At worst, you can inadvertently commit fraud or face other serious legal repercussions due to signing a flawed contract. At best, you will reduce your profit margin because the practice value is not optimized. Preparation is the key to a hassle-free, high-profit sale. Here are a few of the most important things you can do, long before you put your practice on the market or talk to a potential buyer.

| JULY 2017

Optimize Your Office

On average, the number of hours a doctor spends at a computer is triple the time actually spent with patients. This staggering statistic highlights the importance of data management, virtual paperwork, software, and all things digital. Not surprisingly, these things can have a significant impact on the value of your practice, and its desirability to potential buyers. An efficient office will not only make a good impression on buyers, but also make the transition of ownership smoother. You will need detailed financial, legal, and organizational data. A little preparation can ensure that it is accurate and easily accessible. â&#x20AC;˘ Are your medical records digitized, patient files organized, and books in order?

By Naren Arulrajah Ekwa Marketing • Are your files and records complete and up to date? Are insurance codes used correctly? • Do you have a centralized system for organizational files? • Is everything backed up? • Are all services and file storage locations compliant with HIPAA and any other applicable regulations?

Create Digital Curb Appeal

First impressions matter, and not just with people. If you have ever sold a home, you surely understand the importance of curb appeal. When people arrive at the house, either they like what they see, or not. If the first impression is not favorable, you are facing an

uphill battle to change their minds, no matter how many great features are inside. The concept of curb appeal applies to selling a medical practice as well, except that the first impression is usually formed long before the person lays eyes on your building. Just like patients, potential buyers are likely to start by looking up your practice online. Make sure your profiles on business directories and social media, are current and complete. Respond to any negative reviews, and encourage your happy patients to review your practice. It is also a good idea to step up your marketing efforts now, because a wellknown and highly rated practice is most appealing continued on page 20

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continued from page 19

to buyers. If your reputation precedes you, buyers may have a preconceived notion about whether your practice would be a good investment.

Increase Your Practice Value

The fair market value of a medical practice is usually calculated from a combination of accounts receivable, tangible assets, and intangible assets. The first two categories are easily quantifiable. Intangible assets are more challenging to evaluate, but also tend to present the best opportunities to increase practice value. This includes: • Trained personnel – Consider hiring specialists, expanding your clinical team, or investing in additional training for staff members. Don’t overlook customer service training for your front office staff, because their actions have a significant effect on patient loyalty, and conversion of new leads. • Computer software – An efficient practice management system, billing system, and other programs, will make your practice more valuable and more inviting to the potential buyer. • Potential income – Do your financial projections realistically show expected growth? If not, you need to figure out why, and how to reverse the trend.

Research and Analyze

A good relationship between buyer and seller is essential for a mutually beneficial transaction,

| JULY 2017

and minimal disruption to patients. It is wonderful to trust all parties that you are working with. However, it is a mistake to trust them to look out for your best interests. Before you discuss a bid, know what your practice is worth, how the process works, and what you want to get from the deal. • If you intend to transfer leases, subscriptions, or other legal agreements, review your contracts carefully. Make sure there are no clauses prohibiting transfer, and find out if there are any fees or other requirements. • Finalize your own professional post-sale plans. Many physicians come to regret overly restrictive non-compete clauses. If you want to continue practicing, decide when and where. Don’t let the buyer talk you into an agreement that undermines your plans. • Scope out potential buyers. In most cases, the best candidates are area hospitals, medical centers, a competitor who wants to expand, and/ or a doctor who is ready to open his or her first practice. Often, the buyer will become a partner or employee, eventually purchasing the practice.

• Talk to a lawyer. There is a virtually endless list of potential legal loopholes in a sale agreement. If you don’t understand exactly what you are signing, you could be making concessions you didn’t want to, or making warranties that are not accurate. Remember it’s never too soon to begin laying the groundwork for your practice sale. Ideally, planning should begin at least a year or two in advance. Even better, keep a potential sale, and your target timeframe, in mind when making business decisions from the beginning.  About the Author: Naren Arulrajah is President and CEO of Ekwa Marketing, a complete internet marketing company that focuses on SEO, social media, marketing education, and the online reputations of dentists and physicians. With a team of 140+ full time marketers, www.ekwa.com helps doctors who know where they want to go, get there by dominating their market and growing their business significantly year after year. If you have questions about marketing your practice online, call 855-598-3320 to speak one-on-one with Naren.

features

Selling Your Medical Practice: Steps for Success

By Kaci Durbin, MD FACOG

| JULY 2017

Ready to sell your practice? Not so fast! While selling a medical practice is not impossible, it certainly is not easy. Some practices do not sell or sell for much less than the physician expected. However, many doctors are successful and can make money that exceeded their expectations. Following these steps will not guarantee a sale, but can increase one’s success.

When you are starting to review your options, here are some key points you need to address before putting your practice on the market.

1. Prepare Early Preparation is key when selling any business, including a medical practice. The process should ideally begin at least a year (or more) prior to the goal sell date. Maximizing the value of your practice, improving curb appeal, ensuring your technology is up to par, and assessing your practice value do not happen overnight. If you are thinking of selling, it is never too early to get ready! 2. Maximize Your Practice Value: Stay Productive! The temptation for most physicians is to slow down near retirement or at the time prior to moving. Resist! Avoid going part-time or decreasing your hours. Fewer patients and fewer procedures mean fewer dollars in a sale. Not only will the practice be worth less from an accounts receivable standpoint, but why would a physician or hospital want a practice with minimal patients?

In fact, increasing your hours is the financially-smart thing to do. A booming practice is more desirable. If increasing your hours is not possible, you can consider hiring nurse practitioners, physician assistants, or midwives to increase productivity. At the very least, keep up with your current level of activity.

3. Make the Practice Desirable First, you’ll want to improve the curb appeal of your practice. Similar to a home sale, you’ll want to make the office look good. Most real estate agents will tell you that adding granite countertops and landscaping will not increase the value of your house, but will help it to sell faster and at the price you want. Repaint the walls and baseboards, replace the flooring, clean up the clutter, and fix up the landscaping. The office should be neat, clean and modern. Get rid of dated curtains and carpeting. Power wash the outside of the building. Hire a landscaper.

Also, make sure you are up to speed when it comes to technology. If you haven’t switched over to electronic medical records, now is the time. Just like a home buyer does not want an outdated kitchen, a hospital or physician buying a practice does not want an outdated system. Revamp your website. A website should look professional and be easy to navigate. continued on page 24

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continued from page 23

4. Hire a Professional… the Right Professional Hiring a professional medical practice appraiser, while a higher upfront cost, can save thousands in the long run. Determining the value of a practice is much more difficult than determining the value of a home. Priced too high and the practice will not sell. Priced too low and you could leave thousands on the table. Unless you have an advanced degree in accounting, figuring out the value of your practice is not an easy task. While assets such as accounts receivable, the building, the equipment, and the furniture are easier to calculate, the intangible assets (called goodwill) are more difficult to define. The goodwill of a practice; which includes its reputation, patient population, and location; is incredibly subjective. Although goodwill can be estimated by the Goodwill Registry,1 a published database put out by the Health Care Group, most professionals will tell you that the values are just a starting point. A professional medical practice appraiser will do the dirty work for you (and do it right). He or she will review all of the financial statements over the last five years and review all current assets. More importantly, he or she can evaluate the competition (and how your practice compares), the current market, and the forecasted future value based on past performance. This will give a more accurate and detailed estimate of goodwill than the registry. That being said, do your homework and hire the “right” professional. Medical practice appraisal is an unlicensed practice in many states. Appraising a medical practice is much different than many other businesses and far different from appraising a home. Just because someone is an appraiser does not mean he or she is competent when it comes to medical practices. For starters, it helps to ensure that the appraiser is a member of the Institute of Business Appraisers. Also, ask for references. Have they valued medical practices in the past? How many? Were the physicians satisfied with the job done? Your local medical society might be able to help with names as well. 5. Prepare for the Transition Once the prior steps are completed, you are ready

| JULY 2017

for the transition. You know your value and the place is ready to show. How are you going to transition the practice to the new owner? Whether retiring or moving, it can be helpful to offer your assistance to the new owner. For instance, you could stay on for 90 days (or whatever time frame deemed acceptable) to transition the practice to the new owner. If you are not retiring and plan on staying in the community, do you plan on remaining at that office as an employed physician? Offering to make the transition a smooth one by staying on will increase the practice value in the eyes of the buyer. It will be much easier for patients to accept the new physician(s) if you stay in practice a few extra months. 6. Advertise… to the Right People How do you find a buyer? Obviously, you don’t want to stick a for-sale sign in the front of the office. Patients would start leaving and practice value would take a hit. You also have to be careful when it comes to talking to local physicians and hospitals. Similar to that for sale sign, if word gets out, you might be in trouble. Many sellers have used non-disclosure agreements and noncompetition agreements when negotiating with potential buyers. This prevents a buyer from using your information to compete directly with you as well as share the information with others. Also, many professionals will serve as an intermediary, keeping your practice identify confidential to potential buyers until they have signed such agreements. Many factors come into play when it comes to selling a medical practice. Preparation is crucial. Although the tangible values are important, the value of the intangibles cannot be stressed enough. By keeping the production high, improving curb appeal, maximizing technology, and offering transition assistance, a physician can make his or her practice more desirable. Furthermore, hiring professional help is not just a good idea, but in my opinion, essential. Good luck.  References 1 Goodwill Registry and Goodwill Registry Toolkit. (2017). The Health Care Group. Accessed at http:// www.healthcaregroup.com/goodwill-registry-goodwillregistry-toolkit.html

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features

5 Points to Contemplate When Selling Your Practice By Vishal Gandhi, BSEE, MBA Founder and CEO

The market for purchasing or selling medical practices is enormously active at the present time. This doesn’t mean each arrangement is the absolute best, because conditions for an effective deal or buy aren’t always “One Size Fits All.” “With the cost related with giving administrations today, you need a bigger base to share that kind of cost.” - John Fanburg, Managing Director at Brach Eichler Here are a couple tips to consider when selling your practice: 1. Get more than one bidder: Contact your potential prospects to 26

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tell them that you’re thinking about the selling of your practice, and get them thinking about it before you list. • Hospital(s). Tell your hospital administrators about your arrangements. They could be assembling a group interested in practice purchases or might have a recommendation of someone intrigued by a neighborhood practice in your general location. They could also be keen on the possibility of you remaining on as a salaried doctor. • Your Competitors. Contact every single solo practice in your area and let them know

your intentions. A competitor might be interested in your practice, wishing to expand by having another doctor assume control of your established practice. 2. An EHR System is more attractive to potential buyers rather than paper records: An assessment for an ENT practice that hadn’t changed to an EHR system was less marketable even though it was a sound practice in an upscale suburb. Interested ENT doctors left when they found the paper recording system still in place. They perceived the enormous undertaking of changing over

these records – one by one – into an EHR framework. 3. If you own the practice office than plan on two deals: If you own the practice and the office space, then you now have two deals to make; one for the physical office and one for the practice. You have several alternatives: • Sell the practice and rent the space means you’re presently proprietor and screen the deal, your property goes into the hands of Property Management Company, who will gather leases and keep up the office. • Sell the practice and rent the space, with an alternative to purchasing at some future time implies the doctor takes over the practice, but you proceed as the landowner or

find an interested purchaser/ owner for the physical office space. • Sell the practice and offer the space implies the physician/ purchaser is not keen on office possession, so consider finding a purchaser for the office itself. 4. Remain as an Employed Physician: A stipulation to buy your practice by the purchaser might be for you to stay on as a physician at the practice. In the event that a doctor remains for 90 to 120 days after the sale, they can increase the value of the deal. 5. Turning the practice immediately over to the new provider: The final alternative is to sell the practice and turn it over to new proprietor upon the sale.

