< PreviousA PROFESSIONAL DEVELOPMENT JOURNAL for the CONSULTING DISCIPLINES 40 SEPTEMBER | OCTOBER 2019 t h e v a l u e e x a m i n e r ABCDE CategorySurgeon-Owned ASC Single-Specialty ASC Multi-Specialty ASCHospital/Physician ASC 12Ancillary services performed for beneficiaries of federal healthcare programs must be related to the primary procedures performed at the ASC, and may not be billed separately to Medicare or other federal healthcare programs; and, Ancillary services performed for beneficiaries of federal healthcare programs must be related to the primary procedures performed at the ASC, and may not be billed separately to Medicare or other federal healthcare programs; and, An investor’s payment in return for their investment must be directly proportional to the amount of capital they invested; The ASC may not use (1) space, including operating and recovery room space located in or owned by any hospital investor, unless the space lease complies with the space rental safe harbor; (2) equipment provided by any hospital investor, unless the equipment lease complies with the equipment rental safe harbor; nor (3) services provided by any hospital investor, unless the services contract complies with the personal services and management contracts safe harbor;A PROFESSIONAL DEVELOPMENT JOURNAL for the CONSULTING DISCIPLINES t h e v a l u e e x a m i n e r SEPTEMBER | OCTOBER 2019 41 ABCDE CategorySurgeon-Owned ASC Single-Specialty ASC Multi-Specialty ASCHospital/Physician ASC 13StandardsThe ASC and any investors must treat patients receiving medical benefits or assistance under any healthcare program in a nondiscriminatory manner. The ASC and any investors must treat patients receiving medical benefits or assistance under any healthcare program in a nondiscriminatory manner. Ancillary services performed for beneficiaries of federal healthcare programs must be related to the primary procedures performed at the ASC, and may not be billed separately to Medicare or other federal healthcare programs; and, Ancillary services performed for beneficiaries of federal healthcare programs must be related to the primary procedures performed at the entity, and may not be billed separately to Medicare or other federal healthcare programs; 14The ASC and any investors must treat patients receiving medical benefits or assistance under any healthcare program in a nondiscriminatory manner. The hospital’s report, or any other claim for payment from a federal healthcare program, may not include any costs associated with the ASC unless the federal healthcare program requires their inclusion; and, 15The hospital cannot directly or indirectly make or influence referrals to any investor or entity.A PROFESSIONAL DEVELOPMENT JOURNAL for the CONSULTING DISCIPLINES 42 SEPTEMBER | OCTOBER 2019 t h e v a l u e e x a m i n e r Additionally, the above safe harbors are only available to those ASCs that meet the following statutory definition: “any distinct entity that operates exclusively to provide surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed twenty-four hours following an admission. The entity must have an agreement with CMS [Centers for Medicare and Medicaid Services] to participate in Medicare as an ASC…”28 Because no federal licensing is required to operate an OBL,29 they would not be considered an ASC under the AKS (as defined above). Consequently, the specific facts and circumstances related to a given transaction, such as the structure of the hospital-physician joint venture and the various financial relationships included (e.g., OBL space rental, information technology), will guide the applicability of AKS, and its associated safe harbors. CONCLUSION The number of healthcare services provided at ASCs and OBLs continues to increase due in part to the rapidly evolving technological advances that allow many services and procedures to be performed in a safe, high quality, and, often, less costly environment than at many inpatient providers. However, this growth potential may be inhibited by the complex healthcare regulatory scheme that governs the formation, ownership, alignment, and transactions related to these outpatient entities. Consequently, the potential exists for healthcare entities to become subject to substantial penalties arising from their entrance into transactions and arrangements that may subsequently be found to be legally impermissible. This presents an opportunity for valuation professionals to work with healthcare providers considering a potential transaction, as well as healthcare legal counsel, to ensure that prospective transactions and arrangements comply with current laws, as well as satisfy applicable regulatory thresholds. Providers may feel more comfortable with also obtaining a certified opinion prepared in compliance with professional standards by an independent credential valuation professional (under the advice of legal counsel) and supported by adequate documentation as to whether each of the proposed elements of the transaction are both at fair market value and commercially reasonable, so as to establish a risk-averse, defensible position that the transactional arrangement can withstand regulatory scrutiny. Todd A. Zigrang, MBA, MHA, FACHE, CVA, ASA, is president of Health Capital Consultants, where he focuses on the areas of valuation and financial analysis for hospitals and other healthcare enterprises. Mr. Zigrang has significant physician-integration and financial analysis experience and has participated in the development of a physician- owned, multispecialty management service organization and networks involving a wide range of specialties, physician- owned hospitals, as well as several limited liability companies for acquiring acute care and specialty hospitals, ASCs, and other ancillary facilities. E-mail: Jessica L. Bailey-Wheaton, Esq., serves as Vice President and General Counsel of Health Capital Consultants (HCC), where she conducts project management and consulting services related to the impact of both federal and state regulations on healthcare exempt organization transactions, and provides research services necessary to support certified opinions of value related to the Fair Market Value and Commercial Reasonableness of transactions related to healthcare enterprises, assets, and services. E-mail: jbailey@ healthcapital.com 28. “Definitions,” 42 U.S.C. § 416.2. 29. See “Facts about Office-Based Surgery Accreditation,” The Joint Commission, February 16, facts_about_office-based_surgery_accreditation/ (Accessed 9/18/19). VEA PROFESSIONAL DEVELOPMENT JOURNAL for the CONSULTING DISCIPLINES t h e v a l u e e x a m i n e r SEPTEMBER | OCTOBER 2019 43 I hope you enjoyed the last issue’s interview with Zach Sharkey. Our interview series continues, with this issue featuring Trisch Garthoeffner. SNAPSHOT: My credentials: ABV, CVA, MAFF, EA I’m located in: Naples, Florida On my own since: June 2013 Name of my firm and website URL: Anchor Business Valuations and Financial Services, LLC My practice sweet spot is: valuation for marital dissolution, shareholder disputes, and M&A Typical size company I value: two to four million dollars in sales Rod: So the BVFLS profession isn’t exactly a calling. Tell us about your background and how you got to where you are today. Trisch: The business valuation profession IS my calling… whether I knew it or not when I first started working. I started working in finance as an investment advisor at Merrill Lynch in the Empire State Building (exciting stuff for a girl from Missouri!). I soon obtained my FINRA Series 7 and Series 63 licenses. I also discovered that sales were not my forte, but I loved the research side of the position. Lehman Brothers was located across the atrium from Merrill Lynch in the World Financial Center. In those days, Lehman and Merrill were always pulling employees from each other. One day I received an opportunity to work at Lehman as a “Conflicts Officer” in the investment banking division. The job entailed helping the investment banking side with the filings of new public companies. It also involved ensuring the “Chinese Wall” was not violated between the retail side and the investment banking side of the company. My department consisted predominately of lawyers, and they needed an additional attorney and convinced me that I would make an excellent attorney. I was working at Lehman Brothers on 9/11. Shortly after that horrible event, I thought a break from New York City and a new adventure was needed. I applied to and was accepted by Penn State Law School, which was near my family’s home in Pennsylvania. After one year in law school, I realized I was a lot more “black and white” than I ever realized. I returned to New York City and began working at a two-billion-dollar hedge fund. There, I worked with financial analysts and started getting into the nitty-gritty of public and private company valuations. The financial crisis was what brought me to settle in Florida and begin my own business. I went back to the old “What Color is Your Parachute” mantra and thought, I’m going to do precisely what I love…research, working one-on-one with professionals and clients seeking my services, and number crunching. Doing what you love is always a good plan, it can just take a bit of time to figure out what your passion is, and mine is business valuations! Rod: What was your first year like, and what would have made it better? INTERVIEW: TRISCH GARTHOEFFNER Trisch Garthoeffner PRACTICE MANAGEMENT PRACTICING SOLO "Practicing Solo” features interviews with our industry’s new and seasoned sole practitioners. If you are itching to join the solo ranks, or striving to be more efficient and effective in your established one-person firm, this column offers you practical advice, steeped in experience from the trenches, that can move you forward. By Rod P. Burkert, CPA, CVA /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// ///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////A PROFESSIONAL DEVELOPMENT JOURNAL for the CONSULTING DISCIPLINES 44 SEPTEMBER | OCTOBER 2019 t h e v a l u e e x a m i n e r Trisch: It was stressful and exciting. I took advice from a friend who suggested I start getting valuation clients by reaching out to divorce attorneys. Within three months, I had a year-long backlog of work—ninety-nine percent of which was in divorce-related matters. If I had had a crystal ball to see into the future, I would have sought out another type of valuation work in that first year. For me, diversification is key. I love having work that is related to a multitude of purposes, not only marital dissolution. Rod: Did you have a formal (or even semi-formal) business plan? Trisch: Semi-formal. I am very good at self-imposed deadlines, so I had a Gantt chart written out that I abided by every day for at least the first two years. Examples of the tasks on this chart: I had X number of meetings that I wanted setup per week (two minimum). There was at least one group marketing event scheduled per month, X number of articles written for various trade magazines, X number of phone calls to peers per week, etc. During