• Member Statistics

    • 817,519 Colleagues-to-Date [Sponsored by a generous R&D grant from iMBA, Inc.]
  • David E. Marcinko [Editor-in-Chief]

    As a former Dean and appointed University Professor and Endowed Department Chair, Dr. David Edward Marcinko MBA was a NYSE broker and investment banker for a decade who was respected for his unique perspectives, balanced contrarian thinking and measured judgment to influence key decision makers in strategic education, health economics, finance, investing and public policy management.

    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

    Professor David Marcinko was a board certified surgical fellow, hospital medical staff President, public and population health advocate, and Chief Executive & Education Officer with more than 425 published papers; 5,150 op-ed pieces and over 135+ domestic / international presentations to his credit; including the top ten [10] biggest drug, DME and pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published academic text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

    Dr. David E. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics trade journals and publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.

    Later, Dr. Marcinko was a vital and recruited BOD  member of several innovative companies like Physicians Nexus, First Global Financial Advisors and the Physician Services Group Inc; as well as mentor and coach for Deloitte-Touche and other start-up firms in Silicon Valley, CA.

    As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

    Dr. David E. Marcinko’s professional memberships included: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA, FPA and HIMSS. He was a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

    Marcinko is “ex-officio” and R&D Scholar-on-Sabbatical for iMBA, Inc. who was recently appointed to the MedBlob® [military encrypted medical data warehouse and health information exchange] Advisory Board.



  • ME-P Information & Content Channels

  • ME-P Archives Silo [2006 – 2020]

  • Ann Miller RN MHA [Managing Editor]

    USNews.com, Reuters.com,
    News Alloy.com,
    and Congress.org

    Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

    Product Details

    Product Details

    Product Details


    New "Self-Directed" Study Option SinceJanuary 1st, 2020
  • Most Recent ME-Ps

  • PodiatryPrep.org

    Lower Extremity Trauma
    [Click on Image to Enlarge]

  • ME-P Free Advertising Consultation

    The “Medical Executive-Post” is about connecting doctors, health care executives and modern consulting advisors. It’s about free-enterprise, business, practice, policy, personal financial planning and wealth building capitalism. We have an attitude that’s independent, outspoken, intelligent and so Next-Gen; often edgy, usually controversial. And, our consultants “got fly”, just like U. Read it! Write it! Post it! “Medical Executive-Post”. Call or email us for your FREE advertising and sales consultation TODAY [770.448.0769]

    Product Details

    Product Details

  • Medical & Surgical e-Consent Forms

  • iMBA R&D Services

    Commission a Subject Matter Expert Report [$2500-$9999]January 1st, 2020
    Medical Clinic Valuations * Endowment Fund Management * Health Capital Formation * Investment Policy Statement Analysis * Provider Contracting & Negotiations * Marketplace Competition * Revenue Cycle Enhancements; and more! HEALTHCARE FINANCIAL INDUSTRIAL COMPLEX
  • iMBA Inc., OFFICES

    Suite #5901 Wilbanks Drive, Norcross, Georgia, 30092 USA [1.770.448.0769]. Our location is real and we are now virtually enabled to assist new long distance clients and out-of-town colleagues.

  • ME-P Publishing


    If you want the opportunity to work with leading health care industry insiders, innovators and watchers, the “ME-P” may be right for you? We are unbiased and operate at the nexus of theoretical and applied R&D. Collaborate with us and you’ll put your brand in front of a smart & tightly focused demographic; one at the forefront of our emerging healthcare free marketplace of informed and professional “movers and shakers.” Our Ad Rate Card is available upon request [770-448-0769].

  • Reader Comments, Quips, Opinions, News & Updates

  • Start-Up Advice for Businesses, DRs and Entrepreneurs

    ImageProxy “Providing Management, Financial and Business Solutions for Modernity”
  • Up-Trending ME-Ps

  • Capitalism and Free Enterprise Advocacy

    Whether you’re a mature CXO, physician or start-up entrepreneur in need of management, financial, HR or business planning information on free markets and competition, the "Medical Executive-Post” is the online place to meet for Capitalism 2.0 collaboration. Support our online development, and advance our onground research initiatives in free market economics, as we seek to showcase the brightest Next-Gen minds. THE ME-P DISCLAIMER: Posts, comments and opinions do not necessarily represent iMBA, Inc., but become our property after submission. Copyright © 2006 to-date. iMBA, Inc allows colleges, universities, medical and financial professionals and related clinics, hospitals and non-profit healthcare organizations to distribute our proprietary essays, photos, videos, audios and other documents; etc. However, please review copyright and usage information for each individual asset before submission to us, and/or placement on your publication or web site. Attestation references, citations and/or back-links are required. All other assets are property of the individual copyright holder.
  • OIG Fraud Warnings

    Beware of health insurance marketplace scams OIG's Most Wanted Fugitives at oig.hhs.gov

Regulations that Impact Medical Practice Value

Understanding USPAP Standards

Dr. David E. Marcinko; MBA, CMP™

Hope R. Hetico; RN, MHA, CMP™  


When a medical practice changes ownership, both the buyer and seller need to understand how industry regulation impacts practice value, as well as have an appreciation for accepted appraisal definitions and methodologies used by qualified appraisers to estimate value.   

Uniform Standards of Professional Appraisal Practice [USPAP] 

USPAP standards are promulgated to provide the minimum requirements to which all professional appraisals must conform. USPAP requires the three recognized approaches to value (the income, market, and cost approaches) be considered to estimate value. 


In the fall of 1994 and 1995, the IRS first issued training guidelines pertaining to the valuation of physician practices. These guidelines suggest that appraisers consider all three of the general approaches to valuation as required by the USPAP. 

