Hospital merger and acquisition activity took a breather in the first quarter of this year. The 19 deals announced then represented a 17% decrease compared with the 23 deals announced in the fourth quarter of 2016, and a 30% decrease year over year.
Readers who saw headlines in April regarding a rush of hospital mergers in the first quarter, according to data published by Kaufman Hall, should know our differing results are due to methodology. We do not report hospital mergers or acquisitions when the announcement involves signing a letter of intent, when many deals fall apart soon after. Our data derives from the more solid step in the process, when both entities have reached a definitive agreement, or completed the transaction.
April saw only four announced hospital deals, which indicated that the second quarter would repeat the activity of the first. Then came May 1, when five deals were announced. Two more were disclosed in the first week of the month. The seven deals involved 10 hospitals and a combined total of 3,106 beds. Quite a change from the previous month.
With those numbers, it’s obvious some large hospitals were trading. Two deals actually did create greater market share for the acquirers. The first is Memphis-based Baptist Memorial Health Care, which operates 17 hospitals in Arkansas, Mississippi and Tennessee.
This major not-for-profit reached across the border to acquire Mississippi Baptist Health Systems, based in Jackson. Mississippi Baptist operates four hospitals in the state: Mississippi Baptist Medical Center in Jackson (629 beds), Baptist Medical Center-Attala (25), Baptist Medical Center-Leake (25) and Baptist Medical Center-Yazoo (25).
The two entities have been in merger discussions since September 2016, and got the blessing of the Federal Trade Commission before going public with the final step. As a result of this merger, Baptist Memorial becomes the largest healthcare provider in the mid-South, and the largest healthcare system in Mississippi.
Further north, another merger created the second largest hospital network in New Jersey, as Hackensack Meridian Health (fka Hackensack University Health Network) merged with JFK Health, a two-campus health system with 357 beds, as well as the Johnson Rehabilitation Institute, skilled nursing facilities, a neuroscience institute and several outpatient programs and services.
The deal creates a system of 15 hospitals, including two academic medical centers, two children’s hospitals and 10 community hospitals; a network of physician practices with 7,000 physicians; more than 140 ambulatory surgery centers; and many other outpatient programs and services.
The largest healthcare system in the state is still RWJ Barnabas Health, formed in July 2014 by the merger of the Robert Wood Johnson Health System and Barnabas Health, which was already New Jersey’s largest healthcare system. RWJ’s four acute-care hospitals were added to Barnabas’ six hospitals. The system also has three children’s hospitals and a 100-bed behavioral health care hospital.
Community Health Systems (NYSE: CYH), HCA Holdings (NYSE: HCA) and Tenet Healthcare (NYSE: THC) all reported first quarter earnings in the first week of May, and with them came more acquisition announcements.
Community Health announced the sale of three hospitals in two separate deals, as part of its previously announced debt reduction strategy. Two Texas-based hospitals (417 beds, combined), went to HCA for an undisclosed price. Its Lake Area Medical Center (88 beds) in Lake Charles, Louisiana was acquired by Christus Health.
Tenet unloaded three hospitals in the Houston metro area: Houston Northwest Medical Center (423 beds); Cypress Fairbanks Medical Center (181 beds); and Park Plaza Hospital (444 beds), to HCA for $725 million. It was the only hospital deal that week to report a price, which averages out to a whopping $691,794 per bed, and multiples of 1.3x revenue and 8.8x EBITDA.
HCA already operates 10 hospitals in the Houston MSA, as well as eight surgery centers, two freestanding emergency rooms and 10 imaging centers.
Both sellers, Community Health and Tenet, reported upbeat earnings in early May, while HCA’s previously released earnings came in slightly below expectations. We may not see more divestitures among these companies, but there may be more activity to come on the not-for-profit side, particularly if the Senate doesn’t follow the American Hospital Association’s recommendation to “rewrite and reset” the American Health Care Act on a friendlier path for hospitals.
