In the past ten years, the healthcare industry has experienced a wave of transaction activity. Private equity transaction activity in the healthcare sector peaked in 2021. However, in the past 18 months both the quantity and value of healthcare transactions have experienced downward pressure. Even so, volume thus far in 2023 is still double the activity level from 2018-2020, which shows promise considering the current economic climate. This article recaps recent transaction activity for healthcare facilities and physician practices, outlines some of the headwinds and tailwinds for transaction activity for both subsectors and reveals our observations and expectations for the remainder of 2023 and into 2024.

Haley S. Adams, a Certified Valuation Analyst (CVA), has been named a Partner in the Consulting Services division at JTaylor, which provides assurance, advisory and tax services to clients locally and nationally.

CMS recently issued the CY 2024 Medicare Hospital OPPS and ASC Payment System Proposed Rule. Despite a proposed rate increase, industry groups remain concerned that the increase does not keep pace with rising costs in today’s inflationary environment. In addition to the rate change, the proposed rule also includes revisions to hospital price transparency requirements and expands access to behavioral health services. A separate proposed rule offers a remedy for historical underpayments for 340B drugs. This article includes a recap of key provisions of both rules.

CMS recently released the CY 2024 Medicare Physician Fee Schedule Proposed Rule. The most concerning provision is a conversion factor that reflects a 3.36% decrease from the CY 2023 rate. Industry groups continue to lobby for a legislative fix, claiming that the budget neutrality rules that govern physician reimbursement result in reimbursement that is inadequate as costs of running a practice continue to rise. Providers maintain that this reimbursement structure is unsustainable and will have a negative impact on Medicare patients’ access to care. Below is a recap of the key provisions contained in the proposed rule, other relevant factors that will impact Medicare reimbursement, and current activity in the push for legislative changes.

Daniela Arroyo, CPA, a tax senior manager at JTaylor, has been in the spotlight lately. She was named to the Fort Worth Business Press “40 Under 40” list, which is published annually to recognize individuals under the age of 40 who are helping to shape Fort Worth’s future through their professional accomplishments and community involvement. She also was named as one of the “50 Emerging Leaders” by the Fort Worth Hispanic Chamber of Commerce in connection with its 50th-anniversary celebration.

Cristo Rey Fort Worth recently held its “Celebrating Milestones” banquet to honor corporate partners and graduating seniors. A key tenet of the college preparatory school is the work-study program, in which each student is matched with a corporate partner to gain real job experience. During the banquet, Monica Collins, JTaylor’s Corporate Administrator, received the “Outstanding Supervisor Award” after being nominated by two work-study students who have spent the last four years with JTaylor.

There can be real power in putting together an effective monthly operating report (MOR). If your organization is performing well, you can celebrate success and strive to even greater heights. On the other hand, if your organization is struggling, you can identify specifically where deficits exist and work towards correcting them, where possible. Assembling an MOR with a medley of key performance indicators (KPIs) and related targets is a foundational way to measure organizational performance and have an organizational snapshot in time.

Each March, the Medicare Payment Advisory Commission (MedPAC) releases a report with recommendations to Congress regarding Medicare payment policy. In this edition of JTaylor’s Partner Insights Series, we highlight some of the trends MedPAC has uncovered and discuss the implications if Congress adopts these recommendations.

Organizational structure helps outline the relationships among the many components of an organization to optimize performance. Leaders struggle to implement and maintain management reporting relationships within an organizational structure which align with effective practical application. As hospitals, health systems, and physician organizations grow, management reporting relationships and structures must change to allow for utmost effectiveness.

Rural hospitals are an essential component of the healthcare system in rural communities, providing vital medical services to over 60 million Americans. However, in recent years, many rural hospitals across the U.S. have been facing financial difficulties, resulting in a significant number of closures. The closure of rural hospitals can have severe consequences for the surrounding communities, leaving residents with limited access to medical care and resulting in longer travel times to receive necessary treatments. Additionally, the loss of these hospitals can have an adverse impact on the local economy, as many hospitals are major employers in rural areas. There are many factors contributing to the closure of rural hospitals, including declining populations, inadequate reimbursement rates, and rising operational costs. Addressing these challenges will be critical in ensuring that rural communities have access to the healthcare services they need to lead healthy lives.

In today’s world, the emergence of large corporations is having a drastic impact on small business in almost every industry. Healthcare is no different. Although historically it seems that the industry has fared well, new threats are quickly discouraging traditional providers. In recent years, big business has taken advantage of economies of scale leading to lower prices and increased service offerings – something that private practices often cannot compete with. This article explains recent integration trends, the expansion of retail players into the healthcare industry, and the impact on traditional providers.

