Retail Clinics Popular with High Earners

Trending up – that’s what a late 2012 survey report revealed about the use of retail clinics (generally located in drug stores and staffed by nurse practitioners or physican's assistants).   Not a surprise... that the survey publisher attributes the rise in use to convenience of appointment-free services, expanded hours compared to the average physician office and lower costs.  The survey from healthcare market research publisher, Kalorama Information, reported that 21.3% of US adults have visited a retail clinic - up from 10% in 2006.  

Now, Kalorama reports that retail clinics are favored more by higher earning households.   A survey of 2000 adults revealed that “59% of survey participants who said they used retail clinics had a household income of more than $50,000, while only 16 percent had a household income of under $25,000.”  Again, not a big stretch...as higher earners are visiting stores more frequently.  

As chain operators (Walgreen’s, CVS, Wal-mart, etc.) continue to promote their in-store clinics and offer services attractive to this income group (e.g.: camp physicals, weight loss programs), increased retail clinic visits is expected.  >>Read more

Direct Access in All 50

Done deal!  Indiana, with signed legislation, becomes the last state to allow residents to seek physical therapists’ services without a physician referral.  The state chapter of APTA has been working on Direct Access for over 13 years... now a reality beginning July 1st.

Benefits of Direct Access include a patient’s quicker access to care and medical cost reduction.  >>Read more

Plus 2 for The Ensign Group

The Ensign Group, Inc. ended the month of May with two more assisted living facilities under its corporate umbrella.  With operations primarily in the western US, the company now enters California's Central Coast region and complements existing facilities in the greater Salt Lake City-area.

118 Facilities in 11 States 

Last week’s acquisitions continue the company’s expansion of its assisted living base, increasing Ensign’s healthcare facility portfolio to 118 in 11 states.  Ensign group service companies include skilled nursing, rehabilitative care, home health care, hospice care, urgent care in addition to assisted living.

The Ensign subsidiary, Bridgestone Living, Inc. will oversee the transition of the 110-unit Santa Maria Terrace (Santa Maria, CA) and 69-unit Lake Ridge Senior Living (Orem, UT).   

>>Read More about Ensign's California and Utah acquisitions.

The Other Three R's

Remember the three “Rs”? 

While the educational approach to - Reading, (w)Riting and (a)Rithmetic - has changed over the years, I suspect that many of today’s business leaders excelled in one or more of these disciplines.  And, now... there’s another set of “R’s” for them to focus on.

Doug Dickerson, a leadership consultant, outlines the value that all leaders can bring to their teams through...

• Recognition
• Respect
• Reinforcement

John Maxwell, another leadership writer, asserts that you don’t have to be the main leader to make a significant impact on your organization. >>Read more to learn how to add value as a Leader.

“People always move towards someone who increases them and away from someone who decreases them.” ~ John Maxwell

NAPA Nabs Nearby NJAG

North American Partners in Anesthesia known as NAPA and headquartered in the New York metro area didn’t go far to expand its influence. The New Jersey Anesthesia Group (NJAG) recently joined NAPA, the largest anesthesia management company in the U.S.

The New Jersey Anesthesia Group anesthesia practice adds 73 clinicians to NAPA’s operations and 1000 clinicians.  The northern New Jersey-based organization currently provides services to 4 hospitals as well as 12 regional outpatient facilities.  Additionally, NJAG’s pain management division (Total Pain Care) serves northern New Jersey counties, Passaic and Bergen. 

NAPA’s expansion efforts have been aided by the 2011 recapitalization by Moelis Capital Partners.  The NJAG acquisition follows NAPA’s acquisition of two Pennsylvania anesthesia practices last December (2012).

>>Read more

Clinic Efficiency Tips...Worth Repeating

In the words of Dictionary.com:  
ef·fi·cien·cy [ih-fish-uhn-see]:  accomplishment of or ability to accomplish a job with a minimum expenditure of time and effort.

Efficiency...We’re always trying to improve upon it whether at home or work.  The weekly PPS multibriefs newsletter recently offered key efficiency tips for rehab therapy owners - which can clearly be leveraged by other healthcare-related clinics. 

Quick Tips:

1. Establish a process and share with staff & patients
2. Keep traffic flowing.
3. Avoid handoffs:  one focused staffer best.
4. Huddle up.. review daily schedules with staff
5. Create a culture of timeliness.  Respect time of others.
6. Find your groove...what’s your best work style?
7. Get techy.  Today’s devices are time savers.

>>Read more

Start New Managers on Road to Success

© Stock Free Images

It happens in many businesses... management identifies a good employee and promotes them into a leadership role (e.g.:  manager, supervisor, etc.).  While “promoting from within” is a noble practice, there’s more required of management than changing a title and adjusting salary.  