Valuation Approaches

Specifically in transactions involving physician organizations, the IRS implied: 1. The discounted cash flow (DCF) analysis is the most relevant income approach. 2. The DCF must be done on an “after-tax” basis regardless of the tax status of the prospective buyer. 3. Practice collections must be projected for DCF based on reasonable and proper assumptions for the practice, market, and health industry. 4. Physician compensation must be based on market rates consistent with age, experience, and productivity. 


And so, what is your experience with the above USPAP regulations, or are they new to you? 

NOTE: For comprehensive institutional information on this topic, please subscribe to our premium, 1,200 pages, 2-volume quarterly print subscription guide: Healthcare Organizations [Financial Management Strategies]       http://www.stpub.com/pubs/ho.htm  OR  www.HealthcareFinancials.com  

Speaker: If you need a moderator or a speaker for an upcoming event, Dr. David Edward Marcinko; MBA is available for speaking engagements. Contact him at: MarcinkoAdvisors@msn.com

On Ambulatory Payment Classes [APCs]

Join Our Mailing List

Understanding Outpatient Payment Schemes

[By Dr. David E. Marcinko; MBA, CMP™]

[By Hope R. Hetico; RN, MHA, CMP™ ]

David and HopeSome physicians are still unaware of the Medicare payment regulations implemented a few years ago regarding outpatient or ambulatory care.  

Ambulatory Payment Classifications (APCs), originally termed Ambulatory Payment Groups (APGs), replaced former cost based, or cost plus reimbursement contracts for outpatient services.  

Much like Diagnostic Related Groups (DRGs), which were enacted for hospitals in 1983 and divided disease management into groups (based on ICD-9-CM diagnoses, procedures, age, sex and discharge disposition), APCs changed the hospital and IPA landscape, forever.  

The Federal Government planned this shift to prospective payments through its Outpatient Prospective Payment System (OPPS) for more than a decade, as a result of the Omnibus Budget Reconciliation Act (OBRA) of 1986.  

Defining the APC

The Ambulatory Payment Classifications (APCs) system was designed to explain the amount and type of resources utilized in outpatient visits.

Each APC consisted of patients with similar characteristics and resource usage and include only the facility portion of the visit, with no impact on providers who were paid from the traditional CPT-4 fee schedule and modifier system.

This effectively eliminated separate payments for operating, recovery, treatment and observation room charges [fragmentation]. Anesthesia, medical and surgical supplies, drugs (except those used in chemotherapy), blood, casts, splints and donated tissue were packaged into the APC. Unbundled, fragmented or otherwise separated codes were eliminated from claims prior to payment.  

APC Types 

APCs group most outpatient services into classes according to ICD-9-CM diagnosis and CPT-4 procedures. This included surgical APCs, significant APCs, medical APCs, and ancillary APCs.

Surgical, significant and ancillary APCs were assigned using only the CPT-4 procedure codes, while medical APCs were based on a combination of ICD-9-CM and E&M CPT-4 codes.

Evolving Impact 

The full impact of this regulation on facilities and IPAs is still evolving but it seemed to decrease reimbursement for about 75 percent of all ambulatory facilities. This occurred because the initial variable used in reimbursement determined the principle procedure.

Payments were then calculated for each APC by multiplying the facility rate, times the APC weight, times a discount factor (if multiple APCs are performed during the same visit). Total payment was the sum of the payments for all APCs.

However, no adjustment provisions are made for outliers or teaching facilities, rural hospitals, disproportionate share or specialty hospitals or facilities. 

Affected OPPS Facilities 

Facilities affected by Medicare’s OPPS include those designated by the Secretary of Health and Human Services, such as hospital outpatient surgical centers, hospital outpatient departments not part of the consolidated billing for Skilled Nursing Facility (SNF) residents, certain preventative services and supplies, covered Medicare Part B inpatient services if Part A coverage is exhausted, and partial hospitalization services in Community Mental Health Centers (CMHCs).  

Exempted facilities include clinical laboratories, ambulance services, End Stage Renal Disease (ESR) centers, occupational and speech therapy services, mammography centers and Durable Medical Equipment (DME) suppliers. The remaining facilities experienced a slight payment increase. 

Time-Line to Launch 

Although the Balanced Budget Act (BBA) of 1997 required an OPPS implementation by January 1, 1999, Y2-K concerns initially delayed implementation until “as soon as possible after January 1, 2000.” This delay meaningfully led to a Y-2001 implementation date and functionally to a Y-2002 date. APCs are fully implemented in Y-2008. 

Relevance of APCs 

APCs are relevant to medical investors, hospital administrators, IPA physician executives and those physicians who use hospital or ambulatory wound care centers, physical therapy centers, emergency rooms and clinics, and hospital or Ambulatory Surgical Centers (ASCs).

Moreover, confusion was a hallmark of the regulations since coding challenges were many and complex.  

For example, ensuring that all visits are coded accurately, completely and specifically is difficult. Other billing challenges include multiple visits on the same day, recurring and line item services, lack of pre-billing edit capacity, handling or late fees, reconciliation of billed versus paid amounts, and the clarification of provider based status, to name a few.

The Duopoly

Obviously, it is safe to say that while some hospitals languished and collapsed under the DRG systems, others flourished. Similarly, if outpatient facilities are to be successful in the futuristic OPPS / APC era, transition planning, monitoring and APC implementation and management must continue now, as it gains momentum in the future.


And so, as a physician or healthcare executive of a medical facility, what has been your experience with APCs during the past five years, and how has their segmentation into even more classes [tranches] for 2008 affected you?

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com


DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Product DetailsProduct DetailsProduct Details

%d bloggers like this: