Capital Expenditures Increased at Rural Hospitals That Merged Between 2012 and 2015.

EXECUTIVE SUMMARY: The number of rural hospital mergers has increased substantially in recent years. A commonly reported reason for merging is to increase access to capital. However, no empirical evidence exists to show whether capital expenditures increased at rural hospitals after a merger. We used a difference-in-differences approach to determine whether total capital expenditures changed at rural hospitals after a merger. The comparison group (rural hospitals that did not merge during the 2012 through 2015 study period) was weighted using inverse probability of treatment weights. The key outcome measure was logged total capital expenditures.Merging resulted in a 26% increase in capital expenditures and also was associated with a significant improvement in plant age. The postmerger improvement in plant age may have been partially attributable to merger-related accounting changes and partially attributable to increased capital expenses, possibly on long-term asset renovations and replacement.These findings suggest that through mergers, rural hospital board members and executives who have accepted or are considering a merger may improve a hospital's ability to increase capital expenditures. Further, increased capital investments in rural hospitals may be an important signal to the community that the acquirer intends to keep the rural hospital open and continue providing some volume and level of services within the community. Future research should determine how capital is spent after a merger.

Skilled Nursing Center Data In For 2016.

Taking stock of the market's current and recent trends can help owners assess their business strategies.

The performance of the leveraged buyout of the Hospital Corporation of America, Inc.

BACKGROUND: A leveraged buyout (LBO) is a type of corporate reorganization and acquisition practice whereby private investors borrow a substantial amount of debt to acquire a firm by buying back its publicly held stock to go private. The Hospital Corporation of America, Inc. (HCA), went through its second LBO in July of 2006. A prior study on the performance changes of the first LBO found no significant changes in revenues, expenses, or profitability. PURPOSES: In this study, we evaluated the changes in performance measures for HCA hospitals during the second LBO period. We looked at the effect of the LBO on financial and operational performance indicators, controlling for market and hospital characteristics. METHODOLOGY: We identified 121 urban HCA hospitals that consistently reported data over a 4-year window from 1 year pre-LBO to 3 years post-LBO and evaluated their study performance changes during the period. Primary data for operational and financial measures are derived from Health Care Cost Report Information System data sets. FINDINGS: On the basis of this study, the LBO led to significant increases in cash flow margin, net patient revenues, and total asset turnover ratio. It also increased operating expenses significantly. However, it was not associated with changes in labor costs, staffing, and capital investment. PRACTICE IMPLICATIONS: The management of publicly traded hospitals that consider an LBO should develop operating strategies to maintain a strong cash flow performance and find ways to boost patient volume. It also needs to determine if it would be able to continue investing in its facilities to keep physicians and patients loyal and to keep investing in the training and retention of employees, which ultimately improves the quality of care and enhances operational efficiency.

Capital expenditure trends in California hospitals: 2002-2007.

From 1997 to 2001, hospitals expanded their capital expenditures by only 1% while future capital investment was expected to grow by 14% (Healthcare Financial Management Association 2004). Analyzing California hospital data from 2002 to 2004 to 2005 to 2007, the author identified and classified capital expenditures into 4 major types. Between the 2 study periods, growth in capital purchases exceeded 23% for medical equipment, expansion, and maintenance types of projects. Large nonprofit hospitals capturing a greater share of the market and serving fewer uninsured and government payers had a greater number of these types of capital purchases.

Association of market, organizational and financial factors with the number, and types of capital expenditures.

BACKGROUND: Prior literature provides only a descriptive view of the types and numbers of capital expenditures made by hospitals. PURPOSES: This study conducted an empirical analysis to assess simultaneously what market, organizational, and financial factors relate to the number of capital projects as well as the specific types: medical equipment, expansion, and maintenance projects. METHODOLOGY/APPROACH: Sampling California hospital capital expenditure data from 2002 to 2007, this study aggregated the number of capital projects by each type of capital investment decision: medical equipment, expansion, and maintenance/renovation per hospital. Using ordinary least squares regression, this study evaluated the association of these factors with these types of capital investment projects. FINDINGS: This study found that hospitals capturing a greater share of the market, maintaining high levels of liquidity, and operating with more than 350 beds invested in a greater number of capital projects per hospital as well as medical equipment and expansionary projects per hospital. PRACTICAL IMPLICATIONS: Within the state of California, the demand for health care services within a hospital market as well as cash and investment reserves were key drivers in the hospital CEOs and boards' decision to increase their capital purchases. The types of purchases included capital outlays related to medical equipment, such as CT scanners, MRIs, and surgical systems, and revenue-generating expansionary projects, such as new bed towers, hospitals wings, operating and emergency rooms, and replacement hospitals from 2002 to 2007.