For healthcare providers and their governing boards, access to care is a fundamental concern and a part of every hospital’s charge. Philosophically, all providers desire to provide open access to all who need medical care. Further, there is an increasing awareness nationally of the need to improve health equity. However, financial and operational realities exist now more than ever that require providers to choose how, where, and when to provide access to healthcare services.

In today’s world, we are seeing more and more rural hospitals close. Hospitals are closing obstetrical units and other less profitable but important service lines due to poor ongoing financial performance. Safety net providers are continuing to utilize funding from taxes and other governmental sources to fortify losses, but not without tension. Providers are struggling to keep up with patient demand as high costs and labor shortages continue. Financial pressures are leading to gaps in patient access, particularly in rural areas.

Enacted on December 29, 2022, the Consolidated Appropriations Act, 2023 included the “Secure 2.0 Act of 2022” that contains important changes to retirement plan savings. While many provisions impact employer sponsorship of retirement plans and how those plans are administered, the focus of this article is the key provisions that affect individuals with retirement savings accounts.

The TCU accounting program recently honored Anna Brewer with the Outstanding Accounting Alumna Award and Andrew Darr as an Outstanding Scholar in Accounting.

The omnibus bill passed by Congress just before the holiday recess includes several provisions impacting the healthcare industry. In the federal spending bill, healthcare providers get some, but not all, of what they were seeking. This article recaps the key provisions impacting the industry.

CMS issued the Calendar Year 2023 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule on November 1. Though industry groups were pleased that the payment rates will be higher than what was reflected in the proposed rule, they remain concerned that the increase does not keep pace with rising costs in today’s inflationary environment. In addition to the rate change, the final rule also implements provisions relating to the new Rural Emergency Hospital (REH) model, as well as updates to the 340B Drug Pricing Program. This article recaps significant provisions of the final rule.

CMS released the CY 2023 Physician Fee Schedule Final Rule on November 1. The final rule adopts a conversion factor that reflects a 4.5% decrease from the CY 2022 rate. This article recaps the key provisions contained in the final rule, as well as other relevant factors that will impact overall Medicare reimbursement for physicians.

The IRS granted relief from failure to file penalties for individual and business tax returns for 2019 and 2020, as well as certain information returns.

The Inflation Reduction Act (IRA) was signed into law on August 16, 2022. The key components of the legislation include new corporate taxes, climate initiatives, additional funding for the Internal Revenue Service (IRS), and healthcare provisions. The full package includes over $250 billion in green energy tax credits, tax incentives for electric vehicles, and funding for climate and consumer energy initiatives. It also provides subsidies for Affordable Care Act health insurance coverage, seeks to reduce Medicare spending on drugs, and restructures the Medicare Part D program to reduce the out-of-pocket cost to beneficiaries. This article provides a broad overview of the key provisions.

The Oklahoma State University School of Accounting launches a new communication center, with JTaylor as the lead donor. The center will support accounting students through teaching effective written, verbal and visual communication skills.

CMS recently released the CY 2023 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule. Industry groups are once again expressing concern that the minimal rate increase does not keep pace with rising costs in today’s inflationary environment. In addition to the rate change, the proposed rule also includes proposals relating to the new Rural Emergency Hospital model, as well as the 340B Drug Pricing Program. This article recaps significant provisions of the proposed rule.

CMS recently released the Proposed Calendar Year 2023 Physician Fee Schedule. While the proposed conversion factor decrease was expected in light of budget neutrality requirements, the reality is that Medicare reimbursement to physicians and advance practice providers will decline from current levels in 2023 at the same time medical practices are facing inflationary challenges. Industry groups have already been lobbying Congress to intervene, and that effort is likely to intensify between now and January 1, 2023. This article recaps the key provisions contained in the proposed rule, as well as other relevant factors that will impact overall Medicare reimbursement.

Arielle Schmeck as been named a Partner in the Consulting Services division of JTaylor.

The 2022 annual Medicare Trustee report paints a dire picture of the sustainability of the Medicare programs as currently structured. What does that mean for retirees and the healthcare providers who serve them? Is Medicare reimbursement at risk if this critical Federal program is running out of money in the near future? How would that impact access to care for this patient population? This article addresses the forecasted depletion of the trust fund for Medicare Part A in 2028, as well as some potential solutions. Additionally, it considers how a decrease in Medicare reimbursement could impact healthcare providers who are currently facing a variety of challenges.

