THe Diffenbaugh Report; A Medical Industry Newsletter for Healthcare Professionals

December
2001
Issue

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Ardent Health to Acquire KY Hospital

Ardent Health Services of Nashville, Tenn. (formerly Behavioral Healthcare Corp) announced that it has signed a definitive agreement to purchase Samaritan Hospital in Lexington, Ky. Samaritan Would Be Ardent's Second Medical/Surgical Hospital Purchase Since Announcing Plans to Expand Company Beyond Behavioral Health Services

      Ardent is purchasing the 336-bed hospital from Nashville-based HCA. Samaritan is the second medical/surgical hospital to be purchased this year by Ardent. The company purchased 201-bed Summit Hospital in Baton Rouge, La., in August.

      Samaritan Hospital opened in 1888, and serves the Lexington-Fayette County area and its surrounding Central Kentucky counties. The area has experienced significant growth in recent years, surpassing the national growth average by nearly five percent during years 1990 to 2000.

      Nashville, Tenn.-based Ardent Health Services is a provider of health care services to communities throughout the United States. In May, 2001, Welsh, Carson Anderson and Stowe, one of the country's largest private equity firms, became a majority owner of Behavioral Healthcare Corporation and re-named the company Ardent Health Services to reflect the expansion into medical/surgical hospitals. Ardent currently owns 21 free-standing pyschiatric and 2 acute care hospitals in 11 states, providing a full range of medical/surgical, psychiatric and substance abuse services to patients ranging from children to adults. Back to TOC

LifePoint Hospitals Completes Acquisition of Ville Platte Medical Center

LifePoint Hospitals, Inc. announced that it has completed, effective December 1, 2001, the purchase of Ville Platte Medical Center, a 116-bed acute care facility located in Ville Platte, Louisiana, and serving Evangeline Parish and South Central Louisiana.

      Kenneth C. Donahey, chairman and chief executive officer of LifePoint Hospitals, said, "We are excited to complete this acquisition. The Ville Platte community and medical staff have been tremendously supportive throughout this process. We look forward to working closely with the medical staff, employees and community to support the healthcare needs of Ville Platte and Evangeline Parish."

      LifePoint Hospitals, Inc. operates 23 hospitals in non-urban areas. In most cases, the LifePoint facility is the only hospital in its community. LifePoint's non-urban operating strategy offers continued operational improvement by focusing on its five core values: delivering high quality patient care, supporting physicians, creating excellent workplaces for its employees, providing community value, and ensuring fiscal responsibility. Headquartered in Brentwood, Tennessee, LifePoint Hospitals is affiliated with over 6,000 employees. Back to TOC

Life and Health Insurers Suffer 42 Percent Profit Decline

Profits of the nation's life and health insurers declined $6 billion, or 42 percent, during the first six months of 2001, compared to the same period in 2000, according to Weiss Ratings, Inc., the only provider of independent insurance company ratings and analyses.

      Meanwhile, the industry's return on assets fell 44 percent to 0.51 percent, and its return on equity fell 45 percent to 7.3 percent, with the latter falling below 10 percent for the first time since 1995. The profit declines are primarily due to a $2.2 billion capital loss on the sale of invested assets as well as a $3.1 billion decline in overall operating profits.

      "All of these declines took place in the first and second quarters of the year, long before the September 11 events, and they began well before the onset of the recession, now officially pegged to March," commented Martin D. Weiss, Ph.D., chairman of Weiss Ratings, Inc. "With the recession deepening in the second half and continuing into 2002, more profit declines are very likely as consumers delay the purchase of insurance, frequently viewed as a non-essential item."

      In addition, insurers selling fixed annuities face a double threat: First, with rapidly falling interest rates, income on their investment portfolios may have fallen below the rates they have committed to pay to policyholders. At the same time, junk bonds, one of the industry's favorite vehicles for generating more yield in this environment, have exposed insurers to increasing defaults. Back to TOC

Notable Upgrades and Downgrades

Among the 980 companies reviewed by Weiss using second quarter 2001 data, 7 were upgraded and 13 were downgraded.


      Notable upgrades include:

  • Savings Bank Life Insurance Company (Conn.) from D+ to C-

Notable downgrades include:

  • Scottish Re US Inc (Del) from C- to D+
  • American Life & Annuity Ins Co (Texas) from C to D
  • OakRe Life Ins Co (Mo.) from B- to C

Weiss issues safety ratings on more than 15,000 financial institutions, including life and health insurers, HMOs, Blue Cross Blue Shield plans, property and casualty insurers, banks, and brokers, and the risk-adjusted performance of more than 11,000 mutual funds. Back to TOC

HMA, Inc. Completes Acquisition of 88-Bed Acute Care Hospital in Florida

Health Management Associates, Inc. announced it has completed the transaction to acquire the East Pointe Hospital, an 88-bed acute care hospital located in Lehigh Acres, Florida, effective November 30, 2001. This is the first acquisition of fiscal year 2002.

