Cain Brothers Investment Bankers to the Health Care Industry

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Cain Brothers' Columns & Articles


Hospital and ASC Trends from 4Q13 Earnings

By Jamie King, Cain Brothers' Industry Insights newsletter #862, 03/24/14.
Jamie King provides an update on recent inpatient and outpatient volume and revenue trends.


Stand-Alone Hospitals Continue to Exhibit Weaker Capital Investment

By Dean Scarano, Cain Brothers' Industry Insights newsletter #861, 03/17/14.
Dean Scarano provides an update of his hospital capital investment analysis and comments on the continuing pressures that stand-alone hospitals face.


Hospitals and ACOs Are Learning Many SNFs Aren't Network Ready

By Bill Pomeranz, Cain Brothers' Industry Insights newsletter #860, 03/10/14.
Bill Pomeranz notes that most SNFs are not network-ready and that hospital executives need to pay greater attention to cultivating their post- acute care network relationships.


Shifting the Model: Direct Access to Physical Therapy

By Haneul Aharoni, Cain Brothers' Industry Insights newsletter #857, 02/17/14.
Haneul Aharoni discusses consumer direct access and self-referral to physical therapy, which is becoming an increasingly important driver of outpatient therapy utilization.


A Stable Outlook Ahead for the Senior Living Sector

By Liza Hing, Cain Brothers' Industry Insights newsletter #852, 01/13/14.
Liza Hing discusses the stable outlook for the senior living sector by highlighting and expanding upon recent comments by Fitch Ratings.


Managing Increasing Continuing Disclosure Requirements

By James Conahan, Cain Brothers' Industry Insights newsletter #848, 12/02/13.
James Conahan offers some continuing disclosure requirement advice to tax-exempt borrowers.


Dodd-Frank Swap Regulations

By Andy Labovitz, Cain Brothers' Industry Insights newsletter #842, 10/21/13.
Andy Labovitz discusses the effect of the Dodd-Frank legislation on participants in the interest rate swap market.


Shifting Risk / Reward in the CRO Market

By Chris McDonough, Cain Brothers' Industry Insights newsletter #841, 10/14/13.
Keying off of Merck's recent announcement about reducing its R&D budget, Chris McDonough discusses outsourcing and the pharma contract research organization sector.


CMS' Policy on Home Health Shifts from Death by a Thousand Cuts to Swinging a Hatchet

By Eugene Goldenberg, Cain Brothers' Industry Insights newsletter #826, 07/01/13.
Due to the substantial proposed cuts in Medicare reimbursement for home health care services announced last week by CMS, Eugene Goldenberg foresees a massive consolidation opportunity for the well-capitalized and payer-aligned providers, who, if successful at weathering the initial reimbursement storm shakeout, may be able to acquire home health assets at significantly depressed valuations.


Does Size Matter?

By Elizabeth Kim, Cain Brothers' Industry Insights newsletter #824, 06/17/13.
Elizabeth Kim points out that the first and foremost question the boards and management teams of acute care organizations should be asking is not "Are we big enough?" but "How do we stay relevant in our market?"


State Health Insurance Exchanges Are Just Around the Corner

By Ed Fishman, Cain Brothers' Industry Insights newsletter #823, 06/10/13.
Ed Fishman provides his perspective on state health insurance exchanges.


Strategic Alternatives for Government-Owned Hospitals

By Chris Everett, Cain Brothers' Industry Insights newsletter #820, 05/20/13.
In light of recent Florida legislation that requires government-owned hospitals to evaluate the benefits of selling or leasing their facilities, Chris Everett discusses the applicability of such a process to government-owned hospitals throughout the country.


The Broken Not-for-Profit Capital Model

By Carsten Beith, Cain Brothers' Industry Insights newsletter #815, 04/15/13.
Hospitals and health systems have the daunting challenge of needing to build balance sheet cash to maintain access to tax-exempt debt, while also making capital investments in areas like IT and physician integration strategies that reduce the very same balance sheet cash and dont support tax-exempt financing. As a result, Mr. Beith expects to see more not-for-profit organizations linking with investor-owned operators in order to access the for-profit sector's more efficient capital.


Hospital Capital Spending Builds Closer to Historic Levels

By Dean Scarano, Cain Brothers' Industry Insights newsletter #811, 03/18/13.
Not-for-profit acute care hospital and health system capital expenditures in 2012 are on track to approximate their all-time high record set in 2008 of $50.8 billion, once numbers are finalized. However, although the percentage of capital expenditures to depreciation expense has risen for two consecutive years, it still lags the ten-year historic average of 160%, which suggests that increased capital spending will continue to rise in the coming year.


