News & Events

Our Take: Considering Quality in a Business Combination 

Of the umpteen elements hospital leaders evaluate when considering the viability of a potential partner, quality is generally at the top of the list.

A larger partner can bring the scale, resources and expertise many smaller hospitals and systems seek to improve care quality for their community. This can include enhanced clinical protocols and standards, facility and equipment investments, deployment or recruitment of highly-skilled medical staff, patient support programs and more. Integrated delivery systems are also better positioned to address population health and health inequities, offering new approaches to keeping communities well and synergies with readmissions reduction strategies.

A partnership can provide a host of opportunities to improve care quality and patient outcomes, but in the early stages of exploration there is limited ability to dive deep into tactics. Instead, hospital leaders look for succinct ways to ascertain a potential partner’s quality of care.

Countless measures can be equated to quality, from objective metrics like infection and readmission rates, to the more subjective, like noise levels at night.  And there is no shortage of options for comparison: CMS Hospital Compare, Leapfrog, Consumer Reports, US News & World Report, the Commonwealth Fund. Many states

In the News: Temple hires Juniper as it explores possible sale

Temple University announced Monday it has retained the services of Juniper Advisory to pursue strategic options for Temple University Health System, which include the possible sale of Fox Chase Cancer Center, neighboring Jeanes Hospital or both.

The move comes about a month-and-a-half after Temple’s Board of Trustees announced it had authorized a series of steps aimed at strengthening the health system’s finances and “preserve its ability to serve its mission.” One of those steps was authorizing the engagement of a financial advisor.

Juniper is an independent and privately-held investment banking firm, based in Chicago, that specializes in hospital merger and acquisition and other strategic affiliation consulting. The firm served as advisor to Aria Health, the operator of three hospitals in Northeast Philadelphia and Bucks County, for its dealing that led to the health system joining Jefferson Health.

Click here for the full article from August 6, 2018. 


Juniper on Speaking Faculty at Healthcare Law Conference

Juniper VP Rex Burgdorfer presented at the 2018 Healthcare Law and Compliance Institute annual event at The Fairmont Hotel in Dallas, TX.

Rex presented “Managing M&A in an Increasingly Competitive and Transparent Marketplace.” Other speaking faculty included representatives from The Cleveland Clinic, Stanford Health Care, Intermountain Healthcare, Ropes & Gray, Skadden, Dell School of Medicine UT Austin, Katten Muchin, Hogan Lovells, Henry Ford Health System, Vanderbilt University Medical CenterYale New Haven Health, and many others.  We were honored to be included


Click here to learn more about the conference.


April 25th, 2018|News & Events|

How Good Shepherd Health System Jumped Four Moody’s Ratings

Good Shepherd Health System (GSHS), which operates two acute care hospitals, trauma centers, a joint venture home health agency, as well as other ancillary medical services, saw its Moody’s ratings improve by four levels.

Moody’s raised the Longview, Texas–based system’s rating from Caa1, the highest Caa level, to Ba3, the lowest Ba level. If an organization is rated Caa, Moody’s rates a system to be of “poor standing and subject to very high credit risk,” whereas those in Ba “have speculative elements and are subject to substantial credit risk.”

GSHS suffered for years from declining patient volumes, rising costs, and severe operational challenges prior to joining CHRISTUS Health System, a Catholic nonprofit that oversees more than 60 hospitals and hundreds of medical facilities, in February 2017.

Improvement in the Moody’s ratings were due in large part to CHRISTUS management, including a service line review regarding different services offered by GSHS as well as strategies to improve cash flow and liquidity.

In FY 2017, GSHS had $42 million on hand, due to “significant losses and turnaround costs.” By the end of 2017, GSHS improved to $45 million on hand,

April 24th, 2018|News & Events|

Cleveland Clinic Selected as Hospital Partner of Choice in Vero Beach, Florida

Members of the Indian River Medical Center (IRMC) Board of Directors and the Indian River County Hospital District (IRCHD) have selected Cleveland Clinic as their partner to fuel future growth and the continued delivery of quality healthcare services by IRMC. This decision was reached after a partnership process that involved careful consideration by both the Hospital Board and the District Trustees. With Cleveland Clinic, IRMC will continue a long history of patient-first healthcare delivery to Indian River County and surrounding areas.

Cleveland Clinic and Community Benefit

Juniper Advisory is acting as IRMC’s financial advisor during this strategic partnership process. IRMC’s ability to attract interest in a business combination from four exceptional hospital companies is a significant accomplishment for the hospital and its local communities. In particular, the selection of Cleveland Clinic by a mid-sized hospital in Florida represents the first partnership of its kind between such a highly-ranked, internationally known health system and a hospital.

