In today’s highly competitive healthcare environment, investors may find themselves in an auction process where they must conduct due diligence pre-exclusivity. With limited time and mounting pressure, it can be difficult to know what issues to prioritize. Here are some practical tips for focusing your due diligence efforts strategically in a pre-exclusivity setting:

  • Quality of Earnings: Against the backdrop of high valuations, quality of earnings should be a key diligence focus, particularly in the context of high-complexity transactions  such as corporate carve-outs, partnerships with corporates and public-private pairings. For example, it is critical to examine the pro forma EBITDA to see if it excludes costs or includes questionable adjustments or add-backs.
  • Timeline: How competitive is the auction process and when are bids due? Does the buyer plan to conduct a full due diligence review pre-exclusivity, or instead look for big ticket liabilities that have a potential to impact valuation or derail the transaction?
  • Legal Showstoppers: Keep an eye out for legal showstoppers—issues that go to the core of the business, are not isolated incidents and are not fixable through purchase price adjustments, indemnification, escrow or enhanced compliance measures. For example, referral relationships that are based on illegal arrangements, systemic upcoding, quality of care issues, tenuous relationships with hospital partners, untenable and promised salary increases, a culture of non-compliance, or a retiring physician workforce without adequate succession planning.

As you plan your due diligence, keep in mind these additional factors that can inform how you structure your efforts:


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The current environment for healthcare transactions is fiercely competitive with high prices, tough deal terms and limited time for proper due diligence. In terms of both value and number of deals, 2018 was the biggest year for health care private equity (PE) since the financial crisis. More large cap PE firms are moving into the small and mid-cap space, increasing competition. At the same time, non-health-care entrants are competing with US and international PE, especially in the area of physician practice management and other related health care services.

Faced with this stiff competition, sponsors are getting more creative in their healthcare partnerships, whether that means partnering with management teams on new strategies, partnering with large strategics or even with one another.  These innovative collaborations can open up more investable opportunities, including public to privates and secondary trades among sponsors.

Even with these creative new opportunities, submitting a winning bid for a health care services business in a hotly contested auction can be a Herculean task. When outbidding the competition is not an option, here are some tips to help differentiate your offer:


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Megan Rooney
Partner
Office: Chicago
Years at Firm: 13

What is your favorite part about practicing health care law at McDermott? 

The team, the team, the team! It’s a pleasure to work with colleagues who have deep substantive expertise, prioritize client service, and are good human beings. As a healthcare M&A attorney, I am responsible for leading large teams of attorneys, including a variety of subspecialists, to drive efficient and effective outcomes and achieve business goals. I love knowing that, in nearly every instance, when an issue arises we have the specific expertise to handle it and there is no need to reinvent the wheel.

What is the biggest opportunity facing clients in your area of focus today? 

Our hospital and health system clients have a tremendous opportunity to improve the delivery of patient care, expand services provided to their communities and defend against the challenge of declining reimbursement through strategic partnerships. In addition to traditional hospital and health system M&A, our hospital and health system clients are increasingly pursuing Collaborative Transformations – that is, partnerships with non-traditional health care players. A successful Collaborative Transformation takes cultural integration between non-traditional partners, incorporating new technologies into health care regulatory compliance structures, and so much more.


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Matt Friendly
Associate
Office: Miami
Years at Firm: 5

What is your favorite part about practicing health care law?

I appreciate that health care is constantly evolving and changing. While the vastness of the field can be intimidating for some, it provides career-making opportunities to gain experience in a sub-specialty and build a reputation within