HEALTHCARE VALUATION: Terms and Definitions

By Health Capital Consultants, LLC

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The term “value” has many different meanings and definitions to different parties. Therefore, at the outset of each valuation engagement, it is critical to define appropriately (and have all parties agree to) the standard of value to be employed in developing the valuation opinion.

The standard of value defines the type of value to be determined and answers the question “value to whom?” There are several standards of value that may be sought, including: Fair Market Value (FMV), Fair Value, Investment Value, and Liquidation Value. (Read more...) 

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Multi-Specialty Surveys for Physician Compensation – Released

By Health Capital Consultants, LLC

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It’s the most wonderful time of the year – Survey Season! Beginning in late May each year, numerous industry normative benchmark physician production and compensation surveys begin publishing the most recent year’s reports. These healthcare and specialty specific surveys annually report specific types of physician compensation and productivity metrics across the country for various specialties and are widely used by hospitals, physician practices, and healthcare compensation and valuation experts, are often used for the determination of Fair Market Value (FMV) physician compensation for regulatory compliance purposes.

CITE: https://www.r2library.com/Resource

Additionally, the government has referenced and utilized industry normative benchmark compensation surveys (including those listed below) in reviewing and litigating physician compensation arrangements, indicating their reliance on this data as well. (Read more…)

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PHYSICIAN APPRAISAL ENGAGEMENTS: Investment Banking, FMV and Venture Capital

By Staff Reporters

SPONSOR: http://www.MARCINKOASSOCIATES.com

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There are a myriad of reasons for obtaining a Fair Market Value [FMV], Venture Capital [VC} and/or Investment Banking [IB] funding appraisal engagement:

  • Outright Selling-Buying
  • Partnership and Associate buy-in / buy-out
  • Mergers and Acquisitions
  • Organic growth tracking
  • Hospital integrations
  • Private and public reporting
  • Financing and Venture Capital
  • Estate and Tax Planning

And, there are many cautions, too. On July 19, 2023, the Federal Trade Commission (FTC) and the Department of Justice (DOJ) released a draft update of its Merger Guidelines, which guides the regulatory agencies in their review of both mergers and acquisitions in evaluating compliance with federal antitrust laws.

The new Guidelines replace, amend, and consolidate the Vertical Merger Guidelines and Horizontal Merger Guidelines, which were published in 2020 and 2010, respectively.

Our Value Analysis: https://marcinkoassociates.com/fmv-appraisals/

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HOME VALUES: Appraised vs. Assessed vs. Fair Market Value

KNOW THE THE DIFFERENCE

By Staff Reporters

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As doctors, nurses and medical professionals try to get an idea of what their home is worth, please go into the process with the knowledge that the concept of “value” can carry a different definition depending on who’s assigning it.

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Home Value Estimator | What Is Your House Worth?

For example:

  • Appraised value – The appraised value of your home is the number assigned to it by a professional appraiser. This value is especially important when a home buyer is getting a mortgage. The lender will typically require a professional appraisal to verify that the borrower hasn’t agreed to an unrealistic valuation.
  • Assessed value – The assessed value of your home is the figure assigned to it by the county where it’s located for property tax purposes. While an appraisal involves someone inspecting the interior and exterior of your home, assessments are often conducted in a mass approach by using pricing trends.
  • Fair market value – The fair market value of your home doesn’t involve a professional. Instead, it involves other people just like you who might be willing to pay more because they love a home or a certain neighborhood. So, for example, an appraised value might be $300,000, but a recent surge in buying activity and limited supply might motivate a buyer to go above that price. On the flip side, keep in mind that those buyers might be willing to pay less than what you believe it’s worth, too.
  • CITE: https://www.r2library.com/Resource/Title/082610254

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MORTGAGES: https://medicalexecutivepost.com/2022/01/23/manual-mortgage-underwriting-what-is-it-really/

RENT v. BUY: https://medicalexecutivepost.com/2017/03/14/the-apartment-rent-vs-home-buy-decision/

MORTGAGE CALCULATOR: https://www.msn.com/en-us/money/personalfinance/use-this-calculator-to-find-out-how-much-house-you-really-can-afford/ar-AATkoSK?li=BBnb7Kz

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Understanding the Premise of Appraisal Value and Investment Time Horizon

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Key Issues in Healthcare Entity Valuation and Appraisal

By Robert James Cimasi; MHA, ASA, AVA, CBA, CMP™

cimasiwww.HealthCapital.com

The Premise of Value under which any healthcare entity fair market valuation is conducted is an assumption further defining the Standard of Value to be used.