The Centers for Medicare and Medicaid Services (CMS) recently released the proposed rule dictating payment provisions for inpatient and long-term hospitals. The fiscal year 2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) proposed rule (Proposed Rule) includes not only updates to payment rates, but also includes new measures intended to enhance health equity.

Oklahoma State University announces that nominations and applications are being accepted for the 2023 Cowboy100, celebrating the fastest-growing and top 10 revenue-generating businesses owned or led by OSU graduates. JTaylor serves as the accounting partner for the Cowboy100 program.

JTaylor's Arielle Schmeck, CPA/ABV, CM&AA, was recently published in the American Health Law Association's Health Law Connections magazine. The article explores PE healthcare deal activity pre- and post-emergence of COVID in the United States and key drivers in PE health care investment throughout this time period.

On March 15, 2022, President Biden signed the omnibus bill (H.R. 2471) funding the federal government for fiscal year 2022, which actually began on October 1, 2021. While the bill does contain some important healthcare provisions, it also leaves out several key components that many in the healthcare community had been pushing for.

JTaylor, a professional services firm that provides accounting, assurance, consulting and tax services, distinguished from its peers by high-end technical and strategic capabilities, has announced two new Partner and two Senior Manager promotions. The two new Partners are Marc Geisler, CPA, and Andrew M. Pirtle, CPA. The two new Senior Managers are Julie La Pata, CPA, CM&AA, and Ronald Woodruff, CPA.

Congress passed legislation that would delay almost 10% of cuts to Medicare reimbursement for healthcare providers that was otherwise scheduled to be implemented effective January 1, 2022. This includes a delay in the resumption of sequestration as well as a delay in PAYGO payment reductions. This article details the various components and associated effective dates.

In December 2020, CMS issued the 2021 Medicare Physician Fee Schedule ("PFS") final rule that implemented the most substantial changes in many years. Health systems that employ physicians were left scrambling to understand how the changes would impact both revenue and physician compensation. Part 1 of this 4-part series recapped the core issues and the scope of the impact. Part 2 explored the specialties that benefitted the most from the PFS changes – primary care, office-based medical specialties, and urgent care. Part 3 discussed the implications for surgical specialties. Part 4, the final part of the series, addresses hospital-based specialties, which experience the most unfavorable impact from the PFS changes since they do not utilize the office E&M codes and therefore experience more of a
financial hit from the conversion factor decrease.

COVID-relief legislation included payroll credits for employers to recover qualified paid leave wages. After several extensions, the program has now expired. This article addresses important information for employers.

In December 2020, CMS issued the 2021 Medicare Physician Fee Schedule ("PFS") final rule that implemented the most substantial changes in many years. Health systems that employ physicians were left scrambling to understand how the changes would impact both revenue and physician compensation. Part 1 of this 4-part series recapped the core issues and the scope of the impact. Part 2 explored the specialties that benefitted the most from the PFS changes – primary care, office-based medical specialties, and urgent care. Now, in Part 3, we discuss the implications for surgical specialties. Since E&M services make up a much smaller percentage of overall practice activity for these physicians, there is less upside from the PFS changes. The result for surgical specialties is mixed. This article provides our findings and some examples regarding the impact of the changes on physician compensation. The final part of the series will address hospital-based specialties.

In December 2020, CMS issued the 2021 Medicare Physician Fee Schedule ("PFS") final rule that implemented the most substantial changes in many years. Health systems that employ physicians were left scrambling to understand how the changes would impact both revenue and physician compensation. Part 1 of this 4-part series recapped the core issues and the scope of the impact. This article addresses the specialties that benefit the most from the PFS change: primary care, office-based medical specialties, and urgent care.

Entering 2020, private equity investment in health care service was happening at a record-setting pace. By mid-March 2020, activity came to a halt as COVID-19 forced businesses to close and created significant economic uncertainty. This article explores PE healthcare deal activity pre- and post-emergence of COVID in the United States and key drivers in PE health care investment throughout this time period.

In December 2020, CMS issued the 2021 Medicare Physician Fee Schedule ("PFS") final rule that implemented the most substantial changes in many years. Health systems that employ physicians were left scrambling to understand how the changes would impact both revenue and physician compensation. Part 1 of this 4-part series will recap the core issues and the scope of the impact.

The IRS continues to experience significant delays in performing key functions, creating frustration for both taxpayers and tax practitioners. The National Taxpayer Advocate's midyear report to Congress gave a grim assessment of IRS service for the 2021 filing season. This article provides statistics regarding unprocessed returns, poor phone service, and other evidence of the magnitude of the problem, as well as some electronic IRS tools taxpayers can use.

