Eyeworld

22 Ophthalmology Business • March 2017 8 merger and acquisition trends that your practice should keep in mind by Vanessa Caceres, Contributing Writer said Michael Gurman, an attorney and partner, Abrams Fensterman, Lake Success, New York. "Solo ophthalmologists are realizing it's becoming harder for them to survive due to decreased reimbursement and rising costs. Joining larger group practices has allowed them to con- tinue their business autonomy to an extent while obtaining the benefits of a large practice," he said. 2. There is an increasing num- ber of contractual arrangements in addition to—or instead of—mergers and acquisitions. Within the sub- specialty of retina, Ms. Laigaie saw a downturn of M&A activity in 2016. "All of a sudden, we're seeing a pause in the merger and acquisition world," Ms. Laigaie said during a presenta- tion at the 2016 American of Acade- my of Ophthalmology annual meet- ing. However, she now sees more lease arrangements, personal service arrangements, patient-centered medical homes, and even account- able care organizations interested in retina practices. "The mergers may have slowed down, but contractual affiliations are continuing," she said. Mr. Wybo has noticed a similar trend throughout ophthalmology in general. "Ophthalmic specialists and small practices are seeing increasing costs and decreasing revenues from recent regulations, causing many to think about consolidation. This leads us to a new trend in health care involving strategic mergers, partner- ships and joint ventures for the first time in a long time between hospitals and ophthalmic practices," he said. 3. Buyers consider ophthalmol- ogy more closely nowadays due to appealing demographics. The large and growing number of senior patients seen by ophthalmologists eight trends within mergers and ac- quisitions (M&A) in health care and ophthalmology as shared by health care M&A experts. 1. The M&A field within health care—including ophthalmology— has seen a whirlwind of activity the past several years, said Steve Wybo, senior managing director, Conway MacKenzie, Birmingham, Michigan. Mr. Wybo specializes in helping distressed businesses and is a certified turnaround professional. "2015 was the biggest year ever for health care mergers and acqui- sitions, with $500 billion in sector investments," Mr. Wybo said, citing data from the trade magazine Modern Healthcare. Since the passage of the Affordable Care Act (ACA), M&A for medical practices continued to rap- idly increase, with the exception of dips in 2012 and 2013 amidst further reform initiatives. The shift to newer health models, including population health and value-based reimburse- ments, has factored into the M&A activity, Mr. Wybo said. Ophthalmology arrived late to the M&A table but is catching up, Buyers, business partners eye ophthalmology's attractive demographics A n ophthalmologist may consider a merger or an acqui- sition by another practice for several reasons. A larger-sized practice offers economies of scale during purchasing and gives practices more ability to meet regulatory requirements such as PQRS, Meaningful Use, Value-based payment modifier, and the Mer- it-based Incentive Payment System (MIPS), as well as engage in larger clinical trials, said Brenda Laigaie, an attorney with Wade, Goldstein, Landau & Abruzzo, Berwyn, Penn- sylvania. Practices also can maintain their patient base while expanding their geographical scope. Some ophthalmologists are interested in mergers and acquisitions as a vehicle for succession planning. Here are

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