Eleven essential steps to purchasing or selling a medical practice.

Based on our experience in representing more than 100 doctors and medical specialists in practice sales and acquisitions, we have identified 11 key considerations important to a deal. There are several issues to consider while going through the process of buying or selling a practice including the implementation of a "letter of intent" as a first step rather than drafting a contract, securing a lease, and verifying the property is not in violation of the local zoning requirements. There are also considerations with regard to the patients, which range from how will the accounts receivable at the time of the closing be handled to who is responsible for the handling of continued treatment in an ongoing case after a deal is finalized. This article details these considerations and more.

Medical leasing.

Leases for medical space can have far-reaching (and sometimes unintentional) consequences for the future of the practice and the costs of the business. In order to prevent hardship and expense down the line, it is especially important to review the lease to make sure that it reflects the practice's goals, needs, and structure. This article provides a number of provisions that are especially crucial to review and negotiate when leasing medical space, including use restrictions, assignment and subleasing clauses, build-out terms, and legal compliance requirements.

Evaluation of the signalling and referral system for households at risk of eviction in Amsterdam.

In Amsterdam, over 1400 households are evicted each year. We describe the results of an evaluation of the functioning of the signalling and referral system, set up for households at risk of eviction, through a qualitative and quantitative study. Interviews and questionnaires completed by employees of 12 housing associations (for rent arrears) and by employees of 13 nuisance control care networks (for nuisance), were used. Data on households with rent arrears, for which a court eviction order was requested, were collected prospectively in September and October 2003, and retrospectively on households causing nuisance and/or who were known to be evicted due to nuisance in 2001-2003. Functioning of signalling, of the 'alarm' of problems underlying rent arrears and/or nuisance, was evaluated by the extent of problems that were identified by the employees. Functioning of referral was evaluated by comparing the identified problems with the assistance contacts. For 275 households with rent arrears, housing associations reported social problems in 196 (71%), of whom 94 (48%) were in contact with social assistance, and medical problems in 62 (23%) of whom 18 (29%) were in contact with medical assistance. House visits resulted in a much higher identification of problems, and were associated with a reduced eviction risk [relative risk 0.57 (95% confidence interval: 0.43-0.75)]. For 190 nuisance households, nuisance control care networks reported social problems in 103 (54%), of which 13 (13%) were in contact with social assistance, and medical problems in 155 (82%), of which 142 (92%) were in contact with medical assistance. To prevent evictions in Amsterdam, housing associations should improve their signalling role by conducting more house visits, and they should refer more households to medical assistance. Nuisance control care networks should refer more households to social assistance. Only a systematic and integrated approach can keep more households at home.

Examining the impact of the new Stark rules on joint ventures.

The new Stark rules will affect joint ventures involving physicians and hospitals in four primary areas: Services provided "under arrangement". "Per click" lease arrangements. Percentage-based compensation. "Stand-in-the-shoes" provisions.