The new owner/physician will then have to acquaint themselves with their new patients and staff. At that time, they can either continue with the office procedures in place or implement their own. The Business Understanding There is no assurance that future execution of the practice will give the new owners the same rewards as when you were the proprietor. Medical facilities making a weak showing in regards to charging and accumulations will often ponder decreased collections and debilitated net incomes. The value of your facility reflects your execution in managing the practice up to the point of sale. The value of the practice after that point reflects the execution and marketing skills of the new proprietor. 

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features

Strategic Diligence of Physician Practice Mergers

By Nick Hernandez, MBA, FACHE CEO and Founder of ABISA In recent years, there has been noticeable increase in practice mergers among physician groups. Undoubtedly with the ever-evolving reform of the U.S. healthcare industry, there is a lot of uncertainty for private practice physicians. Some practices are content with no organizational changes and some have decided to be acquired by hospitals. Others have gone the route (or are pondering) of merging with another private practice (either same specialty or different specialty). The decision to buy, sell, or merge a medical practice is more complicated than ever, and determining a medical practice’s worth is 28

| JULY 2017

just one element crucial to this process. For those that are considering merging with another private practice entity, there are many things to strategize about and that’s assuming there will be a windfall of benefits by consummating a merger. Physician owners must have a clear rationale for a transaction or truly understand a deal’s impact on their practice’s long-term financial future. Too often, however, there’s a misguided sense of why the merger should take place at all, and there’s far too little time spent defining how the merger enables them to beat competitors and increase organizational value. Those

They should also see if their vision of the future operating model is actually achievable. A strategic diligence should explicitly confirm the assets, capabilities, and relationships that make a buyer the best owner of a specific target acquisition. It should bolster the physician owners’ confidence that they are truly an “advantaged buyer” of an asset. Advantaged buyers are typically better than others at applying their established skills to a target’s clinical and business operations. They also employ their privileged assets or management skillset to build on things like a target’s practice reputation, patient experience, or relationships with referring physicians. Naturally, they also turn to their special or unique relationships with vendors and the community to improve performance, leading to advanced synergies that go beyond what’s normal. When change comes suddenly, it can turn strengths into weaknesses and sweep away dreams of success. The aim of a merger should be to achieve mutually reinforcing advantages. Michael Porter wrote that competitive advantages stem from how “activities fit and reinforce one another. . . . creating a chain that is as strong as its strongest link.” By undertaking strategic diligence, physician owners will be able to not only define their main objectives, but also gain greater control over the desired direction of the new entity after the merger is consummated. Some of the strategic diligence questions to ponder include: l What

are the strengths of each practice? could our practice be doing better? l What opportunities exist as a result of this merger? l What threats do we face by completing this merger? l What is the current culture of each practice? l What

that fail to take this into account contribute to the failure rate of physician group mergers. For many physician groups, the link between strategy and a transaction is broken during due diligence. By focusing strictly on financial, legal, tax, and operations issues, the typical due diligence around a proposed merger fails to test whether the strategic vision for the deal is valid. To do so, physician groups should bolster the usual financial due diligence with strategic due diligence. They should test conceptual rationale for a deal against more detailed information available to them after signing the letter of intent.

It is critical for physician owners to be honest and thorough when assessing their advantages. Ideally, they develop a fact-based point of view on their beliefs — testing them with anyone responsible for delivering value from the deal, including physicians, physician extenders, clinical staff, and front and back office personnel. Above all, when it comes to the merger of two physician groups, culture is a key decision criteria. Culture should be evaluated and discussed prior to any financial considerations. In my experience this is of paramount importance for practice-to-practice mergers and is meticulously examined only through strategic diligence.  MED MONTHLY MAGAZINE

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features

Do Your Homework When Selling Your Practice

By Thomas Hibbard Creative Director Med Monthly

| JULY 2017

Every physician and practice owner will sell their practice during their career or the practice will close. That’s just a fact.

