Healthcare Financial Services
Finance is the backbone of all industries and healthcare is no exception. Healthcare is complex, with economic decisions having a lasting impact on health systems and providers. The rapid changes concerning reimbursement along with the movement to value-based care and industry consolidation can present challenges to decision-makers to stay abreast of the changes and have the resources to address the issues.
Business transactions between healthcare entities often warrant the advice of outside reviewers. Coker offers a wide range of healthcare financial services including fair market value and commercial reasonableness opinions for compensation valuation and business valuation engagements. In addition we provide valuation advisory services, alignment due diligence, hospital revenue cycle and reimbursement analyses, and general financial advisory services.
Coker understands what health systems and provider groups are facing and has the experience and proficiency to assist in a variety of areas. Support can range from performing pro forma analyses as part of the strategic planning process, functioning as a third-party valuation consultant on contemplated transactions, helping to develop compensation strategies for physicians and mid-level providers that are adaptive to the changing reimbursement landscape, to ensuring that the payments to physicians are consistent with fair market value and are commercially reasonable.
Coker’s healthcare financial services group works with prominent health law firms, health systems, ancillary service providers, physicians, medical groups, and other entities across the country and all sizes of organizations to ensure they have the resources needed to succeed in the future.
Compensation Valuation—Fair Market Value Opinions
To ensure that payments to physicians are appropriate and market-based, Coker provides compensation valuations and fair market value and commercial reasonableness opinions.
For compliance purposes, fair market value and commercial reasonableness opinions relative to any type of physician compensation arrangement are helpful in ensuring that the compensation provided is market-based and the overall arrangement makes sound business sense. For example, if a hospital contracts with a physician for a medical directorship, the hospital needs to ensure that the compensation complies with fair market value and there is a solid business case for providing said compensation.
Our services can range from reviewing one-off physician arrangements to enterprise-wide reviews of all physician arrangements in place. The types of services reviewed can include employment arrangements, call pay arrangements, professional services agreements, hospital-based subsidy arrangements, ACO/CIN distribution methodologies, administrative services arrangements, and more.
Provider Compensation Development and Redesign
The growth in hospital-employed networks calls for the standardization of compensation and the development of compensation models that allow for success in both the fee-for-service and fee-for-value environments. Part of Coker’s healthcare financial services are developing new compensation models or revising existing compensation plans that assist hospitals and physician practices in creating effective compensation programs. This can be for both currently employed providers as well as providers who are in the midst of joining the employed network. Coker will consider current provider compensation strategies and work collaboratively with key stakeholders (health system, physicians, etc.) to develop a compensation plan that is responsive to the current reimbursement landscape.
Commercial Reasonableness Opinions
Performed separately or in conjunction with a fair market valuation, Coker can provide a commercial reasonableness opinion on any transaction to help document the rationale or business case for the transaction in question.
Coker can function as the independent third-party valuator for contemplated transactions on behalf of both the buyer and seller. When hospitals acquire other hospitals, physician practices, ambulatory surgery centers (ASC), or other enterprises, the value of the entity must be determined. This can result in a need to value assets, not services. The assets/business can range from a particular set of tangible assets to a carve-out of a service line in a hospital. We value medical practices, diagnostic imaging centers, ambulatory surgery centers, laboratories, hospitals, and many other entities. Our experienced healthcare appraisers, certified by the American Society of Appraisers, perform these valuations as part of our healthcare financial services.
Coker reviews valuations completed by other firms. This occurs often for medical practice clients who are selling either their practice or ASC, and the acquirer underwrites the valuation. Coker reviews the valuation for methods, assumptions made, accuracy in calculations, etc., to help our client (the practice) get maximal value for their assets.
In addition to functioning as an independent third party in a valuation capacity, we can provide valuation advisory services, assisting in performing preliminary valuation due diligence to determine the value of the entity our client is planning to sell or acquire. Coker functions in a consultative capacity, providing buy-side or sell-side due diligence.
Alignment Due Diligence
The Coker team also has significant experience in preparing entities contemplating an alignment transaction. Coker is available to assist in the background, developing financial pro formas and other analysis to support potential transactions. This support is similar to buy-side/sell-side due diligence from a valuation perspective, but with more focus on the contemplated/anticipated services arrangement.
As consolidations accelerate, health systems need assistance in vetting potential partners, either as the acquiring party or the one being acquired. Coker provides financial, cultural, and strategic due diligence assistance to not-for-profit and for-profit hospitals throughout the country.
Hospital Revenue Cycle and Reimbursement
There is not one healthcare organization that does not consistently and proactively focus on improvement of their respective revenue cycle management (RCM) components. Coker utilizes not only its significant experience in revenue cycle, but assigns its colleagues with entity specific experience (past chief financial officers, central business office directors, vice president/RCM, patient account executives) in assisting clients with all aspects of revenue cycle. Many times, simply an objective outside perspective is all that’s needed to bring RCM operations back with anticipated metrics and improved results.
General Financial Advisory
A relatively new healthcare financial service being completed by Coker relates to clinically integrated networks (CIN). As CINs grow in popularity and prevalence, the need increases for experienced counsel on how dollars earned through the CINs should be distributed to all constituents, i.e., participating providers, hospital partners, or retained within the CIN. Coker provides assistance on financial distributions for both physician-sponsored and hospital-sponsored CINs.
General Financial Advisory
Coker is willing and able to undertake many other projects where clients need assistance.