Government-Affiliated Hospital Business Combinations: The Governance Dynamic

Many governmental hospitals might benefit from ownership change; in certain instances it is acutely needed. They face the same pressures to improve quality and lower costs that challenge most hospitals and health systems. In addition, they are confronted with complicated governance structures and disclosure requirements along with restrictions on capital.…

April 26th, 2019| Publications|

Regulatory Implications for Change of Control in Hospital M&A

The Federal Trade Commission (FTC) has provided new guidance on non-profit hospital business combinations that will result in more hospital transactions being reportable under the Hart-Scott-Rodino Act (HSR). Any affiliation that may result in a change in a hospital’s beneficial ownership, not just a change in governance, will likely now need to be reviewed by the FTC.…

February 20th, 2019| Publications|

Analysis: Hospitals Buoyed by Tenuous Investment Income

Investment income resulting from a strong stock market has propped up many standalone hospitals’ balance sheets over the past two years, according to a recent evaluation by Juniper Advisory. In analyzing a sample of independent hospitals’ financials, Juniper Advisory found that investment income accounted for nearly half of the hospitals’ net margin.…

December 12th, 2018| News-Home, Publications, Uncategorized|

The Intersection of Mission and Margin

As health care has transformed from a nascent local patchwork of services to one of our country’s leading industries, hospitals hold steadfast to their missions that have roots going back a century or more.

The precursors of many of our country’s public and non-profit hospitals were almshouses or sanitariums created by municipalities or religious orders.…

October 22nd, 2018| Publications|

Demonstrating Fairness in a Market Approach to Hospital M&A

As transactions between large systems become more common, and more strategically focused on patient concentration and needs rather than geographic boundaries, state regulators are taking a closer examination of hospital business combinations.

From California to Illinois to Florida, state attorney generals have applied increased scrutiny to recent hospital transactions, regardless of tax status or ownership type.…

September 26th, 2018| Publications|

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.…

August 29th, 2018| News & Events, Publications|

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.…

Our Take: A Case Study of Rural Success

Rural providers have been somewhat insulated by the transformation in the health care market over the past decade. Caught between understanding and implementing population health strategies, they are still heavily reliant on fee-for-service reimbursement models versus value-based care.  Rural hospitals are fighting for their margins, with few resources available to pilot innovative care strategies or make capital upgrades.…

July 25th, 2018| Publications|

Valuing the Troubled Hospital

Financial difficulties are commonly the catalyst for hospitals to begin exploring partnership options. As Rex Burgdorfer, Juniper Advisory Vice President, outlines in his latest article “Valuing the Troubled Hospital”, court-led restructuring is an option often considered by those with liquidity constraints and significant financial liabilities.…

June 22nd, 2018| Publications|

Multi-State Health Systems: On Their Way at Last

As mid-size health systems seek growth and meaningful scale, the most effective way to achieve this will be system combinations, and these will include those across state lines. The recently completed combination of Advocate Health Care of Chicago and Aurora Health Care of Milwaukee is an example of this kind of transaction cross-border combination.…

June 13th, 2018| Publications|