      East Pointe Hospital is HMA's twelfth Florida hospital, and joins our Top 100 Charlotte Regional Medical Center in Punta Gorda, Florida, in providing high quality medical services to non-urban areas of Southwest Florida.

      HMA is a hospital operator of general acute care hospitals in communities situated primarily in the Southeast and Southwest. The Company, upon completing the previously announced transaction to acquire four hospitals from the Clarent Hospital Corporation, will operate 43 hospitals in 15 states with 5,913 licensed beds. HMA has experienced 13 years of uninterrupted operating earnings growth. Back to TOC

Correctional Properties Trust Reports 21% Quarterly FFO Growth per Share

Correctional Properties Trust, a real estate investment trust (REIT), announced funds from operations for the three months ended September 30, 2001, of $4.1 million, or $0.57 per diluted share, on revenue of $7.5 million. Net income for the third quarter of 2001 was $2.3 million or $0.32 per diluted share. The Trust reported funds from operations of $3.4 million for the third quarter of 2000, or $0.47 per diluted share, on revenue of $5.7 million. Net income for the third quarter of 2000 was $2.0 million or $0.29 per diluted share.

      Correctional Properties Trust also announced that its Board of Trustees increased the quarterly dividend to $0.375 (thirty seven and one half cents) per share on each common share of beneficial interest, payable December 4, 2001, to shareholders of record at the close of business November 16, 2001.

      Correctional Properties Trust, based in Palm Beach Gardens, Florida, was formed in February 1998, to capitalize on the growing trend toward privatization in the corrections industry. Correctional Properties Trust is dedicated to ownership of correctional facilities under long-term, triple-net leases without occupancy risk or development risk.

      Correctional Properties Trust currently owns 13 correctional facilities in nine states, all of which are leased, with an aggregate initial design capacity of 7,282 beds. Back to TOC

Cornell Companies Raises $48.3 Million With Sale of 3,450,000 Shares of Common Stock

Cornell Companies sale, which included the sale of an over-allotment of 450,000 shares, eliminates all of Cornell's balance sheet debt and leaves approximately $50 million of cash, creating a stronger position to capitalize on opportunities for expansion. Presently, there are a number of projects coming up for bid in the corrections industry and Cornell will be well positioned tocapitalize on these opportunities.

      Cornell Companies is another provider of privatized correctional, treatment and educational services outsourced by federal, state and local government agencies. Cornell Companies provides a diversified portfolio of services for adults and juveniles related to incarceration and detention, transition from incarceration, drug and alcohol treatment programs, behavioral rehabilitation and treatment and K-12 education. Cornell Companies provides these essential services through its 69 facilities in 13 states and the District of Columbia. Back to TOC

ManagedCare Profits Healthy, But Higher Costs Loom

Healthy third-quarter profits show most U.S. managed care companies remain a step ahead of rising medical costs, but a slowing economy will make ittougher for insurers to raise premiums and grow enrollment going forward, analysts said.

      "It's the one sector of health care that is most affected by the weakening economy," said Banc of America Securities analyst Todd Richter. "A weakening economy means rising unemployment, which means more people uninsured, which means less enrollees."

      Two large health plans, Health Net Inc. (NYSE:HNT - news) of Los Angeles and Trigon Healthcare Inc. (NYSE:TGH - news) in Richmond,Virginia, on Friday reported sharp declines in third-quarter income after charges.

      Health Net, with 5.5 million members in 13 states, said net income fell to $2.3 million, from $44.6 million a year ago, after a $79.7 million restructuringcharge for job cuts.

      Trigon, Virginia's largest health insurer, said net income fell nearly 54 percent as weak financial markets hurt the company's investments.

      Health Net and Trigon were the last of the major publicly traded health maintenance organizationsto report their third-quarter results, with the exception of Anthem Inc. (NYSE:ATH - news), which went public on October 30 in a $1.73 billion offering. Anthem will report earnings on Wednesday. Back to TOC

HMO PREMIUMS RISE FASTER THAN HEALTH COSTS

Most HMOs this year negotiated hikes in the premiums paid by employers that outpaced increases in costs for physicians, hospitals and pharmaceutical services.