Reasons for selling your practice: • Retirement • Partner Buy-in or Buy-out • Choosing to sell your practice to a hospital system and becoming an employed physician • Merging your practice with a larger practice • Death or disability • Divorce or identifying greener pastors • Family relocation issues

What are some considerations that you should take into account?

Check List When Selling Your Practice aDo you have a really sharp and informative website?

aDoes your practice show well?

aDo you need fresh paint,

carpet cleaned, landscaping, etc.?

• Patient well being - Will the purchasing physician continue to see my patients as I did. Will their quality of care be to the standard they are accustomed to when visiting the practice.

aAre your financials in order

• Employees – What will happen to your staff? Most employers are close to their employees and want to be sure that their staff will be taken care of in the future by the purchasing physician.

aIs your practice staff solid or

• What is your practice worth? If your operating agreement indicates the stock is worth $1, it may make negotiating the sale of that stock more challenging.

aDo you have any debt?

• How will you be paid? This sounds like a simple question, but can be complex in practice. Everyone wants to make sure that the value of their company is maximized and you get as much cash up front, without hamstringing the future capital of the practice. • Cost of Tail policies if you carry any claims made insurance policies. Medical Professional Liability (medical malpractice) are commonly written on this type of insurance policy form.

The best tip is to do your homework. If you have proper planning on the front end by drafting an operating agreement, buy/sell, stock repurchase, you will have an opportunity to exit your practice on excellent terms. The patient base and the medical community you have contributed to will be able to survive and thrive into the future, thanks to you doing the proper amount of homework during the sale of your practice. 

and can you put your hands on them? do you need to hire a new staff member?

Will your debt be paid off before closing or at closing?

aAre there any unresolved

situations; lawsuits, partner buy-in or buy-out problems?

aAre all of your taxes, interest and penalties paid?

aIs your practice building

leased or owned? Do you want to lease, sell or lease with an option?

aDo you have an attorney? MED MONTHLY MAGAZINE

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Practices for Sale Medical Practices Pediatric Practice Near Raleigh, NC

Location: Minutes South of Raleigh, North Carolina List Price: $145,000 Gross Yearly Income: $350,000 Year Established: 1980(s) Average Patients per Day: 16-22 Total Exam Rooms: 5 Building Owned/Leased: Owned. Will sell or lease. Contact: Philip at 919-848-4202

Urology Practice near Lake Norman, NC Location: Minutes from Charlotte, NC List Price: $165,000 Gross Yearly Income: $275,000 Year Established: 1980 Average Patients per Day: 12 to 15 Building Owned/Leased: Leased Contact: Philip at 919-848-4202

Primary Care specializing in Women’s Practice

Family Practice/Primary Care

Location: Hickory, North Carolina List Price: $425,000 Gross Yearly Income: $1,5000,000 Year Established: 2007 Average Patients Per Day: 24-35 Total Exam Rooms: 5 Building Owned/Leased: Lease or Purchase Contact: Philip at 919-848-4202

Location: Morehead City, N.C. List Price: Just reduced to $20,000 or Best Offer Gross Yearly Income: $540,000 average for past 3 years Year Established: 2005 Average Patients per Day: 12 to 22 Building Owned/Leased: MD owned and can be leased or purchased Contact: Philip at 919-848-4202

Med Spa

Family Primary Care Practice

Practice Type: Mental Health, Neuropsychological and Psychological

Location: Minutes East of Raleigh, North Carolina List Price: $15,000 or Best Offer Gross Yearly Income: $235,000 Average Patients per Day: 8 to 12 Total Exam Rooms: 6 Physician retiring, Beautiful practice Building Owned/Leased: Owned (For Sale or Lease) Contact: Philip at 919-848-4202

Location: Coastal North Carolina List Price: $550,000 Gross Yearly Income: $1,600,000.00 Year Established: 2005 Average Patients Per Day: 25 to 30 Total Exam Rooms: 4 Building Owned/Leased: Leased Contact: Philip at 919-848-4202

Location: Wilmington, NC List Price: $110,000 Gross Yearly Income: $144,000 Year Established: 2000 Average Patients Per Day: 8 Building Owned/Leased/Price: Owned Contact: Philip at 919-848-4202

Special Listings Offer We are offering our “For Sale By Owner” package at a special rate. With a 6 month agreement, you receive 3 months free.