Paul Spiegelman, CEO of BerylHealth suggests that preparation is key to turning a good worker into a great manager. Consider Spiegelman’s “Must-do” list to set your newly promoted leader on the path to success:

• Give them a mentor for a period of time.
• Invest in either internal or external training.
• Guide them in how to be an example to others.
• Teach the difference between management and leadership.
• Check in often to help them with new issues they'll deal with.
• Make sure they enjoy the new role.

>>Read more
Source:  Inc. Magazine

Goldman Investment Forms Resolute Anesthesia

Resolute Anesthesia and Pain Solutions, LLC, was recently formed by a Goldman Sachs Private Capital Investing Group investment in two Florida practices -  Broad Anesthesia Associates and Mid-Florida Anesthesia Associates.  The new physician-led organization is based in Boca Raton, FL, and provides anesthesia and pain management services. 

Currently, Resolute serves 25+ locations in Florida, Missouri, and Illinois.  With Goldman Sachs backing, the company has access to additional capital and management expertise - key to its expansion goal of becoming a national provider of anesthesia and pain solutions. Andrew Barnett, with  experience as former CEO of The Center for Wound Healing, will lead the organization's growth.  >>Read more

Interest in Animal Healthcare Continues

New Owner for Best Friends

Webster Capital, a private equity partnership whose investments include healthcare services will give Best Friends Pet Care a new home.  Brynwood Partners, the seller, will maintain a minority stake in the business.

Best Friends operates 42 centers nationwide (including Walt Disney World Resort) offering pet boarding, grooming, training and veterinary services.  Webster will partner with vet industry expert, Shane Kelly, to extend company’s animal healthcare services – adding six veterinary hospitals adjacent to current Best Friends locations.  >>Read more

Ensuring Healthy and Happy Friends

Other 2013 sector acquisitions:  Perrigo, entered the animal health market with its October, 2012 acquisition of Sergeant's Pet Care Products Inc., maker of flea and tick medicines.  Complementing Sergeant’s is the 2013 planned acquisition of Velcera Inc., another maker of flea and tick medicines sold over the counter.  >>Read more

Acquisition of Teva Pharmaceutical Industries (Shawnee, KS) in early 2013 strengthened German-based BayerDVM HealthCare’s leadership in the companion animal and food animal health industry. Dermatology products and nutraceuticals encompassing joint and gastro-intestinal products for companion animals is part of the acquired product portfolio.   >>Read more 

Heska, a provider of veterinary diagnostic and specialty products acquired roughly 55% of Cuattro Veterinary USA, LLC.  According to Robert Grieve, Heska CEO,

“Digital imaging and the long-term archival of imaging studies in cloud-based data centers is one of the fastest growing segments in veterinary medicine.” 

Cuattro Vet fills this niche with best-in-breed digital radiography, cloud-based PACS, ultrasound and imaging services suite in veterinary medicine.  With Heska’s established and extensive sales network, exposure and placement of the Cuattro Vet systems is greatly enhanced as is revenue and growth potential for Heska. >>Read more

A Different Flavor for EHR...DocuTAP

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The latest buzz surounding electronic health record provider, DocuTAP, is the additional venture capital financing for the Sioux Falls company founded in 2000.  The $11.9M injection is earmarked for increased marketing.

What caught my eye is their departure from the “vanilla” EHR varieties.  DocuTAP’s is focusing on one of the fast growing healthcare “flavors du jour” - Urgent Care.  The company appears to know its niche – experiencing significant growth over the last 12 months and consequently, tripling their workforce to support their services. 
"How Sweet!"... for their financial partners, Bluff Point Associates and Bessemer Venture Partners.  Read more

AxelaCare Finds Harvest Home

© Dreamstime Stock Photos

Founded in 2008, AxelaCare has been on a quick pace to becoming one of the country’s leading home infusion therapy providers.  Therapies provided range from immune globulin (IG) therapy to antibiotics and nutrition therapy.  Investment from Excellere Partners in 2010 aided AxelaCare’s innovation and tremendous growth - 30-40% per year.

AxelaCare’s management team and New York-based Harvest Partners, LP recently completed the acquisition of the company from Excellere.  Harvest’s senior managing director, Ira Kleinman noting, 

“The company’s [AxelaCare] investment in processes, technology and people has led to an efficient, scaleable model with opportunity for continued growth as a larger share of the population seeks access to these vital services.”  

Read more        

Trading for Healthcare Services

It’s an old practice...that enjoys renewed interest in tough economic times.  
Bartering...it's a cost containment strategy - on that is appealing to more small businesses to address the current healthcare conundrum.  According to a director of a national bartering service organization,

“We’ve seen growing demand over the past five or six months for healthcare services...”  

