Even before the pandemic, change was in the air. Medical practices were working to keep up with regulatory requirements, shifts in technology, constantly changing reimbursement rules and economic fluctuations

The impact of the lockdown reminded many practices of the value of regularly reviewing their business structure to determine how it fits their priorities and how well it positions them to deal with future challenges.

"We were already doing due diligence for several clients who were looking at a variety of options, and we had recently completed oversight of the sale of a dermatology practice to an equity fund," said Jonathan Kassouf, CPA, PFS, who is a health care business specialist at Kassouf & Company P.C. "In this particular case, some of the physicians in the practice were approaching retirement and were looking for a transition that would allow them use more of their time doing what they loved, which was practicing medicine, rather than constantly dealing with the stresses of business management. So far, it has worked out well for them."

Selling to an equity company wasn't their only option and isn't necessarily the best option for everyone looking to change their business structure. They could have chosen a merger, hired a management company or added the expertise of a consultant, or a business manager, IT specialist or whatever knowledge was needed in-house.

"So much depends on what your goals are," Kassouf said. "Are you willing to swap some of your autonomy for less stress and more time practicing medicine? You will have the proceeds of the sale in hand to put toward your personal financial priorities, but you will be working under an employee contract. However, you will continue seeing your own patients, which could be an advantage compared to going to work for a hospital or other third party.

"You'll likely also receive equity in the equity company, but I always caution people to be sure they are happy with what they are being paid for the sale of their share of the practice because the value of equity they receive is likely to be hard to determine for some time. Most of all, it helps to have good attorneys, good accountants and other professionals who have experience in these types of transactions and will work together to see that you have a seamless transition."

Another local practice that has recently restructured is SouthEast Gastro, which chose a more classic merger to become Gastro Health.

"We had previously merged with another local practice and saw the advantages in economies of scale and strength in numbers," Miles E. Gresham MD, VP Clinical Affairs at Gastro Health Alabama, said. "In our specialty, large regional practices merging with local practices in different cities is becoming common. We looked at a couple of possibilities, and were particularly impressed with Gastro Health, which has grown up the coast of Florida and is now in Alabama.

"I would strongly recommend that anyone considering a merger do due diligence and actually go and talk with people in another practice that has already joined the group you are considering. See for yourself what the daily routine is like and talk with the people who work there. We received rave reviews from other members of the group who seemed to be quite satisfied.

"We've been well satisfied ourselves since joining the group. When you have economies of scale, you can afford a higher level of expertise in your IT and management staff. They've done a great job upgrading our IT, and there seemed to be advantages in numbers in getting supplies, especially when PPE was hard to locate.

"You'll want to have people who understand this type of transaction handling the legal and accounting side. That's another part of due diligence to avoid surprises and make sure everyone is happy with the transaction."

Perhaps after a review, you'll decide the current structure of your practice is exactly what it needs to be, or it may be that working in pandemic mode has given you ideas for improving what you already have. You may decide to cross-train more of your staff so there's always backup, and you may know more now about your key positions, who you can count on in a crunch, and whether there are work policies that could be adjusted to work better.

Soon, we hope, this pandemic will be behind us. But one lesson we've all learned is that it's never too soon to start getting ready for whatever lies ahead.