Across the country, radiology groups, faced with a less-than-favorable reimbursement outlook and increasing expenditures, are considering selling their practices to or entering into joint ventures with hospitals. As with any major financial decision, a detailed discussion of the pros and cons is required, and there are several factors of which groups should be aware when considering selling their businesses. For these reasons, performing a go/no-go assessment, aided by a third-party advisor and a valuation professional, is critical.
To begin, groups should break down their concerns into qualitative and quantitative issues, with quantitative issues defined as factors that can be measured and qualitative issues defined as those that are less tangible.
In order to sell, a group must work with a valuation professional to determine what the technical component of its practice is worth. It has been our observation that physicians, particularly radiologists, tend to focus on their professional revenue, but it is important to determine, if the hospital purchases the imaging center that they own, whether the radiologists will retain any revenue from the technical component. If so, will it be enough to subsidize the recruitment of additional physicians, the addition of subspecialty service, or any of the other investments that might have been underwritten by that revenue in the past?
Radiologists might underestimate the contribution that technical revenue has made to their practices. Even large radiology groups sometimes fail to view their business as the combination of two components, and to understand that their compensation is reliant on both. The process of valuation helps groups look at their businesses as they never have before, breaking down volume, reimbursement, and operating expenses to determine the viability of surviving with a smaller (or nonexistent) portion of the technical-component revenue.
From there, further quantitative issues arise. If your group’s agreement with the hospital is for you to capture a percentage of the overall imaging-center revenue, for instance, you need to consider whether the cost of an exam will rise or fall following the acquisition. If the hospital is offering a fixed fee per scan, but the higher copayments and deductibles associated with hospital imaging stand to affect your volume negatively, you will be faced with lower revenue.
An assessment of the potential outcomes of each of these scenarios will help radiology groups understand whether selling is truly to their advantage—or whether it would be more profitable, in the long term, to remain independent.
Profitability, though, is only one consideration. Qualitative factors are of equal (or, perhaps, even greater) importance when performing a go/no-go assessment. Unlike quantitative factors, they are difficult to assess and weigh, making the presence of a third-party advisor critical to ensuring cooperation and consensus among members of the radiology group.
An example of a qualitative factor to consider might be the issue of control. In selling to a hospital, you lose control over certain processes, over strategic decision making, over equipment selection, and over other matters. Are you comfortable surrendering this kind of authority? The quality of your new partner, itself another qualitative issue to assess, comes into play here as well. Will this hospital or health system allow your group to have a voice in higher-level decision making? Will it permit you the kind of autonomy to which you’ve become accustomed?
Further, is this partner one with which you want your brand associated? Is the hospital or health system prestigious in your market, and if not, what does that mean to your business?
It is likely that in partnering with a hospital, you will transition away from being a low-cost provider of imaging services, as the reimbursement differential between outpatient and freestanding imaging is part of what is currently motivating hospitals to buy. There is a justifiable pride that comes from offering high value at a lower cost, particularly in an increasingly consumer-driven health-care marketplace; this dynamic can (and should) be taken into consideration before making a decision.
Leveraging the assistance of experts, from valuation professionals to outside advisors, is critical for groups in fully understanding the dynamics of the go/no-go assessment.