Sector Report: COVID-19 & U.S. Hospitals and Healthcare Systems

Los Angeles, CA — As the U.S. faces an unprecedented era of heightened uncertainty stemming from the outbreak of COVID-19, we as a nation have been starkly reminded of the critical role our hospitals and healthcare systems play in the provision of essential clinical services to communities and patients across the country. While under immense systematic pressure, exacerbated by COVID-19, it remains of vital importance for hospital and healthcare system leaders to actively monitor organizational readiness, embrace value-based care initiatives, and financial sustainability. In this report, FocalPoint's Healthcare Investment Banking team discusses the current state of the hospital and healthcare system sector as well as key elements facing providers as our healthcare system continues to transform.

The past several years have been characterized by an ever-increasing number of hospital and healthcare system providers falling into one of two distinct segments—the "haves" or the "have nots". The "haves" are described as providers with ample access to capital and resources to ensure organizational longevity and service continuity while the "have nots" are described as those lacking the size, scale and access to capital to ensure sustainable clinical operations.

This increasing divergence of hospital and healthcare system sector participant categories is highlighted through a historical analysis of recent hospital and healthcare system merger and acquisition ("M&A") trends. In both 2018 and 2019, of the M&A transactions that involved hospital and healthcare system target organizations, the vast majority were organizations characterized by relatively smaller net patient revenue bases. In 2018, of the 107 targets that reported revenues, nearly 80% were organizations with less than $500 million in net patient revenue, while 36% fell below the $100 million threshold. This trend persisted in 2019. Of the 86 hospital and healthcare system target organizations that executed M&A transactions in 2019, approximately 80% had a net patient revenue base below $500 million, with approximately 43% generating less than $100 million in total net patient revenue.

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About FocalPoint Partners, LLC
FocalPoint is an independent investment bank specializing in mergers and acquisitions, private placements, financial restructurings, and special situation transactions. The firm provides advisory services to middle market clients in aerospace and defense, business services, consumer, energy, financial services, healthcare, industrials, and media/technology. With offices in Los Angeles, Chicago, New York, and Shanghai, and affiliated partner offices around the world, FocalPoint's domestic and international coverage across eight key industry verticals is truly global. Visit focalpointllc.com and follow us on LinkedIn and Twitter.

About FocalPoint Healthcare Investment Banking
FocalPoint's Healthcare Investment Banking team provides differentiated M&A and financial advisory services to a wide range of healthcare providers and organizations. Our team's experience and expertise includes advising hospitals and healthcare systems across the country in the analysis and execution of all forms of strategic transactions spanning from less-integrated strategic affiliations and joint ventures to fully-integrated membership substitutions, mergers, acquisitions, and assets sales and dispositions. FocalPoint's in-depth knowledge of the clinical, financial and strategic factors impacting hospitals and healthcare systems enables us to serve a diverse client base ranging from rural community-based hospitals to multi-hospital, regional and national integrated health systems. For more information, visit focalpointllc.com/healthcare or contact a healthcare practice team member:

Michael Fixler, Managing Director, mfixler@focalpointllc.com
Hector Torres, Managing Director, htorres@focalpointllc.com