      The cost of large employers' health benefit plans will increase about 14 percent on average in 2002, the highest year-over-year rise in more than a decade, according to a survey released this week by consulting firm Towers Perrin.

      Higher premiums resulted in solid profit growth for most managed care companies in the latest quarter that largely met or beat Wall Street forecasts.

      WellPoint Health Networks Inc. (NYSE:WLP - news), UnitedHealth Group Inc. (NYSE:UNH - news), Humana Inc. (NYSE:HUM - news), Coventry Health Care Inc. (NYSE:CVH - news) and PacifiCare Health Systems Inc. (NasdaqNM:PHSY - news) all reported operating profits in excess of 20 percent.

      Cigna Corp., the third-largest HMO, reported lower earnings, but the decline was smaller than analysts had expected.

      Only one major health insurer, Aetna Inc. (NYSE:AET - news), recorded a loss in the third quarter. Aetna, the largest managed care company, said it lost $54.4 million as it continued to pare membership in unprofitable government-sponsored plans.

      However, with the economic downturn reversing the fortunes of companies across a wide swath of industries, from technology tomanufacturing to financial services, managed care providers will be hard-pressed to match the rate increases that have helped provide tidy profits this year, analysts said. Back to TOC

Employees to Pay More

"We think employers will push back, they will want to buy cheaper products. We think margins in the industry, which are already at peak levels, must turn down in '02," said Credit Suisse First Boston analyst Joseph France.

      Trigon Chief Executive Thomas Snead said most of Trigon's customers have been purchasing the company's benefit-rich plans, but more will switch to lower-cost plans with fewer frills as medical expenses continue to rise."New cost-sharing products are beginning to sell quite well," Snead said in an interview.

      The Standard and Poor's Managed Care Index (^SPHMO - news) is down about 17 percent year to date. The index has slumped 4.5 percent over the past three days after Aetna posted its loss.

      While concerns about earnings growth in the second half of 2002 have dampened investor enthusiasm for the managed care sector as a whole, some companies will continue to produce results that outshine their peers, analysts said.

      Employers are considering a number of measures to control rising health expenses, including passing on more of the costs to employees in the form of higher monthly contributions, deductibles and co-payments, according to Towers Perrin. Fueling the increased medical costs are higher costs of prescription drugs and hospital services.

      Escalating medical costs have been a persistent challenge for the HMO industry, prompting premium hikes and service cutbacks for consumers and forcing numerous smaller and less profitable plans to dissolve or merge in recent years. Back to TOC

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In This Issue--Also See Archive

Ardent Health to Acquire KY Hospital
Ardent Health Services of Nashville, Tenn. announced that it has signed a definitive agreement to purchase Samaritan Hospital in Lexington, Ky. Samar...
LifePoint Acquires Ville Platte
LifePoint Hospitals, Inc. announced that it has completed, effective December 1, 2001, the purchase of Ville Platte Medical Center, a 116-bed acute ca...
Life & Health Insurers Down 42%
Profits of the nation's life and health insurers declined $6 billion, or 42 percent, during the first six months of 2001, compared to the sa...
Notable Upgrades and Downgrades
Among the 980 companies reviewed by Weiss using second quarter 2001 data, 7 were upgraded and 13 were downgraded. Notable upgrades inc...
HMA, Inc. Acquires Acute Care in Florida
Health Management Associates, Inc. announced it has completed the transaction to acquire the East Pointe Hospital, an 88-bed acute care hospital locat...
Correctional Properties Trust Reports Growth
Correctional Properties Trust, a real estate investment trust (REIT), announced funds from operations for the three months ended September 30, 2001, o...
Cornell Companies Raises $48.3 Million
Cornell Companies sale, which included the sale of an over-allotment of 450,000 shares, eliminates all of Cornell's balance sheet debt and leaves app...
ManagedCare Up, but Future Cloudy
Healthy third-quarter profits show most U.S. managed care companies remain a step ahead of rising medical costs, but a slowing economy will make ittou...
HMO Premiums Outpace Health Costs
Most HMOs this year negotiated hikes in the premiums paid by employers that outpaced increases in costs for physicians, hospitals and pharmaceutical s...
Employees to Pay More
"We think employers will push back, they will want to buy cheaper products. We think margins in the industry, which are already at peak levels, must t...
LifePoint Q3 Earnings Up 66.7%
Third Quarter Highlights: Continuing strong financial performance Quarterly EPS of $0.20 compared with $0.12 in the prior year (excl...
Health Costs Rising in 2002
With the economy reeling from terrorist attacks and a prolonged slowdown, both employers and employees are bracing for higher health insurance costs.
Tenet Completes $1.1 Billion Tender
Tenet Healthcare Corporation has announced that it has successfully completed its offer to purchase five series of its senior notes. The company's ca...
WellPoint Creates Hurdle For Trigon
WellPoint Health Networks Inc. $1.3 billion proposed purchase of CareFirst will make Trigon Healthcare Inc.'s ambition to become a leading Southeaste...