Considering your practice options? Call us today. 32

| JULY 2017

MODERN

Urgent Care

Serving Raleigh, Cary, Apex, Holly Springs, Fuquay Varina, Brier Creek and South Point Mall areas.

State of Cha-Ching. Lindsay Gianni, Agent 12333 Strickland Road Suite 106 Raleigh, NC 27613 Bus: 919-329-2913 lindsay.gianni.f23o@statefarm.com

This is certainly one of the most consistently utilized practices serving a large demographic area. 6 exam or procedure rooms, 1 X-Ray in a well appointed and nicely designed practice. Averaging 28 to 30 patients per day, year round and open 365 days per year. The staff includes two providers and full experienced staff to include X-Ray personal. The gross revenues of this practice exceeds one million two hundred thousand yearly. Priced at $260,000.

Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

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PRIMARY CARE PRACTICE East of Raleigh, North Carolina We are offering a well established primary care practice only minutes east of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day. Currently operating on paper charts, there is no EMR in place. The Gross revenue is about $235,000 yearly. We are offering this practice for $50,000 which includes all the medical equipment and furniture. The building is free standing and can be leased or purchased. Contact Philip at 919-848-4202 to receive details and reasonable offers will be presented to the selling physician.

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202 MED MONTHLY MAGAZINE

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Pediatric Practice Available Near Raleigh, NC

MD STAFFING AGENCY FOR SALE IN NORTH CAROLINA The perfect opportunity for anyone who wants to purchase an established business.

Pediatric practice located minutes south of Raleigh, North Carolina is now listed for sale. Located in an excellent area convenient to Raleigh, Cary, and Durham, it is surrounded by a strong health care community. This is a well established practice with a very solid patient base. The building is equipped with a private doctorâ&#x20AC;&#x2122;s office, five exam rooms, and an in-house lab.

Established: 1980s l Gross Yearly Income: $350,000 Average Patients per Day: 16 to 22 l List Price: $145,000

l One

of the oldest Locums companies l Large client list l Dozens of MDs under contract l Executive office setting l Modern computers and equipment l Revenue over a million per year l Retiring owner

Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

Please direct all correspondence to driverphilip@gmail.com. Only serious, qualified inquirers.

PHYSICIANS NEEDED: Mental health facility in Eastern North Carolina seeks: PA/FT ongoing, start immediately Physician Assistant needed to work with physicians to provide primary care for resident patients. FT ongoing 8a-5p. Limited inpatient call is required. The position is responsible for performing history and physicals of patients on admission, annual physicals, dictate discharge summaries, sick call on unit assigned, suture minor lacerations, prescribe medications and order lab work. Works 8 hour shifts Monday through Friday with some extended work on rotating basis required. It is a 24 hour in-patient facility that serves adolescent, adult and geriatric patients. FT ongoing Medical Director, start immediately The Director of Medical Services is responsible for ensuring all patients receive quality medical care. The director supervises medical physicians and physician extenders. The Director of Medical Services also provides guidance to the following service areas: Dental Clinic, X-Ray Department, Laboratory Services, Infection Control, Speech/Language Services, Employee Health,

Pharmacy Department, Physical Therapy and Telemedicine. The Medical Director reports directly to the Clinical Director. The position will manage and participate in direct patient care as required; maintain and participate in an on-call schedule ensuring that a physician is always available to hospitalized patients; and maintain privileges of medical staff. Permanent Psychiatrist needed FT, start immediately An accredited State Psychiatric Hospital serving the eastern region of North Carolina, is recruiting for permanent full-time Psychiatrist. The 24 hour in-patient facility serves adolescent, adult and geriatric patients. The psychiatrist will serve as a team leader for multi-disciplinary team to ensure quality patient care/treatment. Responsibilities include:

evaluation of patient on admission and development of a comprehensive treatment plan, serve on medical staff committees, complete court papers, documentation of patient progress in medical record, education of patients/families, provision of educational groups for patients.