The Premise of Value defines the hypothetical terms of the sale and answers the question, “Value under what further defining circumstances?”  Two general concepts relate to the consideration and selection of the Premise of Value, i.e., “value in use” and “value in exchange.”

Value in Use

Value in use is that premise of value that assumes that the assets will continue to be used as part of an ongoing business enterprise, producing profits as a benefit of ownership.

For example, in valuing the assets of a surgical hospital, the valuator must determine whether it is appropriate to value simply the tangible assets, or if it is appropriate to consider the enterprise as a going concern and incorporate the potential value of intangible assets. Orderly liquidation value involves assuming that the equipment is sold, perhaps separately, over a reasonable period of time. Forced liquidation assumes that the equipment is sold as quickly as possible to the first bidder.

Value in Exchange

Value in exchange is often referred to as “liquidation value.”  Liquidation value describes a sale of the assets of a business enterprise under conditions other than its continued operation as a going concern.

The liquidation can be on the basis of an orderly disposition of the assets where more extensive marketing efforts are made and sufficient time is permitted to achieve the best price for all assets, or on the basis of forced liquidation where assets are sold immediately and without concern for obtaining the best price.

hospital

Liquidation

Of course, costs of liquidation should be considered in the value estimate when using this premise of value.  Shortening the investment time horizon may have a deleterious effect on the valuation of the subject entity as it presents a restriction on the available pool of buyers and investors and the level of physician ownership, as required under the standard of Fair Market Value.

Assessment

Do the dual issues of value premise and time horizon still seem logical in modernity; why or why not? How comfortable are you that a reasonable FMV can be determined for any healthcare entity after passage of  The Patient Protection and Affordable Care Act in March of 2010? Please comment and opine. 

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Conclusion

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Proposed Disallowance of Fair Market Value for FLPs

On the HR 436 Proposal for FLPs

By Linda Trugman; CPAtrugman, MBA, ABV, ASA, MCBA

On January 9, 2009 the US House of Representatives introduced HR 436. The Bill would establish the federal estate tax exemption at $3,500,000, and set the tax rate for estates exceeding that amount at 45 percent, eliminating the currently scheduled 2010 phase-out and subsequent reversion to pre-Bush tax cut levels with the $1 million exclusion and a 55 percent tax rate.

Estate Planning Technique Elimination

Importantly, the Bill, if enacted as proposed, would remove a popular estate planning technique by eliminating most discounts associated with what is referred to generically as family limited partnerships [FLPs, a general term applied to closely held asset holding companies often holding non-business assets].

FLP Non-Controlling Interests

Currently, when a physician-investor or any other individual transfers a non-controlling interest in a FLP, whether by gift or at death, the interest is valued at the price that a willing buyer would pay for the partnership interest, or fair market value. Since such FLP interests are not publicly traded, and do not represent a controlling interest in the partnership, business appraisers often assign substantial discounts in valuing these interests.

Case Model:

For example, a 10 percent limited partnership interest in a partnership that holds $1 million worth of securities would not be valued at $100,000 under current law. Rather, because a buyer of the partnership interest cannot sell the interest on the open market, nor exert control prerogatives on the partnership, he or she would pay materially less for the interest [perhaps 30 percent to 50 percent less]. 

Elimination of FMV Standards

The Bill as drafted would be effective for transfers occurring after the date of enactment. However, there is always the possibility that any final statute might be applied retroactively. While the fate of this piece of legislation is uncertain, it may reflect the attitude of the new administration towards keeping and strengthening the estate tax. 

If HR 436 becomes law, appraisers would no longer be allowed to apply Fair Market Value standards to valuing these non-control FLP interests; they would not be able to apply any discounts to “non-business” assets held by partnerships or other entities. Instead, those assets would be valued as though they were transferred directly to the recipient. 

Assessment

The Bill as drafted would be effective for transfers occurring after the date of enactment. However, there is always the possibility that any final statute might be applied retroactively. While the fate of this piece of legislation is uncertain, it may reflect the attitude of the new administration towards keeping and strengthening the estate tax. I have attached the proposed legislation to this post.

File:  hr-436 

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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