LifePoint Hospitals Reports 66.7% Increase in Third Q EPS

Third Quarter Highlights:
Continuing strong financial performance Quarterly EPS of $0.20 compared with $0.12 in the prior year (excluding $0.02 non-recurring gain) EBITDA margin increased to 20.3%, a 170bp increase over prior year Increase in same-hospital admissions of 6.5% Increase in same-hospital equivalent admissions of 6.0% Signed definitive agreement to acquire 116-bed Ville Platte Medical Center Completed acquisition of 118-bed Athens Regional Medical Center effective October 1.

      LifePoint Hospitals, Inc. (NASDAQ:LPNT - news) today announced results for the third quarter and nine months ended September 30, 2001.

      For the quarter ended September 30, 2001, net revenues were $149.2 million, up 2.7% from $145.3 million a year ago. Net income for the quarter totaled $7.5 million, or $0.20 per diluted share, versus $4.8 million, or $0.14 per diluted share, in the prior-year period, representing increases of 56.9% and 42.9%, respectively. Excluding the non-recurring gain (related to the gain on previously impaired assets) in the prior year period, diluted earnings per share increased 66.7% to $0.20 from $0.12 in the prior year. Shares used in calculating diluted earnings per share for the third quarter of 2001 included 3.7 million additional shares compared with the third quarter of 2000 as a result of the secondary offering of common stock completed in March 2001. Earnings before interest, income taxes, depreciation, amortization, ESOP expense, minority interest and gain on previously impaired assets (EBITDA) increased 12.1% to $30.3 million from $27.0 million in the same period last year.

      For the nine months ended September 30, 2001, net revenues were $455.1 million, up 9.8% from $414.6 million a year ago. Net income for the nine-month period totaled $23.0 million, or $0.63 per diluted share, versus $12.5 million, or $0.38 per diluted share, in the prior-year period, representing increases of 84.2% and 65.8%, respectively. Excluding the extraordinary item and the nonrecurring gain, diluted earnings per share increased 83.3% to $0.66 from $0.36 in the prior year. Earnings before interest, income taxes, depreciation, amortization, ESOP expense, minority interest, gain on previously impaired assets and extraordinary loss (EBITDA) increased 26.3% to $96.1 million from $76.1million in the same period last year.

      During the third quarter, the Company announced the signing of a definitive agreement to acquire 116-bed Ville Platte Medical Center in Ville Platte, Louisiana. This acquisition is expected to close during the fourth quarter. In addition, the Company completed the acquisition of 118-bed Athens Regional Medical Center, located in Athens, Tennessee, effective October 1. Both acquisitions will be funded with available cash.

      Kenneth C. Donahey, chairman and chief executive officer of LifePoint Hospitals, said, "We are pleased that once again we have exceeded expectations. Improving EBITDA margins reflect our success at generating internal growth through cost controls, expanding services and recruiting physicians. During the quarter, we also announced two acquisitions. Our ability to fund these acquisitions with available cash continues to demonstrate our fiscal discipline. In addition to our solid financial performance, we are proud to continue providing quality healthcare in the communities we serve. Combined, these accomplishments solidly position us to reach our immediate and long-term objectives."

      LifePoint Hospitals, Inc. operates 22 hospitals in non-urban areas. In most cases, the LifePoint facility is the only hospital in its community. LifePoint's non-urban operating strategy offers continued operational improvement by focusing on its five core values: delivering high quality patient care, supporting physicians, creating excellent workplaces for its employees, providing community value, and ensuring fiscal responsibility. Headquartered in Brentwood, Tennessee, LifePoint Hospitals is affiliated with over 6,000 employees. Back to TOC

Health Costs Rising in 2002; and Now the Bad News

With the economy reeling from terrorist attacks and a prolonged slowdown, both employers and employees are bracing for higher health insurance costs. Premiums are expected to rise an average 13.6 percent next year, and that doesn't even reflect the increases expected from the threat of terrorism, such as the sudden flood of anthrax testing and treatment.

      Although employers are entering open enrollment season in December and January, the rates and options now being offered for health care plans were negotiated early in 2001, well before the terrorist attacks and even before the economy started sliding into recession.