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email: physiciansolutions@gmail.com 34 | JULY 2017

Modern Med Spa Available

Located in beautiful coastal North Carolina Modern, well-appointed med spa is available in the eastern part of the state. This Spa specializes in BOTOX, facial therapy and treatments, laser hair removal, eye lash extensions and body waxing as well as a menu of anti-aging options. This impressive practice is perfect as-is and can accommodate additional services like primary health or dermatology. The Gross revenue is over $1,500.000 with consistent high revenue numbers for the past several years. The average number of patients seen daily is between 26 and 32 with room for improvement. You will find this Med Spa to be in a highly visible location with upscale amenities. The building is leased and the lease can be assigned or restructured. Highly profitable and organized, this spa is POISED FOR SUCCESS. 919.848.4202 medlisting@gmail.com medicalpracticelistings.com

Practice for Sale in Raleigh, NC Primary care practice specializing in women’s care Raleigh, North Carolina The owning physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however, that could double with a second provider. Exceptional cash flow and profit will surprise even the most optimistic practice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice. Spacious practice with several well-appointed exam rooms and beautifully decorated throughout. New computers and medical management software add to this modern front desk environment.

Primary Care Practice For Sale in Wilmington, NC Established primary care on the coast of North Carolina’s beautiful beaches. Fully staffed with MD’s and PA’s to treat both appointment and walk-in patients. Excellent exam room layout, equipment and visibility. Contact Medical Practice Listings for more information.

List price: $435,000

Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings visit www.medicalpracticelistings.com

Medical Practice Listings

919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com MED MONTHLY MAGAZINE

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Located on NCâ&#x20AC;&#x2122;s Beautiful Coast,

Morehead City

Primary Care Specializing in Womenâ&#x20AC;&#x2122;s Health Practice established in 2005, averaging over $540,000 the past 3 years. Free standing practice building for sale or lease. This practice has 5 well equipped exam rooms and is offered for $20,000. 919.848.4202 medlisting@gmail.com medicalpracticelistings.com

NC MedSpa For Sale MedSpa Located in North Carolina We have recently listed a MedSpa in NC This established practice has staff MDs, PAs and nurses to assist patients. Some of the procedures performed include: Botox, Dysport, Restylane, Perian, Juvederm, Radiesse, IPL Photoreju Venation, fractional laser resurfacing as well as customized facials. There are too many procedures to mention in this very upscale practice. The qualified buyer will be impressed with the $900,000 gross revenue. This is a new listing, and we are in the valuation process.

Urgent Care serving the South Raleigh and Garner, NC area Established practice averaging 25 to 30 patients per day, year round. Open 7 days a week with two providers and established staff members. 4 exam rooms, 1 procedure room and 1 lab-phlebotomy room. This is a very well laid out and attractive practice in a heavily traveled area with excellent parking. Gross revenues of about one million per year and positioned for continued growth. Priced at $200,000.

Contact Medical Practice Listings today to discuss the practice details.

For more information call Medical Practice Listings at 919-848-4202 or e-mail medlistings@gmail.com

www.medicalpracticelistings.com 36 | JULY 2017

Medical Practice Listings Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

Internal Medicine Practice in the Heart of Raleigh

D L

O S

This is a beautiful practice, well appointed with great street visibility, parking and a very strong patient following. There are 4 exam rooms and a procedure room. The lobby is very comfortable with hardwood floors and tastefully decorated. The gross revenues are over $600,000 with a strong income after expenses.

Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

PEDIATRICIAN

or family medicine doctor needed in

PSYCHIATRIST PRACTICE LOCATED IN JACKSONVILLE, FL Established with a solid patient base, this well appointed practice also has a Psychologist in house. The psychiatrist is willing to stay and practice for a month or so assuring a nice patient transition. The city of Jacksonville is underserved by psychiatrist as most patients wait 4 to 5 months to secure an appointment. Treating over a dozen patients per day year round, you can step into this practice with the assurance knowing you will have a solid income and positioning for success. The established doctor is looking to retire but very willing to assure the buyer is comfortable moving forward. Asking $135,000 fully furnished.