Trends in asset structure between not-for-profit and investor-owned hospitals.

The delivery of health care is a capital-intensive industry, and thus, hospital investment strategy continues to be an important area of interest for both health policy and research. Much attention has been given to hospitals' capital investment policies with relatively little attention to investments in financial assets, which serve an important role in not-for-profit (NFP) hospitals. This study describes and analyzes trends in aggregate asset structure between NFP and investor-owned (IO) hospitals during the post-capital-based prospective payment system implementation period, providing the first documentation of long-term trends in hospital investment. The authors find hospitals' aggregate asset structure differs significantly based on ownership, size, and profitability. For both NFP and IO hospitals, financial securities have remained consistent over time, while fixed asset representation has declined in IO hospitals.

Risky business.

Over the past 18 months, as the recession has weighed on the economy and credit markets, American businesses, investors, and consumers have reduced their appetite for risk. Hospitals have rightly joined the pack, reducing exposure to financing risk and decreasing capital expenditures. However, payment reform will force providers to again embrace a type of operational risk that many have avoided since their experience with capitation in the 1990s.

Hospital capital spending: shifting and slowing even before the financial meltdown.

A recent study of changes in U.S. hospitals' capital spending and financing disclosed that between 2001 and 2007: Annual capital spending rose from $25.1 billion to $34.7 billion. Hospitals shifted capital spending toward physical infrastructure and away from equipment. Not-for-profit hospitals spent a significantly lower percentage of available funds on capital improvements in 2007 compared with 2001.

Association of market, operational, and financial factors with nonprofit hospitals' capital investment.

Capital investments in the latest medical equipment and the replacement of aging facilities are critical decisions for sustaining hospitals' financial viability. A recent survey over the period 1997 to 2001 found that hospitals increased their capital expenditures by only 1%. The aim of this study is to gain insight into the changes in market, operational, and financial factors that may have influenced hospital capital investment during this period. The sample consisted of a panel of nonprofit hospitals operating between 1998 and 2001. Capital investment was measured on the basis of capital purchases for buildings, fixtures, and movable equipment during a fiscal year. The results suggest that liquidity-the availability of internal funds-is a critical determinant of capital investment in both urban and rural facilities. From a market perspective, findings indicate that growth in the over-65 population led to increases in the capital investment of rural hospitals. Financially, an increase in cash flow also was strongly related to a change in capital investment among urban facilities. Surprisingly, rural hospitals with aging plants and equipment had declining capital investment.

[Financing problems of capital goods: part 1: leasing as a solution?]. / Finanzierungsproblematik von Investitionsgütern: Teil 1: Leasing als Ausweg?

The provision of financial support of hospitals by States for buying capital goods is becoming increasingly more limited. In order to still make investments, alternative forms of financing such as leasing must be considered in hospitals. However, the change from the classical form of dual financing and the decision to opt for a leasing model involves much more than just a question of costs. Leasing results in easily manageable expenditure, flexibility and adaptability for the choice of model but the leasing installments must be directly financed by the turnover from diagnosis-related groups and so lead to a reduction in the annual profit. In this article the authors try to give the reader an overview of the complex and sometimes counter-productive effect of financial instruments for investments in hospitals using leasing financing as an example. In the follow-up article the decision-making procedure using dynamic investment calculations will be demonstrated using a concrete example.

Global costs of attaining the Millennium Development Goal for water supply and sanitation.

OBJECTIVE: Target 10 of the Millennium Development Goals (MDGs) is to "halve by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation". Because of its impacts on a range of diseases, it is a health-related MDG target. This study presents cost estimates of attaining MDG target 10. METHODS: We estimate the population to be covered to attain the MDG target using data on household use of improved water and sanitation for 1990 and 2004, and taking into account population growth. We assume this estimate is achieved in equal annual increments from the base year, 2005, until 2014. Costs per capita for investment and recurrent costs are applied. Country data is aggregated to 11 WHO developing country subregions and globally. FINDINGS: Estimated spending required in developing countries on new coverage to meet the MDG target is US$ 42 billion for water and US$ 142 billion for sanitation, a combined annual equivalent of US$ 18 billion. The cost of maintaining existing services totals an additional US$ 322 billion for water supply and US $216 billion for sanitation, a combined annual equivalent of US$ 54 billion. Spending for new coverage is largely rural (64%), while for maintaining existing coverage it is largely urban (73%). Additional programme costs, incurred administratively outside the point of delivery of interventions, of between 10% and 30% are required for effective implementation. CONCLUSION: In assessing financing requirements, estimates of cost should include the operation, maintenance and replacement of existing coverage as well as new services and programme costs. Country-level costing studies are needed to guide sector financing.