the first couple of years of Anchor, it seemed like everything that I did almost, even on a personal level, was somewhat related to work. I am a list gal, so I am sure there were lists everywhere. Rod: How did you first attract clients and how did that strategy evolve? Trisch: Lunches and coffees mostly. Over time, my strategy didn’t evolve. I just started to receive different types of work. From time to time, I will advertise, but it is minimal. Rod: With what kinds of engagements did you start? Trisch: I worked on marital dissolution at first. Florida is an equitable distribution state, and the area in which I live has many privately-owned businesses and high-net-worth families. Rod: Do you practice in a specialized niche today? Trisch: No, although due to the sector concentration in Naples, Florida, the majority of the companies I value are either construction or medical-related. Rod: What has been your best marketing tactic? Trisch: Do a good job and always provide excellent customer service. It sounds too simple, but that has been my secret. Rod: How do you price your work? Trisch: For most jobs, I charge a retainer and I work against the retainer at my hourly rate. From time to time, I can charge a flat fee for a job if the work parameters are specific and documentation is ready to go. Rod: How do you differentiate yourself from larger firms? Trisch: Customer service. Because I work for myself, I can pick and choose the engagements I take on, and I’ve been very fortunate to work with/for some great people and companies. I pride myself on my follow-through and in keeping my clients in the know of their work status. I keep the momentum going through some mode of correspondence—mostly written, but sometimes via a face-to-face meeting or call as well. Rod: Do you work from a home office or an “office” office? Why? Trisch: I recently switched to a home office because the building I was in sold. I bought a new home in April. I’ve almost caught up with everything I needed to have done in the house, so I have not had the time to look for a new space. To date, the home office setup is working great. I will probably have to find a small space once “season” in Naples starts up around the holidays. We’ll see. Rod: What is your current mobile device? Trisch: iPhone 8. Rod: Describe your current computer/workstation set up. Trisch: In New York City, I always had multiple screens, and I got used to the setup. Currently, I have four but I use, on average, three daily. I usually have my e-mail open on one monitor and tax returns or financials open on another monitor. The browser is opened on another monitor. While the report narrative is open on yet another (so that I can add the report text as I am doing the financial analysis). It looks overwhelming, but it simplifies the process for me. Rod: Besides your phone and computer, what apps, gadgets, or tools can’t you work without? Trisch: The basics of course—Microsoft Office (Excel and Word). I put everything into my calendar and I also have a handwritten to-do list that I refer to every day. From time to time, I use Skype for client calls (good for out of town clients). I use GoDaddy as my e-mail platform so that I can have my e-mails available to me wherever I am. Norton for security/ anti-virus purposes. Dropbox for file storage. Rod: What do you listen to while you work? Trisch: The cat water fountain in my kitchen. It’s soothing. I like silence otherwise when I am working. Sometimes if I am entering data into a spreadsheet, I will listen to Sirius XM or any talk radio (besides sports) station. Rod: How do you keep track of what you have to do? Trisch: I write it down, and then at the end of the day, I enter my time into QuickBook’s time activity log. I will have a week or more written out at most times of what I must do. I also A PROFESSIONAL DEVELOPMENT JOURNAL for the CONSULTING DISCIPLINES t h e v a l u e e x a m i n e r SEPTEMBER | OCTOBER 2019 45 have deadlines (mostly self-imposed) for each valuation. Rod: How about your favorite productivity tip that saves you lots of time? Trisch: Any online access that you can get saves time, it seems. I used to waste time and energy searching for files when I was traveling before getting DropBox. I also resisted but ultimately switched to online QB’s, and it is a time saver as well. I can work from wherever now as long as I have a laptop and internet access. Rod: Early bird or night owl—what’s your sleep routine? Trisch: I try to go to bed around 11:00 p.m., but I often stay up later. I try to stop work each day around 7:00 p.m. so that I can get in a workout and maybe some yard work. I’m probably more of a night owl than an early bird. Rod: Do you have a support group to call on? Trisch: Yes, I have a network of professionals that I have become friends with through the years to reach out to for industry advice, work questions, etc. I never feel like I am working alone. I met many colleagues through NACVA, either at a conference or when I was the Florida NACVA state chapter president. I’ve also met several financial and other types of professionals through clients on the engagements on which I have worked. Rod: How do you stay technically current with changes in the profession? Trisch: Conferences, webinars, talking with peers, podcasts (Accounting Today, Built to Sell, Business Wars), constantly tweaking models, reading trade magazines like The Value Examiner, and Business Valuation Update. Rod: What non-BVFLS book have you read most recently or want to get to, and why? Trisch: At the end of the