Largest Physician Site-of-Service Fee Differential


In 2011, the physician coding and reimbursement for lower extremity revascularization changed.  When the professional physician service codes and payments for angioplasty, atherectomy, and stent placement were bundled, it created the largest payment differentials of any physician procedures between facility and non-facility settings. (more…)

340B Drug Program Has Opportunities & Risks


Certain hospitals and other providers can save hundreds of thousands or even millions of dollars on outpatient drug costs by participating in the 340B Drug Pricing Program.  However, compliant participation is not a simple task. (more…)

New Neurology & Psychiatry Book Reviews


neuro-psych covers

Prominent leaders in the fields of neurology and psychiatry have both published books during the past year. In this post, HCTA reviews neurologist Dr. Allan Ropper’s book Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease, as well as former APA president Dr. Jeffrey Lieberman’s book Shrinks: The Untold Story of Psychiatry. (more…)

When is it time to create a management company?


Optimization on Pocket Watch Face. Time Concept.

If you operate a growing healthcare enterprise, starting your own management company can help optimize your expansion efforts. Here are four signs that it may be time to form a management company. (more…)

Physician Practice Mergers Require New Kind of Math


Instability businessman

During a privately held business merger, valuations are usually performed on each of the two target businesses. Each owner’s stake in the new combined business can be determined by comparing the relative values of the two companies before the merger. This common two-valuation approach does not work for physician practice mergers, so a non-valuation approach is required. (more…)

Billed Charges Are Not Reasonable Value


By Carol K. Lucas, Esq., Buchalter Nemer

Wooden justice gavel and block with brass

On October 15, 2014 the California Supreme Court declined to hear the Children’s Hospital Central California v. Blue Cross case, decided by the Court of Appeal in June 2014. The Court of Appeal in Children’s Hospital ruled unambiguously that billed charges do not constitute reasonable and customary value for purposes of non-contracted provider claims. (more…)

Normalizing Out-of-Network Revenues


Normalizing out-of-network (OON) reimbursement to in-network levels is a common, yet fairly sophisticated payor analysis used for strategic planning, business sales, and litigation purposes .  Here are three resources for normalizing OON revenues.


Attorney Stress, Burnout is Contagious


Stress concept.

Psychotherapist Cynthia Lackner focuses her practice on treating attorneys for secondary post-traumatic stress disorder (also known as vicarious trauma).  Attorneys with this condition may be regularly exposed to upsetting and unsettling information and situations which can repeatedly induce stress responses and anxiety.  An unchecked accumulation of stress can lead to emotional and psychological suffering. (more…)

Review of Being Mortal



In his fourth book, Being Mortal: Medicine and What Matters in the End, Dr. Atul Gawande, MD, has ambitiously crafted a historical and narrative account of aging, long-term care, assisted living, and hospice in America. (more…)

Physician Entrepreneurship Society Nurtures Innovation


Interview w/: CEO & President Arlen Meyers, MD, MBA

The Society of Physician Entrepreneurs (SOPE) has grown into an international organization with members and chapters all over the world.  SOPE’s President and Chief Executive Officer, Arlen Meyers, MD, MBA, discusses physician entrepreneurship in this interview.


3 Key Stats on Healthcare Licensing Deals


Intellectual property protection

If you have discovered a treatment, drug, or technology that you can’t afford to develop and commercialize, you can still license the innovation to another organization. Here are three key statistics on healthcare licensing arrangements. (more…)

So, You Paid $67 Million for Intangible Assets?



Over 80% of the value of the S&P 500 index is in intangible assets, and similar trends are evident in healthcare organizations. This article identifies common intangible assets in healthcare businesses. (more…)

Litigation Attorney Talks ASC Shareholder Disputes


Interview with David J. Pivnick of McGuireWoods LLP

“As I have very quickly learned, physicians can get into lots of legal disputes,” says David Pivnick, a litigation attorney in the McGuireWoods healthcare and litigation practice areas. Pivnick estimates that a quarter of his practice is focused on shareholder disputes.  (more…)

3 Major Healthcare Laws Vary by State



Laws that govern how fundamental healthcare services are provided vary significantly from state to state. Here are three major areas of healthcare law which vary by state. (more…)

Call Center Medicine is Here, Adapt


Answering multiple calls at the same time

U.S. telemedicine visits are estimated to grow 22-fold to 130 million by 2018 from only 5.7 million in 2014. Who will be affected most? (more…)

Time Running Out for Healthcare M&A Buyers


chess clock and kings

Investment bankers and M&A brokers know how to create competition for healthcare business sales. Successful buyers have to outperform competitors on 10 deal milestones. (more…)

How the Domino Effect Closes an ASC



There are subtle chains of events that can shutdown a surgery center with little or no warning  See if you can identify the root cause of this failure. (more…)

8 Ways to Stretch Your M&A Budget in 2015


Several hands stretch of banknotes

None of our clients have unlimited capital.  Capital is a limited resource that has to be rationed for mergers and acquisitions.  Here are eight tricks for stretching your M&A capital budget.


Medicare’s Zombie Problem



In 2011, the Centers for Disease Control and Prevention (CDC) issued the report Preparedness 101: Zombie Pandemic as an educational guide for emergency preparedness. Now it appears the zombies are here. Medicare beneficiaries are using their Medicare benefits from beyond the grave. (more…)

Einstein for Capitation or Fee-For-Service?



Would Albert Einstein favor capitation or fee-for-service payment?  Ninety-three years ago this November, Einstein was awarded the Nobel Prize in physics for tackling a surprisingly similar question.  (more…)