The same executive noted, “Bartering is being used to offer or get primary medical care visits, dental work, chiropractic services, a number of specialty medical procedures and prescription and pharmaceutical goods."  
Bartering...It has survived the test of time and can benefit both the provider and small business owner.  Read more about the process and how several dentists have used the concept.  
What do you think...is bartering healthcare services a viable option for your practice?

 Source:  Healthcare Finance News

PE Investment in Healthcare Svcs

Media and information giant Thomson Reuters offers a glimpse of 2012 private equity activity in healthcare:

Key points for the Medical and Healthcare Services sector:
- Almost $4B in PE investments made in 2012.
- While 2012 lags 2010 (>$6B invested); was better than 2011. 
- Received more than 16% of PE monies (Biotech and Pharma each garnered >20%)
Click here to learn more.
Source:  Thomson Reuters

COMING SOON: Diagnoses and Drugs at a Walgreens Near You

© Webking | Stock Free Images

Walgreens  and its Take Care Clinic is taking another step into the primary care doctor’s space.  The network of retail store clinics will “expand its health care services to include diagnosing and treating patients for chronic conditions such as asthma, diabetes and high cholesterol.” 
Nurse practitioners teamed with physician assistants will conduct tests, make diagnoses and referrals (more tests and doctors, as needed) and help patient manage their conditions. 

The initial reaction from several of the professional physician organizations is “Thumbs Down”.   A key concern is patient safety – with the addition of another primary care provider, can continuity of care be assured?  According to a Walgreens executive, Take Care Clinic staff will be able to transmit test results and info electronically to a patient's primary care physician.  Read more

What do you think...Is Walgreens overstepping the retail clinic’s boundary of care?

Source:  Kaiser Health News  

Steady Healthcare Hiring Continues

© Kulty Stock Free Images

Healthcare continues to be a bright spot when it comes to US employment.  The industry added 23,400 jobs in March and 295,000 over the past 12 months.  The Bureau of Labor Statistics numbers reveal that jobs in ambulatory healthcare services exceeded other healthcare sectors with an increase of 15,000.  Home healthcare services - within the sector, added 6,800 jobs.  Hospital employment also rose in March.

Increase Your Bottomline with More ABC's

© Marcusarm | Stock Free Images

Differentiation.... is a key marketing tenet that transcends industries and is an equally important strategy among healthcare practice owners as for consumer goods product managers. 

In the PT world, a key way to differentiate is through specializing and attaining certification.   While earning credentials expands the staff professionally, it also adds to a practice financially.  Certification enhances credibility among referral sources and... typically, leads to a larger patient base.  In other words, the extra effort pays off, literally.

The American Board of Physical Therapy Specialties, part of APTA, already oversees 8 specialty certifications with current consideration to add acute care, oncology, occupational health and wound care.  Other organizations coordinate certification for other notable specialties:

• Hand Therapy 
• Stroke Rehabilitation
• Aquatic Therapy 
• Astym Treatment

>>Read more

American Family Care Takes Big Step Up

Dr. Bruce Irwin, founder of one of the oldest operators of family care/urgent care clinics announced the acquisition of Doctors Express, the largest US franchisor of urgent care clinics.  The completed transaction (expected in April) will move American Family Care (AFC) to the second largest privately held operator of urgent care centers.  By year end, the merged organization will have a presence in 26 states with more than 140 facilities.  

The Doctors Express name will be retained and the business continue under the current franchise model.   AFC will centralize backroom operations in Birmingham, AL.  Doctors Express is currently headquartered in Baltimore.  >>Read more

Funding Continues for Walk-in Clinics

Private equity firms continue funding of healthcare’s urgent care sector.  This ongoing interest is not surprising given 20% clinic growth in the last 4 years*.  MedExpress, an industry leader, currently with over 100 locations, was one of the first to benefit from PE interest when it had only 6 offices.  More recently, sector funding has come from LLR Partners for Physicians Immediate Care and FFL Partners for WellStreet.

Health insurers and hospital systems also recognize the value of urgent care ownership.  However, their acquisition motivation may be slightly different vis a vis private equity firms.  Humana, owner of 330-clinic Concentra, and other insurers appreciate the cost containment potential with urgent care clinics (e.g.:  Per visit: 30-40% less than doctor visit; 80% less than ER).  Hospitals now own 27% of urgent care centers.  While not expected to be a large revenue stream, hospital-owned clinics offer a great source of patient referrals.  >>Read more

*Urgent Care Association of America

ICV Adds Dialysis Platform

With the recent acquisition of Atlantis Healthcare Group Puerto Rico, Inc., ICV Partners has established a kidney dialysis platform. Atlantis, founded in 2000 by Dr. Otegbola Ojo, has 13 facilities located throughout the island of Puerto Rico.  Dr. Ojo will continue as Atlantis’ President.

