The volume and value of hospital mergers and acquisitions increased in the third quarter of 2013 when compared with the same period in 2012, although the fundamental reasons for the market consolidations are essentially the same, according to a PwC report. Healthcare sector churn is far from settled.
The volume and value of hospital mergers and acquisitions increased in the third quarter of 2013 when compared with the same period in 2012, although the fundamental reasons for the market consolidations are essentially the same, PricewaterhouseCoopers says in a new report (PDF).
The total number of hospital merger and acquisition transactions globally increased from 12 in Q3 2012 to 19 in Q3 2013, an increase of 58.3%. Conversely, for the first nine months of 2013, overall deal volume dropped 6.6%—from 60 in YTD12 to 56 in YTD13. Overall deal value increased significantly from $38 million in Q3 2012 to $12.3 billion in Q3 2013. This is the result of hospital system acquisitions valued at more than $1 billion in Q3 2013. Excluding those mega-deals, PWC says the remaining transactions were smaller and may not have disclosed deal value information based on these being private or not-for-profit transactions.
The merger and acquisition activity was led by Community Health Systems Inc.'s $7.6 billion acquisition of Health Management Associates and the completed merger in September of Scott & White Healthcare and Baylor Health Care Systems.
Dan Farrell, a partner at PwC, says uncertainties around the Patient Protection and Affordable Care Act continue to press consolidation in the healthcare market place: building economies of scale, capital needs, and improving market share. The PPACA creates ramifications for healthcare delivery and reimbursements and capital needs.
"I don't think much has changed in terms of the fundamentals from last year to this year. Everyone is bracing themselves for what they are predicting will be the changes around the Affordable Care Act," Farrell says. "Not too much certainty has been given through today, so people are still placing their bets on where they think things are going to fall out."
Farrell says the concerns of providers around concepts such as accountable care organizations lies not so much in whether or not the new value-based reimbursement model will work, but what optimal structure ultimately will take shape.
"There are two dynamics that everyone can agree on with ACOs and the impact of the ACA," he says. "One, you need to increase your scale because you are going to deal with a lot more at-risk contracts. So, where you have at-risk arrangements, scale can minimize the potential financial risk.
"A little more technically complex is the need to extend your continuum of care, specifically around hospitals and physician practices. Payers are looking at building out their continuum of what they control beyond the four walls of the hospital and into other areas such as home health, long-term care, and skilled nursing. So we see a lot of deals that are focused either around: one, increasing the scale or, two, extending the continuum of care."
While the value and volume of healthcare mergers and acquisitions will vary from quarter to quarter, Farrell says the underlying catalysts will remain in place for the foreseeable future.
"You see the same themes, which is health systems or large national players looking to find lower cost settings of care outside of the hospital," he says. "Once again, coming full circle you have people looking at taking at-risk contracts and accepting more of a population health view and where they do that they want to make sure they are capable of providing care in the lowest possible care setting."
The current healthcare sector churn is far from settled. "As long as there is still some significant uncertainty from the payer/provider perspective, you are going to have people placing their bets on the roulette table on where they think things will shake out," he says. "We had the technical glitches with the insurance exchange implementation, and the effectiveness and structure of the ACOs are still an undecided area. Many people are still considering where they think the sectors individually are going to head. We see transition activity that represents that uncertainty."
John Commins is the news editor for HealthLeaders.