"Have you signed an LOI yet?" This may be one of the most important questions at the outset of a healthcare transaction. Many times, the parties believe a handshake agreement can be magically transformed into a comprehensive and binding contract without change or disagreement. Inevitably, however, the terms of the handshake agreements shift—and continue to shift—until one party surrenders. That is, unless a letter of intent, or LOI, is entered into by the parties.

The VERTESS team of mergers and acquisitions advisors have seen many successes in their careers. We've also witnessed some failures when representing healthcare owners who could not sell their businesses. For some of these owners, their window of opportunity was lost for good. Fortunately, for others, they were able to eventually complete a transaction, but often learned some difficult lessons in the process.

For sellers, there are many factors to consider when evaluating typically complex offers. Once our team gets a business out to buyers, we take competing bids and provide a side-by-side analysis to sellers to help simplify how offers compare with one another. Our job as mergers and acquisitions (M+A) specialists is to explain these in their entirety. Owner financing, carried interest, and indemnification caps all present (possible) future opportunities and/or problems. When these side-by-side comparisons are completed, there is almost always a clear monetary winner. But is it all about the money?

The healthcare industry is continually in flux. Business owners and operators of urgent care centers (UCCs) are constantly experiencing changing regulatory guidelines and suppressing reimbursement from payors. These unpreventable changes and a demanding environment may lead owners to seek monetization of their assets. For those UCC owners considering selling, there's good news: The marketplace is currently hungry for your companies and buyers are eagerly gobbling up well-performing UCCs.

We're in that time of the year when business owners see their year-end financials and begin to make decisions for the upcoming year(s). Oftentimes, the succession planning you had in mind when you started the company, such as passing the torch to a family member, doesn't look as promising as you had hoped (if you even planned that far ahead). If succession planning isn't an option for you, there's one that almost certainly is: selling your company.

Seven out of 10 mergers and acquisitions fail. Why would you consider selling your business with these statistics. We'll highlight nine causes for failed mergers and how to address these shortcomings.

Financial buyers, particularly private equity groups (PEGs), are currently in heated battles with strategic buyers for quality durable medical equipment (DME) deals. Well-run, well-managed DME companies are at the forefront of such intense competitions as they seek all-time-high valuations from financial and strategic pursuers alike.

There's some good news for owners of durable medical equipment (DME) and home medical equipment (HME) businesses: The transactions market (i.e., mergers and acquisitions) is not too hot and not too cold, but just right at the moment.

In years past, strong financial numbers were often enough to hook a qualified buyer. However, these days, buyers — especially those pursuing intellectual and/or developmental disability (I/DD), mental health, and substance use disorder treatment organizations — are looking for much more. They want to see if the organization has special qualities; something that stands out and will help propel the organization to new heights under new ownership. They are looking for the "sizzle."

After years or decades building your healthcare company/practice, it's increasingly likely that you will find yourself thinking about the prospects of selling your company. You should understand the key "value drivers" of your company.

For many entrepreneurs, moving on from their business — especially if it's a business they founded — is one of the most difficult decisions to make. For owners of provider agencies that support individuals affected by an intellectual and/or developmental disability (I/DD), the decision can prove even more difficult when the owner has a personal attachment to and passion for the space. However, while many owners find it difficult to start the process of selling their business, the reality is that it's a necessary and important step. As the old adage says, "Failing to plan is planning to fail."

What you will quickly learn is that the value of your company is directly tied to numbers — more specifically, your bottom line and quality outcomes. It doesn't matter how wonderful you believe your company to be. You discover that you didn't monitor your financials closely enough and there are probably some significant changes you should have made long ago. The good news is that if you plan wisely, you can avoid such a scenario and not need to rely on luck to secure a fair sale price for your business. Here are nine steps I would advise you to take instead of leaving the value of your company to chance.