ICV, in partnership with Dr. Ojo, noted nephrologist Dr. Randall Maxey, and health care executive Ruby Harford have concurrently formed American Alliance Dialysis Holdings, LLC (“AAD”).  The team at AAD will identify and vet strategic investment opportunities located in North America and the Caribbean.  >>Read more

Patients Asked, ZoomCare Answered...

ZoomCare, a company that bridges the gap between ER and primary care physician visits took action based on patient input... adding physical therapy treatments in 2 of its Portland clinics. 

Co-CEO Dr. Dave Sanders recounted that, "ZoomCare customers have been asking us for years to offer a PT service with all the convenience, quality and low cost features they love about ZoomCare everyday care....”.  He added “PT is a great fit for Portland's active, outdoor community."

Founded in 2006, the Portland-based urgent care chain has grown to 18 clinics in Oregon, Washington and Idaho. In addition to same-day scheduling, the clinics give patients a guaranteed visit time, issue no bills, have an on-site laboratory and pharmacy and charge the same price for all visits.

Source:  Portland Business Journal

Should you Sell? Ask Yourself 10 Questions...

Selling a business is a “Big Deal”  for most small business owners and requires more than the "Luck of the Irish". As snap decisions are not encouraged, Curtis Kroeker, GM of several business-for-sale marketplaces, offers key questions to determine if selling is the right decision. 


1.   Is my business ready to sell?  Key:  2-3 yrs of tax returns, showing maximum profitability.
2.   How is a buyer going to value my business?
3.   Who should be on my team when I sell?  Engage the Experts, if needed, whether an Accountant, Lawyer, Business Broker...
4.   Is it the right time to sell?  Easier when business is on the upswing.
5.   Is the market right?
6.   Can I cope with the changes on the horizon?
7.   Can my business thrive without me?  
8.   Would I be willing to stay on if the buyer wants me to?  Transition flexibility could improve chances of a done deal.
9.   What are the potential deal breakers?  Resolve them before the deal nears closing!
10. Would I consider alternatives to an outright sale? 

>>Read more for greater insight.       

Source:  Entrepreneur.com

Happy St. Patrick's Day!

Another Investment in Heart to Heart Hospice

Summit Partners continues its support of a leading hospice care provider with its recent minority investment.  Heart to Heart Hospice, headquartered in Plano, TX, offers quality care to approximately 1,200 patients in 11 locations across 88 Texas counties.  It was founded in 2003 and currently employs a care team staff of 600.

Heart to Heart Hospice Locations

Founder Kelly Mitchell applauds Summit’s ongoing involvement and role in the “success and growth of Heart to Heart Hospice.”  Mark deLaar and Jesse Lane from Summit will join the hospice care provider’s Board.

The investment will be used “...to support several growth initiatives that will allow us to bring hospice care to a greater number of people.” according to Heart to Heart President, Bill Thurman.  >>Read more

Satori's Entrée to Healthcare...Longhorn

Austin, TX-based Longhorn Health Solutions was acquired recently by Dallas private equity firm Satori Capital.  

Longhorn is a direct-to-consumer distributor of durable medical equipment, consumable medical supplies and pharmaceutical prescriptions (e.g.: incontinence supplies, enteral nutrition products, and diabetic testing supplies) to home-based Medicaid, Medicare and privately insured patients across Texas. The Satori partnership will offer Longhorn opportunities for “organic expansion and growth via acquisition” according to Britt Peterson, CEO. 

Peterson will continue to lead the company with 10 Texas warehouses and 150 employees.  He notes:  

"Longhorn has earned a reputation for excellence through its reliable performance, dedicated customer service, statewide presence, and commitment to integrity and kindness across everything that we do...”

>>Read more

US HealthVest to Acquire Psychiatric Facilities

Co-founders Richard Kresch, MD and Polaris Partners are focused on expanding access and improving psychiatric care with their new company.  According to Dr. Kresch, President and CEO of US HealthVest:   

"The need for quality psychiatric care is increasing rapidly. US HealthVest has the experience and resources to expand access to care by developing new facilities and acquiring existing facilities with untapped potential...”

Previously, Dr. Kresch launched and sold two companies including Ascend Health, owner of multiple free-standing psychiatric inpatient facilities.   Venture Wire reports the US HealthVest team “hopes to get six clinics up and running within the next year.”  Facilities offering inpatient and outpatient programs will include development of new and the acquisition of existing facilities. 

In addition to Kresch and Polaris, US HealthVest partners include the company’s management team, Fidelity Biosciences and notable health care and technology investors. >>Read more