Contact Philip or Danielle at 919-848-4202 or email medlistings@gmail.com

Urology Practice minutes from Lake Norman, North Carolina

FAYETTEVILLE, NC

Comfortable seeing children. Needed immediately.

Urology Practice minutes from Lake Norman is now listed for sale. This excellent located practice is convenient to Charlotte, Gastonia, Lincolnton and Hickory. With a solid patient base, procedures currently include; Adult & Pediatric Urology, Kidney Stones, Bladder Problems, Incontinence, Prostate Issues, Urinary Tract Infections, Wetting Problems, Erectile Dysfunction and related issues. Three exam rooms with two electronic tables and one flat exam table. Established: 1980 l Gross Yearly Income: $275,000 Average Patients per Day: 12 to 15 l List Price: $165,000

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com

Contact Philip or Danielle at 919-848-4202 or email medlistings@gmail.com MED MONTHLY MAGAZINE

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Pediatrics Practice Wanted

We have several qualified MDs seeking established Urgent Care Practices in North Carolina.

Pediatrics Practice Wanted in NC Considering your options regarding your pediatric practice? We can help. Medical Practice Listings has a well qualified buyer for a pediatric practice anywhere in central North Carolina. Contact us today to discuss your options confidentially.

Medical Practice Listings Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

Urgent Care Practices Wanted If you have an urgent care practice and would like to explore your selling options, please contact us. Your call will be handled confidentially and we always put together win-win solutions for the seller and buyer.

Call Medical Practice Listings today and ask for Philip Driver 919-848-4202.

PRIMARY CARE PRACTICE - Hickory, North Carolina This is an outstanding opportunity to acquire one of the most organized and profitable primary care practices in the area. Grossing a million and a half yearly, the principal physician enjoys ordinary practice income of over $300,000 annually. Hickory is located in the foot-hills of North Carolina and is surrounded by picturesque mountains, lakes, upscale shopping malls and the school systems are excellent. If you are looking for an established practice that runs like a well oiled machine, request more information. The free standing building that houses this practice is available to purchase or rent with an option. There are 4 exam rooms with a well appointed procedure room. The owning physician works 4 to 5 days per week and there is a full time physician assistant staffed as well. For the well qualified purchasing physician, the owner may consider some owner-financing. Call us today. List price: $425,000 | Year Established: 2007 | Gross Yearly Income: $1,500,000

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202 38

| JULY 2017

Eastern North Carolina Family Practice Available Well-appointed Eastern North Carolina Family Practice established in 2000 is for sale in Williamston, NC. This organized practice boasts a wide array of diagnostic equipment including a GE DEXA scanner with a new tube, GE case 8000 stress testing treadmill and controller and back up treadmill, Autoclave and full set of operating equipment, EKG-Ez EKG and much more. The average number of patients seen daily is between 12 to 22. The building is owned by MD and can be purchased or leased. The owning physician is relocating and will assist as needed during the transition period. The gross receipts for the past three years average $650,000 and the list price was just reduced to $185,000. If you are looking to purchase a well equipped primary care practice, please contact us today. 919-848-4202 medlisting@gmail.com medicalpracticelistings.com

Discounts as big as a house. Or condo. Or apartment. Lindsay Gianni, Agent 12333 Strickland Road Suite 106 Raleigh, NC 27613 Bus: 919-329-2913 lindsay.gianni.f23o@statefarm.com

See just how big your savings could be. Your savings could add up to hundreds of dollars when you put all your policies together under our State Farm roof. GET TO A BETTER STATE. CALL ME TODAY. ÂŽ

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Internal Medicine Practice for Sale Located in the heart of the medical community in Cary, North Carolina, this Internal Medicine practice is accepting most private and government insurance payments. The average patients per day is 20-25+, and the gross yearly income is $555,000. Listing Price: $430,000

Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com MED MONTHLY MAGAZINE

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