Following legislation enacted in December 2020, HHS, the Department of Labor, and the Department of Treasury released the first set of regulations addressing protections from surprise medical bills and balance billing. These rules offer protection for emergency services as well as services provided by out of network providers at in network facilities. The rules are generally effective beginning January 1, 2022.

There are important changes to the child tax credit for 2021 that you should be aware of, including advance payments begining July 15. Find out more about the changes and actions you may need to take now such as unenrolling from the advance payments.

Even though the IRS automatically extended the deadlines for certain tax filings and payments for individuals and businesses that reside or have a principal location in Texas, Oklahoma, and Louisiana, you may still receive a late filing notice. Find out why and what you should do.

HHS released an updated Notice of Reporting Requirements and updated FAQs related to Provider Relief Funds. These updates include important information about deadlines for both using PRF money and reporting on the use of funds. It also provides guidance on the specific data that is required to be reported, including expenses incurred to prevent, prepare for, and respond to coronavirus and lost revenues attributable to coronavirus.

H.B. 1445, passed in the 87th Texas Legislative Session, made changes to the Texas Tax Code codifying the definition of medical and dental billing services and affirming that such services performed before the original submitted claim are not taxable.

JTaylor published an article in the June issue of AHLA Health Law Connections. In it, author Herd Midkiff addresses the goals of recently enacted price transparency rules requiring hospitals to post a list of standard negotiatiated charges for a list of "shoppable" services, as well as expected impacts, challenges, and penalties for noncompliance.

Oklahoma State University will host its inaugural Cowboy100 Honoree Gala to celebrate the fastest-growing and top 10 revenue-generating businesses owned or led by OSU graduates. JTaylor will process program applications and perform the calculations that will determine the winners.

Texas recently enacted legislation allowing businesses to exclude forgiven proceeds from PPP loans and other COVID-19 relief programs from revenue for franchise tax calculations, and to deduct applicable expenses paid using qualifying proceeds from these programs. The filing deadline for Texas franchise tax has also been delayed.

Residents of Texas, Oklahoma, and Louisiana are entitled to tax deadline extensions resulting from winter storms. JTaylor summarizes the various types of returns impacted by the extensions and actions that should be taken by affected taxpayers.

The SBA has opened applications for the Restaurant Revitalization Fund, which has $28.6 billion available to be awarded to eligible businesses. JTaylor addresses eligibility requirements and how to determine the funding amount, as well as other key components of the program. Even though the program is reserved for priority applicants for the first 21 days, eligible businesses should apply as soon as possible since the funds are expected to be depleted quickly.

Recent COVID-relief legislation allows for a 100% deduction for eligible food and beverages purchased from a restaurant in 2021 and 2022. for business-related purposes. JTaylor explains details for determining eligible expenses so you can take advantage of this increased deduction.

Healthcare providers had access to many COVID relief programs established through the CARES Act, ARPA, and other legislation, including Provider Relief Funds, Medicare Advance Payment Program, Paycheck Protection Program, Employee Retention Credit, Deferred Payroll Tax, and more. Each program carries tax implications that must be considered to ensure appropriate treatment in accordance with evolving guidance.

The American Rescue Plan Act included provisions providing a temporary premium subsidy for eligible individuals who have lost employer-provided healthcare coverage due to termination of employment or reduction in hours. JTaylor discusses the responsibilities of employers, from identifying eligible individuals to providing required notifications, as well as how to claim the associated credit.

A temporary property tax exemption is available to certain property owners who incurred damages resulting from the winter storm in Texas in February 2021. JTaylor provides information regarding eligibility and the methodology for determining the amount of the temporary exemption so you can apply before the May 28, 2021 deadline.

Strategic planning for hospital operations after COVID requires an understanding of the constants in healthcare as well as permanent changes that we must adapt to. JTaylor offers insight of considerations your hospital should incorporate into its short and long-term planning.

The American Rescue Plan Act includes provisions that impact taxes for businesses and individuals for both 2020 and 2021 tax years. JTaylor recaps the key provisions you should consider to ensure you maximize any tax benefits available to you.

The IRS recently issued clarifying guidance for employers claiming the Employee Retention Credit (ERC) for eligible wages paid in 2020. This guidance includes key definititions impacting elibility and how to determine qualified wages. It also addresses important considerations for employers who received PPP loans. JTaylor summarizes the key information to help your business maximimze the ERC opportunity.

Joe Taylor, founder and chairman of JTaylor, will be honored as a disinguished alumni of Oklahoma State University as he is inducted into its School of Accounting Hall of Fame.

