interrobang

Spotlighting original BirdDog reporting and why a few headlines from elsewhere matter for Tennessee.

A private equity shop courts LifePoint Health . Photo by Rick Tap on Unsplash

FROM BIRDDOG

New: Cash is king in opioid treatment centers, new Vanderbilt policy center finds

New: Blockchain, journalism and the tension between search and quality

Early voting for the primary kicked off just over a week ago. Here’s what statewide turnout looked like in the first week, and catch up on why this is a pivotal election that could up-end a 40-year governorship cycle and why the “future of the Republican Party is at stake.”

FROM ELSEWHERE

1. Buyout firm Apollo in advanced talks to buy LifePoint Health

Reuters

This is an interesting (prospective) deal for greater Nashville as health care confronts a variety of industry-shaping trends. Hospitals, including those owned by LifePoint, are seeing more care shift to outpatient settings and feeling the pinch as people pick up larger shares of bills under high deductible health plans. LifePoint noted that both trends will continue in its most recent quarterly filing.

Bits to consider:

»»LifePoint operates in 22 states and at the end of March had 71 hospitals. Per Reuters, Apollo wants to merge LifePoint with RCCH Healthcare Partners, which would add 16 hospitals in eight new states.

That mash-up would create an operator with nearly 90 hospitals that isn’t beholden to the quarterly scrutiny of investors and the drum beat to hit guidance.

HCA Healthcare emerged from a PE-owned stint stronger than when it was purchased. For a full history lesson, read this.

»»The Apollo deal would put RCCH into a larger platform, potentially unlocking workforce synergy — to use corporate jargon. LifePoint and RCCH headquarters are three miles apart in Brentwood.

And, it would mean that Nashville’s roster of hospital operators would be consolidated down to Ardent Health Services, Community Health Systems, HCA Healthcare and LifePoint. RCCH is the combined entity out of the RegionalCare and Capella Healthcare merger in 2016.

»»Rural hospitals face a variety of challenges, including these LifePoint mentioned in its recent 10Q:

• a harder time bringing in patients who may opt to travel to a larger facility in a nearby metro area
• self-rationing of care as rural economies stagnate
• “extreme competition” when recruiting physicians, particularly specialists

LifePoint’s payor mix at the end of Q1 was 38 percent Medicare, 14 percent Medicaid, 46 percent private payor, 0.4 percent self-pay, and 1.7 percent other. LifePoint has an earnings call scheduled for July 27 — if there’s not a separate call to discuss the proposed transaction before, that call should be interesting.

As they say, you can take the reporter off the M&A beat but you can’t take the M&A beat out of the reporter. So when I saw this late Friday, I had the urge to hop on the phone to start drumming up the details about who is advising which party and ask what kind of debt would be issued — all the goods I chased for 5.5 years on the power/utility M&A beat in NYC. Alas.

2. Americans paid over $100 billion in credit-card interest in 2017—and they’ll pay even more this year

Maria Lamagna, Marketwatch

The credit card interest and fees that Americans paid in 2017 ($104 billion) were 35 percent higher than five years prior, and the amount is set to grow this year if the Federal Reserve raises rates four times, according to analysis by MagnifyMoney.

Excerpt: “Americans carry a collective $687 billion in credit card debt that is not paid in full each month… that breaks down to an average balance of $6,348 for people with credit cards, according to the credit agency Experian.”

3. Casualties Mount Around the World in Trump’s Trade War

Bloomberg

Bookmark this if you want to check in on which company says what about tariff impacts, and when. Bloomberg is updating this page with comments and color codes whether companies will be negatively or positively impacted.

4. Insurance companies say they have enough doctors, but complaints of long wait times form patients persist

Megan Messerly, The Nevada Independent

Across the country insurers are moving to narrower networks, which cuts costs by limiting the roster of physicians a person can see.

In Tennessee, Networks that excluded Saint Thomas Health and Vanderbilt University Medical Center on the federally run exchange in years past spurred outrage from people who would see their doctors go out-of-network. Narrow networks may be features of employer-sponsored plans as well.

This is a great dive into how narrow networks can create “two realities” writes Messerly, excerpt: “On one hand, insurance companies insist that they have enough physicians to meet state and federal standards, where those standards exist; on the other, lawmakers say their constituents complain of sometimes months-long wait times to get in to see a doctor.”

•