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Health care costs + prospective pricing = riskier capital financing.

The author discusses four types of strategies that hospitals can employ to maintain or enhance their access to the capital markets during the era of prospective pricing: (1) diversification of assets, (2) diversification of funding sources, (3) assumption of greater risk, and (4) increasing use of financial guarantee intermediaries.

Capital Financing↗

Capital financing options for group practices.

Group practices that are looking for capital partners need to demonstrate that they have the necessary management capability to operate a successful business capable of repaying the debt. Two basic types of debt financing are available to group practices: fixed-rate financing and variable-rate financing. Fixed-rate financing, the more common method, involves borrowing a specific amount of money and then paying off the debt in principal-and-interest payments, much like a fixed-rate mortgage. Variable-rate financing, on the other hand, involves obtaining a letter of credit from the lender itself or independent guarantor to secure a loan. The variable-rate method is more efficient and flexible, because the notes secured by the letter of credit can be rated independently and sold into public capital markets like short-term, variable-rate paper. Both types of financing can require the personal guarantee of all physicians in the group practice.

Capital Financing↗

Predictions about the future of capital financing.

Ratings analysts, investment bankers, and hospital and association executives examine current and expected constraints on access to capital, some alternatives to traditional tax-exempt financing, and the types of strategies hospitals and their boards need to pursue.

Capital Financing↗

Strong cash flow, balance sheet, management, key to capital needs. Symposium on Healthcare Directions: the capital financing imperative.

For a full day, 10 individuals representing varied health fields and viewpoints within the healthcare industry discussed a number of topics confronting health care and predicted what the environment is likely to be in three years (see accompanying sidebars for symposium participants and purpose). This article focuses on one of the symposium topics, capital availability and financing, and the implications in a time of declining utilization.

Capital Financing↗

Opportunities and risks in Philadelphia's capitation financing of public psychiatric services.

The city of Philadelphia was one of nine sites selected by the Robert Wood Johnson (RWJ) Foundation and the U.S. Department of Housing and Urban Development (HUD) to receive five-year funding to improve the delivery, quality and cost efficiency of public mental health services to its chronically mentally ill population. As part of the RWJ project, the city plans to restructure its delivery and reimbursement system, creating a not-for-profit central authority which will function as a health insurance organization (HIO) responsible for coordinating and managing psychiatric care to Medicaid clients. Operating under a model of capitation, the central authority will employ diverse funding mechanisms to finance and manage service delivery. This paper examines the benefits and risks inherent in the reorganization of Philadelphia's mental health service system under a capitation financing model. Issues considered include cost and utilization patterns, treatment outcomes, providers and their staffing patterns, service mix and the overall impact of capitation on clients.

Capitation Fee↗

Critical access hospitals enter a new era of capital finance.

One day this month, with the grand opening of Rio Grande Hospital in Del Norte, Colo., the healthcare industry will have cause to celebrate the completion of the first critical access hospital (CAH) financed with bonds enhanced by HUD FHA-242 mortgage insurance (average interest rate: 5.45%; rating: AA/Aa/AA).

Capital Financing↗

Capital finance and ownership conversions in health care.

This paper analyzes the for-profit transformation of health care, with emphasis on Internet start-ups, physician practice management firms, insurance plans, and hospitals at various stages in the industry life cycle. Venture capital, conglomerate diversification, publicly traded equity, convertible bonds, retained earnings, and taxable corporate debt come with forms of financial accountability that are distinct from those inherent in the capital sources available to nonprofit organizations. The pattern of for-profit conversions varies across health sectors, parallel with the relative advantages and disadvantages of for-profit and nonprofit capital sources in those sectors.

Capital Financing↗