What is quality of earnings (QOE) in healthcare transactions?

QOE is an in-depth analysis of historical performance, normalizing nonrecurring items, verifying profitability, and identifying risks or adjustments. It helps both buyers and sellers validate price expectations and negotiate confidently.

What does due diligence include in a hospital merger or acquisition?

Healthcare transaction due diligence examines financial statements, payer contracts, compliance risks (e.g. HIPAA, Stark), revenue integrity, coding audits, IT infrastructure, licensing, and real estate and operational reviews.

How does compliance risk factor into healthcare M&A?

Compliance risks are central in healthcare deals. A transaction must evaluate adherence to HIPAA, enrollment and billing compliance, exclusion lists, anti-kickback / Stark laws, regulatory filings, and oversight exposure.

When should an organization engage transaction advisory services?

Ideally at the earliest possible stage—during target assessment, structuring, or before due diligence—so the advisor can influence deal design, identify value levers, and mitigate risks before they become costly.

How do transaction advisors assist in integration planning?

Advisors help design the post-deal plan, align systems and processes, manage change, execute purchase price allocation, coordinate clinical and administrative alignment, and guide transition services or carve-out strategies.

What valuation approaches are used in healthcare transactions?

Common valuation methods include discounted cash flow (DCF), comparable company analysis, precedent transactions, and industry-specific approaches such as reimbursement differential models or royalty relief methods.

What is the “with vs without” method in transaction analysis?

The “with vs without” analysis compares deal financial performance under the scenario that the transaction occurs versus a baseline of status quo, attributing value to the upside (synergies, market expansion, operational gains).

How are provider compensation models handled in M&A settings?

During M&A, advisors structure incentive and compensation frameworks for legacy and acquiring providers—aligning them with organizational goals, adjusting for transaction terms, and mitigating risk of disruption.

Healthcare Transactions Support

PYA’s multi-disciplinary team of subject matter experts helps hospitals and health systems, physician practice management entities, strategic consolidators, and private equity funds maximize the benefits and minimize the risks of business transactions.

With decades of transaction advisory experience, our multi-faceted team of healthcare financial, compliance, and operational experts provide solutions throughout the transaction lifecycle.

Our Healthcare Transaction Services

Due Diligence

Financial Due Diligence Assessments
Revenue Integrity
Coding and Billing Compliance Reviews
Medical Necessity and Care Management
Feasibility Studies
Independent “Black-Box” Reimbursement Differential Analysis
IT Infrastructure Reviews and Risk
Real Estate Assessments
Compliance Program Assessments (e.g., HIPAA/CLIA/OSHA)

Transaction Execution

Valuation Opinions
Sell-Side Transaction Facilitation (Divestitures and Joint Ventures)
Buy-Side Transaction Facilitation (Mergers, Acquisitions, and Joint Ventures)
Regulatory Approval Assistance
Provider Compensation Model Design
Integration Plan Development
Affiliation Design and Modeling

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Integration and Divestiture Advisory

Integration Plan Development
Integration Execution and Project Management
Purchase Price Allocation
Financial Statement Audits, Compilations, and Reviews
System and Organization Control
Tax Compliance
Risk Mitigation Planning
Transition Planning for Divestitures

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SCOUT™

A Comprehensive Healthcare Due Diligence Solution

PYA’s SCOUT solution provides deep subject matter expertise, superior project management, and objective advice specific to each transaction. SCOUT deliverables are clear, intuitive, and actional resources for buyers throughout the transaction lifecycle.

Senior Advisor Involvement

PYA SCOUT disciplines are led by executives with deep expertise and experience in their fields.

Coordinated Risk Analysis

Decades of transaction and due diligence experience combined with PYA’s breadth of expertise, positions SCOUT to view risk across the entire enterprise rather than just individual disciplines.

One Central Point of Contact

SCOUT leverages expertise across multiple PYA resources, and each relationship has a point of contact who coordinates exceptional service, responsiveness, and project management.

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The PYA Difference

Over our 40-year history, PYA has consistently delivered high-value transaction consulting services to our national client base. Our team is deployed to develop custom plans using proven approaches and work plans.