day, I’d rather listen to a podcast than reading, and lately, I’ve been listening to “Gangster Capitalism, The College Admissions Scandal.” It’s fascinating. Rod: How do you recharge? What do you do when you want to forget about work? Trisch: I enjoy traveling and working at locations outside of Naples. One of the great things about working for yourself in our profession is that you often have the liberty to work in new surroundings and climates if you so choose. Summers in Florida are hot, so the change is often welcomed. I think it would be amazing to work from an RV, as I recall there was a Practicing Solo interviewee who worked from an RV? (Rod’s note: I did not pay Trisch to say this.) Rod: What practice areas do you think offer the most promise to someone going solo now? Trisch: I think if you enjoy working on valuations for divorce purposes, then there is plenty of work to be had in that area. At least where I am located. I think that testifying scares away some BV professionals from divorce litigation work. Rod: What is the best work/life advice you have ever received? Trisch: Be able to articulate why you did what you did in a way that the average listener can understand. It sounds easy in theory, but it is not always so. Rod: Finish this sentence: If I knew then what I know now, I would… Trisch: …not change a thing. All of my experiences have ultimately brought something positive to my clients and me. That’s a wrap! Answers have been lightly edited. Do you have a Practicing Solo issue you would like me to address? Please e-mail me I work with BVFLS practitioners and firms who have hit a time or income ceiling and want to grow faster and smarter. If you are feeling frustrated by those limitations, e-mail me at Rod Burkert, CPA, CVA, is a practice development coach who helps overwhelmed BVFLS professionals create more time, money, and freedom in their practices and their lives so they can create the experiences that matter most to them. For Rod, that experience is traveling full time in an RV with his wife and two dogs. What’s yours? Trisch favors a multi-view approach to her valuation work.The Leader in Valuation Data and Research (800) 246-2488 I (877) 727-4690 - FAX 5217 South State Street, Salt Lake City, UT 84107 To express our deep gratitude to our membership, in 2015 we implemented a new member benefit which all members receive for free. That is an EconAssist™ subscription to KeyValueData® (bundle value of $845). EconAssist is the basic KeyValueData subscription and is one of the five KeyValueData subscription levels—EconAssist, Silver, Gold, Platinum, and Titanium. You really need to see for yourself how spectacular these databases are because I promise you, once you do, you will find yourself using KeyValueData on a regular basis, and not just for your valuation work, but for litigation, M&A, and business advisory services as well. Feel free to contact one of HQ’s Member/Client Services consultants if you want more information about EconAssist or any other KeyValueData level. Sincerely, Parnell Black, MBA, CPA, CVA Chief Executive Officer To learn more about each database and resource, and access EconAssist, visit the Member Portal on NACVA.com. Dear NACVA Member: We Have A Member Benefit You Won’t Believe (Worth Thousands) EconAssist includes the following databases: n Archived Industry and Metro Reports (1,100+ reports) n Federal & State Law Cases (2,200+ cases) n Conference Presentations (700+ presentations) n Compensation Data n S-1 Filings (68,000+ filings) n Expert Witness Profiler P.S. Take a look at KeyValueData’s other new service, which is unlimited access to our CPE On-Demand library of over 700 pre-recorded webinars. These are now available to all subscribers for a nominal annual fee. A Valuable Resource 2.1.80.19(NACVA) EcoAsstSpd.indd 17/24/19 4:33 PMThe Leader in Valuation Data and Research (800) 246-2488 I (877) 727-4690 - FAX 5217 South State Street, Salt Lake City, UT 84107 www.KeyValueData.com I info@KeyValueData.com To express our deep gratitude to our membership, in 2015 we implemented a new member benefit which all members receive for free. That is an EconAssist™ subscription to KeyValueData® (bundle value of $845). EconAssist is the basic KeyValueData subscription and is one of the five KeyValueData subscription levels—EconAssist, Silver, Gold, Platinum, and Titanium. You really need to see for yourself how spectacular these databases are because I promise you, once you do, you will find yourself using KeyValueData on a regular basis, and not just for your valuation work, but for litigation, M&A, and business advisory services as well. Feel free to contact one of HQ’s Member/Client Services consultants if you want more information about EconAssist or any other KeyValueData level. Sincerely, Parnell Black, MBA, CPA, CVA Chief Executive Officer To learn more about each database and resource, and access EconAssist, visit the Member Portal on NACVA.com. Dear NACVA Member: We Have A Member Benefit You Won’t Believe (Worth Thousands) EconAssist includes the following databases: n Archived Industry and Metro Reports (1,100+ reports) n Federal & State Law Cases (2,200+ cases) n Conference Presentations (700+ presentations) n Compensation Data n S-1 Filings (68,000+ filings) n Expert Witness Profiler P.S. Take a look at KeyValueData’s other new service, which is unlimited access to our CPE On-Demand library of over 700 pre-recorded webinars. These are now available to all subscribers for a nominal annual fee. 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