1. High level of ownership by physicians in competing centers. Physician ownership in competing centers can cause a conflict of interest for physician-investors when they have to decide where to bring cases. Sixty percent of respondents believed physicians owning stock in competing centers had a very high impact on a center’s value. Most respondents believed the risk was somewhat significant, as no respondents responded that a high level of ownership had a low or very low impact on value.
2. Significant number of active physicians nearing retirement age. A core group of physicians nearing retirement age means an ASC will have to recruit heavily once retirement rolls around — a challenge in many markets where physicians are tied to other facilities. Fifty-three percent of respondents believed a center’s value could be very highly impacted by a majority of aging physicians. Respondents choosing “high” or “very high” made up 93 percent of the total, suggesting that aging physicians are a significant risk to a center undergoing valuation.
3. High reliance upon few physicians to drive majority of volume/revenue. If a few physicians are responsible for the majority of a center’s cases, the ASC could lose significant revenue if one or more of those physicians left. Fifty-three percent believed reliance on few physicians had a very high impact on value.
4. High reliance on out-of-network payors. Perhaps because of the uncertainty of the future of out-of-network reimbursement, 93 percent of operators believed high reliance on OON payors had a very high impact on ASC value. The next most common response was “high” with 7 percent, making it the only other answer selected.
5. High concentration of patient volume/revenue from a single payor. ASC experts agree that a high concentration of volume from a single payor can be risky because the center is at the mercy of the payor’s reimbursement changes. Operators were not in total agreement about the risk posed by reliance on a single payor, but more operators responded that the concentration would have a “very high” impact on value than any other answer at 40 percent.
6. Expected growth in future periods. A valuable ASC will have a strategic plan for growth several years into the future, with the intention to recruit more physicians, expand specialty mix or increase profits in other ways. Forty-seven percent of operators responded that expected growth had a very high impact on value, while 27 percent said growth had a high impact and 20 percent thought it had a medium impact.
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