Readjusting CCRC Pricing and Entrance Fee Refund Levels to Maximize Long-Term Value

By Bill Pomeranz, Cain Brothers' Industry Insights newsletter #810, 03/11/13.
Bill Pomeranz discusses adjusting CCRC pricing and entrance fee refund levels in order to create long-term value and increased financial and operational flexibility.


Good Shepherd Health System's Debt Recapitalization Strategy

By Bette Kraus, Strategic Financial Planning (an HFMA publication), Spring 2013.
Bette Kraus writes about Good Shepherd Health System's strategic approach to debt recapitalization.


Repeal of Medicare's Sustainable Growth Rate Formula - Any Closer to Reality?

By Stewart Carr, Cain Brothers' Industry Insights newsletter #806, 02/11/13.
Stewart Carr writes about the SGR and "doc-fix" and notes that the groundwork has been laid for achieving a long-term solution to a 15-year old dilemma.


Animal Health - Best of Health Care and Retail

By Christian Pesci, Cain Brothers' Industry Insights newsletter #805, 02/04/13.
Christian Pesci discusses the animal health care sector, which is ripe for consolidation.


Risk In All The Wrong Places

By Bill Deuchler, Cain Brothers' Industry Insights newsletter #798, 12/03/12.
Cain Brothers Asset Managements' Bill Deuchler points out that the fixed income market potentially contains far more risk than many investors understand.


Guideposts for Health Care Organizations

By Wyatt Ritchie, Cain Brothers' Industry Insights newsletter #782, 08/06/12.
Wyatt Ritchie draws lessons from the financial services and automotive industries that are applicable to health care organizations.


Value is in The Eyes of the Beholder

By Joe Mulligan, Cain Brothers' Industry Insights newsletter #778, 07/09/12.
Joe Mulligan offers thoughts about using an enterprise valuation approach for enhancing value and increasing debt capacity for senior living providers.


Impact of SCOTUS Health Care Reform Decision on Not-For-Profit Hospitals

By Chris Everett, Cain Brothers' Industry Insights newsletter #777, 07/02/12.
Chris Everett comments on the Supreme Court's PPACA decisions last week (end of July, 2012).


Big Data Coming to Health Care Soon

By Ray Falci, Cain Brothers' Industry Insights newsletter #776, 06/25/12.
Ray Falci discusses the use of Big Data in health care to improve many facets of cost and quality.


Testing the Limits: The Growth of the Medicare and Medicaid Populations

By Alfonzo Leon, Cain Brothers' Industry Insights newsletter #774, 06/11/12.
Alfonzo Leon highlights the unfavorable trend of fewer and fewer employed persons compared to persons covered by Medicare and Medicaid. He points out that, at some point, the basic math behind the trend will force us to make drastic decisions to balance the equation.


New Challenge Ahead: The Commoditization of Health Care

By Carsten Beith, Cain Brothers' Industry Insights newsletter #771, 05/21/12.
Carsten Beith discusses the commoditization of the health care sector.


Transforming Healthcare's Subjective Data Into Information: Driving the Proliferation of Best Practices Toward Evidence-Based Medicine

By Raymond G. Falci, Managing Director, Cain Brothers, and Daniel M. Lindenberg, Esquire, Halloran & Sage, HIT News, Volume 15, Issue 2, May 2012. Copyright 2012 American Health Lawyers Association, Washington, DC. Reprint permission granted.
The authors decode the vocabularies and technologies used to access, store, and create comparability across disparate financial and clinical systems that are being used to create true evidence-based medicine.


Hospital Capital Spending Shows Modest Uptick for 2011 but Deferred CapEx Continues to Build

By Dean Scarano, Cain Brothers' Industry Insights newsletter #768, 04/30/12.
While capital expenditures were up in 2011 after sharp consecutive declines in 2009 and 2010, Dean's analysis shows that the proportion of CapEx-to-Depreciation has not yet stabilized at levels observed in the early 2000s and the amount of deferred capital expenditures continues to build.


Medicare Reform - A Serious Challenge for CCRCs

By Bill Pomeranz, Cain Brothers' Industry Insights newsletter #767, 04/23/12.
Bill Pomeranz discusses challenges facing CCRCs that stem from local housing market conditions, Medicare reform, and the strategies of rental housing providers. He suggests that adding a Medicare component to a CCRC's skilled nursing revenue mix lines can enhance overall profitability.


Post-Acute Services in the Age of Bundled Payments

By Jim Moloney, Cain Brothers' Industry Insights newsletter #754, 01/23/12.
Jim Moloney highlights considerations relating to new strategies and care models in an age of bundled payments.


