Healthcare

No one solution fits all healthcare organizations. As the industry transforms, organizations must assess their unique circumstances to determine the best way forward – financially, clinically, digitally and operationally.

TMO has helped clients across the country plan and implement comprehensive new strategies, working collaboratively with stakeholders to envision and implement future-state models to optimize performance and improve care with minimal disruption.

OUTCOMES

• Achieve high-quality clinical outcomes at lower costs
• Transition to value-based payment models
• Maintain sustainable revenue growth
• Shift site of service to encompass outpatient clinics and ambulatory centers
• Pivot from facility investment to a digital platform to coordinate care across diverse care settings
• Reduce operating expenses
• Uncover alternative sources of capital to fund innovation
• Provide actionable data-driven insights
• Implement data privacy and security assessments
• Analyze population health management functions

A renewed focus on care innovation has emerged from an era of uncertainty. Today’s care models are all about connectivity and coordination, focused on one goal: providing better value. Value for patients, value for providers, value for payers, value for the enterprise and value for the overall health system.

TMO’s Performance Script (PRx) suite of services, backed by a team of clinicians, former healthcare executives, lean specialists, and experiential designers, provides a comprehensive viewpoint of an organization’s current condition, performance opportunities and future growth scenarios. Our focus on operational optimization, strategic planning, business model innovation, care model evolution, and experiential design helps deliver successful outcomes for our clients to optimize performance and transform to compete.

OUTCOMES

The U.S. health system is transforming from a fee-for-service model to one centered around value. This shift requires the entire health industry to re-calibrate its operations and business models to provide the highest value to consumers.

TMO provides the knowledge and tools needed to successfully transform to a value-based payment model and redesign care delivery. We focus improvement efforts on reducing variation in both care delivery and outcomes by implementing standardized care protocols, best practices and collaboration efforts. We start by assessing providers’ historical performance on episodic-based care and provide support, experience and guidance to accelerate improvement at a much faster rate than most providers can develop on their own.

OUTCOMES

• Improve payer contracting techniques
• Improve financial position
• Increase staff productivity
• Enhance private equity relationships
• Strengthen capital structure
• Maximize stakeholder values

Managing risk is critical to the health of both patients and providers. The stakes are high. Healthcare organizations must not only defend against and detect instances of fraud, data or privacy breach, but they must also plan to transparently manage inevitable intrusions, compliance errors and claims denials. It’s not enough for healthcare institutions to comply with regulations. They must be ethical stewards of their patient’s private information and their own intellectual property.

From managing privacy, risk and regulatory compliance to expert testimony, TMO is adept in helping organizations gain appropriate reimbursement for the care they provide to patients.

OUTCOMES

• Enhance patient trust
• Comply with state and federal regulations
• Streamline coding, revenue integrity and billing workflows
• Optimize reimbursement levels
• Align physicians with clinical documentation
• Spot threats and opportunities to capitalize on change
• Transform risk and compliance into business advantage

As the economy continues to embrace technology, healthcare leaders anticipate innovative mergers to have a significant impact on the industry. On the flip side, underperforming hospitals and organizations approaching bankruptcy remains a pervasive challenge. Transforming to compete is often the path to survival, but key details – like identifying the partner right for your organization, M&A due diligence, and change management strategies – are key to any deal’s success.

From strategic planning, to valuation and due diligence, to integration and implementation, our integrated team of advisors can help guide your healthcare organization through an entire transaction process.

OUTCOMES 

Restructuring and turnaround

• Develop strategy for raising new sources of capital
• Maintain cash flow budget
• Project financials
• Conduct four wall analysis
• Develop strategy for reorganization and bankruptcy exit
• Transition from former ownership to new ownership post‑acquisition

Buy-side diligence

• Maintain better control of deal flow
• Experience fewer post-deal surprises
• Identify issues that impact pricing
• Pinpoint critical success factors
• Improve certainty about business and cash flow
• Identify opportunity to sell additional value-add services

Sell-side diligence

• Access outputs of key analyses
• Share identical information with investors
• Lower bid cost to increase amount of bids
• Maintain competition to maximize prices
• Optimize deal structures
• Simplify processes
• Eliminate multiple diligence needs
• Control disclosure of commercially sensitive information

Private equity interest in U.S. healthcare has grown stronger in large part due to new technologies and new entrants, a seismic industrywide shift to outpatient settings for care delivery, and an increased emphasis on value-based outcomes.

TMO provides a comprehensive suite of services to aid in guiding both private equity firms and physician practices, behavioral health organizations and specialized healthcare centers scale for success through PE-funded, full-service management service organizations (MSOs). An MSO not only streamlines business functions through shared infrastructure and consolidation of back-office services, but also helps pave the way for mergers or other new possibilities for physicians considering exit strategies.

OUTCOMES:

• Integrate growth strategy
• Increase EBITDA
• Reduce risk
• Enhance operations
• Enhance coding compliance
• Optimize reimbursement and contracting

In the healthcare industry, the audit is not just an exercise in compliance. It’s essential to ensuring financial health, avoiding fraud and waste and ultimately ensuring and paving the path to improved patient care. It’s not just a snapshot of the past, it’s a roadmap for healthcare organizations to plan and navigate change.

TMO delivers comprehensive and independent audit and assurance services to healthcare organizations of all types. Our professionals follow a common global audit methodology that complies with International Standards of Auditing, as well as other national and local standards, allowing us to efficiently manage multinational audit needs. Wherever they operate, we help clients ensure that both their financial statements and internal controls meet complex regulatory and business requirements, allowing them to navigate an uncertain industry with confidence.

Tax rules have changed more in the past five years than in the past 50, and it appears there’s no end in sight: More than one in four (26%) tax executives are focused on adjusting to continued guidance on federal tax reform changes, according to TMO’s Tax Outlook Survey.

For healthcare leaders, on top of navigating an industry converging from all sides, they must navigate a troika of tax challenges: 1) keeping track of constantly shifting federal, state and local regulations, 2) mapping the impact of those regulations on the company’s total tax liability and 3) adjusting their tax optimization strategies across the entire enterprise. Additionally, the industry is facing rising liquidity challenges and growing concerns around reimbursement, including those stemming from the Tax Cuts and Job Act’s repeal of the individual mandate. The repeal increased healthcare organizations’ uncompensated care risk and still leaves federal, state and local levels of reimbursement in the lurch.

Healthcare executives need a holistic, real-time view of their organization’s total tax liability to maximize tax savings opportunities. At TMO, we advise on key tax reform issues for healthcare, whether it involves the impact of tax reform, forecasting taxable income in the context of a transaction, navigating state and local taxes or understanding opportunities for R&D tax credits or bonus depreciation.

OUTCOMES

• Understand and adapt to changes prompted by the new tax law
• Anticipate additional IRS guidance to ensure favorable outcomes to total tax liabilities
• Account for new tax provisions, including GILTI, FDII, and BEAT
• Adapt to changes to employee fringe benefits
• Securing R&D tax credits