OIG issued a report detailing its findings from an analysis of billing for inpatient hospital stays. The trends relating to billing for the highest severity MS-DRG codes raise concerns over potential upcoding. JTaylor shares what hospitals need to know in light of enhanced scrutiny on hospital billing practices.

In response to the severe winter storms, IRS announced an extension for tax deadlines impacting Texas residents and businesses. JTaylor provides a summary of applicable returns, payments, and other relevant information.

Action steps you can take now if you have sustained casualty losses as a result of the severe winter storm that hit Texas.

HHS released an updated version of the its FAQ related to Provider Relief Funds. This update provides insight regarding eligible uses of funds, and removes key provisions included in prior versions.

On December 1, 2020, the Centers for Medicare and Medicaid Services issued the calendar year 2021 Medicare Physician Fee Schedule final rule reflecting policy changes impacting Medicare reimbursement. Most provisions contained in the rule are effective January 1, 2021. These updates reflect the most substantial changes in many years, which will have a significant impact on physician practice revenue. Furthermore, the changes will impact physician compensation under commonly used production-based compensation models. The impact will vary based on specialty, service mix, payer mix, and other factors, but all physician practice organizations should plan for changes.

On November 20, 2020, both CMS and the OIG issued final rules regarding the physician self-referral regulations, commonly known as the “Stark Law.” These new rules seek to spark innovation aimed at improved coordination and quality of patient care by reducing regulatory barriers associated with value-based arrangements.

FORT WORTH, TX. – The American Institute of CPAs Standing Ovation Recognition Program has selected Arielle Schmeck, CPA/ABV, a Senior Manager in the Consulting Services division at JTaylor, as one of its 22 outstanding young CPAs for 2020. She was honored in the area of Valuations.

New CMS price transparency rules, effective January 1, 2021, are far different than prior CMS efforts. Every hospital (including employed physicians) must publish in machine readable form, its negotiated rates with every payer (and product) for every item, service and service package it provides in both inpatient and outpatient settings. It will be a treasure trove of highly sensitive information for consumers, competitors, payers, consultants, media and the government.

On September 19, 2020, HHS released reporting guidance for entities receiving distributions from the Provider Relief Fund that was established in the CARES Act legislation. Key provisions contained in the notice are summarized in this article.

Centers for Medicare and Medicaid Services (CMS) has issued the final rule relating to reimbursement policies for inpatient and LTCH hospital facilities for fiscal year 2021, which begins October 1, 2020. This article summarizes key provisions of the rule .

Summary of Key Provisions

CMS has released the proposed rule impacting reimbursement for outpatient services in 2021. The proposed changes are intended to increase patient choice by expanding Medicare payments to more services in different sites of service, which will allow patients more flexibility in making decisions with regard to health services. This article recaps the most significant changes reflected in the proposed rule.

Your healthcare real estate should match your strategies and adapt to changing needs! See how the COVID-19 pandemic, consumerism, telemedicine, and health insurance companies are changing how real estate fits into the health ecosystem.

The much anticipated updates to the Stark Law regulations have been delayed until August 2021. These updates will provide updated clarity to the federal government’s definition of Commercial Reasonability and Fair Market Value, and allow for expanded value-based arrangements.

This article outlines important changes to the 2021 Physician Fee Schedule that was just published by the Centers for Medicare and Medicaid Services (CMS).

Relaxation of Loan Forgiveness Rules

New Bonus Depreciation Rules for Qualified Improvement Property

Net Operating Losses Create Tax Refund Opportunities

COVID-19 as a Dam to the Healthcare Volume River

Understanding the Financial Statement Impacts

HHS releases details released regarding funding allocations

How to manage effectively through uncertainty

Focus on stability as economy and healthcare providers face headwinds

FCC Implements $200 Million Program to Promote Telehealth

The CARES Act recently passed in response to economic challenges from the COVID-10 pandemic contains relief provisions healthcare providers.

The CARES Act recently passed in response to economic challenges from the CPVID-10 pandemic contains tax relief provisions that individuals and businesses can take advantage of.

What you need to know about how these rules will impact your business

JTaylor continues to be attentive to the rapidly evolving situation surrounding the COVID-19 virus.

The reimbursement landscape is evolving to focus on rewarding value over the volume of healthcare services provided.

There are a multitude of reasons a physician organization may consider a change in compensation structure for its providers. One significant consideration is whether the financial incentives contained within the compensation plan align with the overall mission and objectives of the organization. This article details two examples of how modifying the provider compensation structure can drive necessary changes in behavior that result in significant improvements.