Will Accountable Mean Enjoinable? - Anti-Merger Enforcement Collides with a Consolidating Hospital Industry

By Steve Renn, Cain Brothers' Industry Insights newsletter #749, 12/05/11
Steve Renn's very informative commentary on recent acute care hospital anti-trust activities is a must-read for hospital executives and advisors contemplating affiliations or mergers and acquisitions.


Physician Partnered Surgical Facilities Trends

By Jamie King, Cain Brothers' Industry Insights newsletter #746, 11/14/11
Jamie King highlights the recent M&A and capital raising activity in physician partnered surgical facilities.


Nontraditional Capital Sources: A Primer on Monetizing Medical Real Estate

By Tim Schier, Cain Brothers' Industry Insights newsletter #741, 10/10/11
Tim Schier provides a brief primer on monetizing medical real estate.


Blurring Lines Between Payors and Providers

By Court Houseworth, Cain Brothers' Industry Insights newsletter #739, 09/26/11
Court Houseworth comments on the how and why the lines between payors and providers are blurring.


Expecting Health Care Reimbursement Cuts

By Wyatt Ritchie, Cain Brothers' Industry Insights newsletter #737, 09/12/11
Wyatt Ritchie reviews what Congress' new Super Committee is tasked with in terms of reducing the Federal budget deficits, notes that health care is the budget's largest single expenditure line item, and concludes that health care is an obvious target for spending cuts.


Henny Penny (aka Chicken Little)

By Ed Fishman, Cain Brothers' Industry Insights newsletter #735, 08/29/11
Ed Fishman suggests that, despite the recent downdraft in managed care stock prices, there are still plenty of opportunities for these companies, although business models may have to change.


mHealth — Enabling the Virtual Marcus Welby

By Ray Falci, Cain Brothers' Industry Insights newsletter #734, 08/22/11
According to Ray Falci, the advent of smart phones and other advanced mobile devices create opportunities to address many of the evolving challenges in our health care system, which has led to escalating investing in mobile health, or mHealth.


Shorter Queues and Lower Rates: An Update on FHA Section 232

By Nick Nicholson, Cain Brothers' Industry Insights newsletter #732, 08/08/11
Nick Nicholson highlights the benefits and program requirements of FHA insured loans for long-term residential facilities and points out that FHA is taking steps to speed the underwriting and commitment process.


Most Current Data on Hospital Capital Spending Show a Growing Backlog

By Dean Scarano, Cain Brothers' Industry Insights newsletter #723, 06/06/11
Dean Scarano highlights Cain Brothers' research that indicates there are $10 - $11 billion of deferred capital expenditures among acute care providers, which is a result of the 2008 credit crisis and subsequent recession. Dean points out the clear implications for increased, catch up borrowings in the public debt markets, as well as an increased interest in strategic combinations, as hospitals strive to remain competitive.


Post-Acute Care and Multi-Level Senior Living

By Bill Pomeranz, Cain Brothers' Industry Insights newsletter #721, 05/23/11
Cain Brothers' research indicates that multi-level senior living facilities that have aggressively pursued short-stay rehabilitative skilled nursing care services and marketing have tended to have more favorable financial results than those that offer predominately convalescent care, even all private pay care, in their skilled care units. An implication of this is that providers without extensive short-stay rehab expertise may wish to consider outsourcing in order to improve profitability, according to Bill Pomeranz.


Managed Care: The Market vs. Reality

By Court Houseworth, Cain Brothers' Industry Insights newsletter #719, 05/09/11
Court Houseworth reviews the stock price volatility of managed care organizations over the past several years and offers the opinion that the MCOs have a strong platform for future growth and role to play in various aspects of health care reform.


Inflation and the Health Care Industry

By Jim Moloney, Cain Brothers' Industry Insights newsletter #710, 03/07/11
Although CPI has remained relatively low, values for certain commodities and low-risk asset classes have increased in recent periods, and the health care industry has benefited from increased valuations and has attracted significant investor interest. However, according to Jim Moloney, if inflation starts to rise and the Fed is unable to successfully keep it in check, higher interest rates could become a challenge, especially for the not-for-profit hospital sector that must rely on debt capital for its primary source of external capital.


Not-For-Profit Behavioral Health Providers Should Consider the Tax-Exempt Financing Market

By Jim Cain, Cain Brothers' Industry Insights newsletter #706, 02/07/11
Not-for-profit behavioral health providers should be taking better advantage of tax-exempt financing alternatives. In that connection, Jim discusses some to the unique factors that the determine credit quality of behavioral health providers and how they differ from acute care providers.


Capitalizing Hidden Values from Hospital Assets

by Carsten Beith and James Vaughan, HFM, April, 2010
Monetizing noncore assets can be a source of capital for hospitals.


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