The Local Government’s Role
Like many hospitals across the United States, IRMC is a community-sponsored hospital company that leases property and buildings from a local governmental entity — in this case, a health district. This is

January 30th, 2018|News & Events, News-Home|

Barry Sagraves Interviewed for McDermott Will & Emery’s Governing Health Podcast Series

Juniper Advisory’s Barry Sagraves was interviewed for Governing Health, a monthly podcast series hosted by the law firm McDermott Will & Emery. Barry, in conversation with McDermott Will & Emery partner Michael Peregrine, presented “Board Oversight of Health Care M&A.”

The podcast, a resource for hospital and health system board members, explored the latest trends in health system partnerships and the shifting factors that may be changing the way transactions are considered and carried out today.

Some topics explored in the interview include:
– Availability of potential partners and the “right time” for a partnership exploration
– Growing public acceptance of the exploration of strategic options by independent hospitals
– Role of economic and non-economic considerations in a process
– Uptick in number of partnerships being pursued by governmental hospitals
– Role of population health and vertical integration in the consideration of a partner
– National macro-factors, including insurance risk corridors and state Medicaid funding and waivers

Click here to listen to the full podcast.

August 22nd, 2017|News & Events|

University Health Care System Acquires Trinity Hospital of Augusta

University Health Care System (UHCS), an integrated nonprofit health system based in Augusta, GA, has acquired Trinity Hospital of Augusta (Trinity) from Quorum Health Corporation, a for-profit system headquartered in Brentwood, TN. The integration of Trinity will allow UHCS to strengthen its delivery of high-quality and efficient care throughout greater Augusta and neighboring communities in Georgia and South Carolina. This includes the enhancement of medical services throughout the region and increased access for the communities that UHCS serves.

UHCS will invest immediately in critical capital improvements at Trinity, including a new roof, installation of a nurse call system, and a full EHR transition to Epic by the end of the year. Trinity will provide much-needed facility space, allowing UHCS to alleviate significant capacity issues at the system’s main campus and positioning UHCS for efficient and cost-effective future growth. Trinity will become a satellite campus of University Hospital and will be renamed University Hospital Summerville in honor of the hospital’s campus in the heart of historic Summerville.

Juniper’s Role
Juniper served as UHCS’s exclusive investment banking advisor as the system pursued a strategic growth strategy. This included an assessment of market

Health System M&A Outlook: Juniper Advisory and Jarrard Interviewed Ahead of Becker’s Hospital Review’s Annual Meeting

Juniper Advisory’s Rex Burgdorfer and Jarrard’s Anne Hancock Toomey were interviewed ahead of their panel for the 8th Annual Becker’s Hospital Review Meeting. The session, titled “The Mergers and Acquisitions Market: Assessing Deals and Whether or Not to Merge, Sell or Align,” also included insights from attorneys Jeff Peterson and Geoff Cockrell of the law firm McGuireWoods.

In the interview, available below, Rex and Anne gave an overview of the current state of the M&A landscape and offered thoughts for health systems currently considering a transaction.

Talk about what you’re seeing in the M&A landscape right now. What’s the rough consolidation outlook?

Rex Burgdorfer:

It’s interesting: This morning I was listening to Atul Gawande’s TED talk again and the things he was talking about five years ago – with checklists and standardization and a reasonable equation between cost and quality – are obviously still huge issues and leading reasons behind health systems’ belief that they need to combine.

The industry

April 19th, 2017|News & Events|

Central Iowa Healthcare Restructures and Joins UnityPoint Health

Juniper Advisory was engaged by the Board of Central Iowa Healthcare (CIH), an acute care nonprofit hospital in Marshalltown, IA, and the Creditors’ Committee to assist leadership in the assessment of partnership opportunities. Following a period of financial distress, including worsened leverage, liquidity, profitability, and collections, Juniper led the debtor in possession through a sale process pursuant to 11 U.S.C. § 363. The transaction allowed the hospital to remain open and retain hundreds of important jobs for the local community. Ultimately, CIH became part of UnityPoint Health, a 19-hospital health system which spans Iowa, Illinois, and Wisconsin. The transaction was awarded one of the The M&A Advisor’s Turnaround Sec. 363 Sales of the Year.

March 23rd, 2017|News & Events|

Rex Burgdorfer Moderates Panel for Healthcare and Life Sciences Private Equity and Finance Conference

Rex Burgdorfer served as the moderator for “Private Equity Investments in the Hospital Sector,” a panel at the 14th Annual Healthcare and Life Sciences Private Equity and Finance Conference, presented by McGuireWoods and RSM.

Panel participants included Sam Hutcheson, Vice President for Strategic Growth and Development for LifePoint Health, David Jarrard, President & CEO of Jarrard Phillips Cate & Hancock, and Jeffrey Peterson, Partner with McGuireWoods.

The panel explored topics related to private equity investments in the acute-care hospital industry from legal, strategic communications, and transactional perspectives, including the unique challenges and opportunities inherent to the space. The group also considered how private equity investments might impact future structural consolidation in the hospital industry.

For more information, including the full conference agenda, click here.

February 22nd, 2017|News & Events|