      "Where we'll see the effect from Sept. 11 is a year from now," says Helen Darling, president of the Washington Business Group on Health, which represents some of the region's largest employers. "We're getting an accidental free ride this coming year, but it's really going to just explode after that."

      Even though rates are going up in the next month or two, those increases are "based on last year's reality," Darling says. Caps and cutbacks Next year, each employee hired will cost employers an average $5,500 to $7,000 in health premium costs, according to the Business Group. "That's why so many small businesses don't offer health plans -- it's extraordinarily expensive," Darling says. "The way we're going about this, we're making health care about as unaffordable as it can be."

      If the Patient's Bill of Rights, now in conference committee in Congress, is passed it would add another 1 to 2 percent to premium costs, Darling says. "Everything they are doing is just adding on. It's all going up." Going into 2002, hot and cold industries will transfer their fortunes to health care, she says. "The security industry will probably enrich their health care plans, while hotels will probably cut theirs back," Darling says. "Employers are looking at different ways to cap their exposure to rising health care costs," says Gregg Lehman, president of the National Business Coalition on Health. For example, companies are:

  • Increasing the payment or deductible employees must pay;
  • Focusing on high-risk populations, such as diabetics or those with high blood pressure, to contain runaway expenses;
  • Restructuring prescription medicine coverage to encourage use of generic equivalents and tiered levels of co-payments.

Workers who are laid off theoretically can keep their former company's health coverage -- if they pay 100 percent of the costs.

      Federal Cobra legislation requires employers to offer employees the chance to stay on their health plan for up to 18 months after termination. Even at some of the group rates, Cobra coverage is very expensive -- as much as $700 to $900 a month. "That's a pretty tough nut to get past," says Ray Werntz, president of the Consumer Health Education Council.

      Cobra coverage also can be quite expensive for the employers, because the former employees who opt for extended coverage are usually the ones who need it most -- and are more likely to need hospitalization or treatment. Back to TOC

Tenet Completes $1.1 Billion Tender, Achieving 96% Success Rate

Tenet Healthcare Corporation has announced that it has successfully completed its offer to purchase five series of its senior notes. The company's cash tender offer and related consent solicitation commenced on Oct. 31, 2001 and expired at 5:00 p.m. EST on Thurs. Nov. 29, 2001, the expiration time.

      As of the expiration time, the following amounts of the company's senior notes had been validly tendered:

      $194,361,000 principal amount of its 7-7/8% Senior Notes due Jan. 15, 2003, representing 97.0% of the outstanding notes, leaving $6,103,000 principal amount outstanding;

      $212,254,000 principal amount of its 8-5/8% Senior Notes due Dec. 1, 2003, representing 93.1% of the outstanding notes, leaving $15,724,500 principal amount outstanding;

      $383,672,000 principal amount of its 8% Senior Notes due Jan. 15, 2005, representing 94.6% of the outstanding notes, leaving $21,957,000 principal amount outstanding;

      $157,465,000 principal amount of its 7-5/8% Senior Notes due June 1, 2008, representing 99.9% of the outstanding notes, leaving $225,000 principal amount outstanding; and

      $99,200,000 principal amount of its 9-1/4% Senior Notes due Sept. 1, 2010, representing 99.7% of the outstanding notes, leaving $250,000 principal amount outstanding.

      The company accepted all notes validly tendered prior to the expiration time. Settlement for the company's purchase is expected to occur today.

      As previously announced, the company will record an extraordinary charge in the second quarter related to the early extinguishment of debt. The company expects that charge to be approximately $103 million.

      In addition, prior to 5:00 p.m. EST on Nov. 14, 2001, the company received requisite consents to the proposed amendments of the respective indentures under which the notes were issued. Supplemental indentures reflecting the amendments were executed promptly after such receipt and the amendments became effective as of today. The amendments eliminated or modified substantially all of the covenants in the indentures governing the notes so that they conform to the covenants in the indenture governing Tenet's senior unsecured notes issued Nov. 6, 2001.

      Tenet Healthcare Corporation owns and operates 114 acute care hospitals with 28,256 beds and numerous related health care services. The company employs approximately 111,500 people serving communities in 17 states Back to TOC

WellPoint Creates Hurdle For Trigon

WellPoint Health Networks Inc. $1.3 billion proposed purchase of CareFirst will make Trigon Healthcare Inc.'s ambition to become a leading Southeastern health plan leader more difficult, as the price of poker just went up!

      WellPoint agreed to buy CareFirst, a nonprofit Blue Cross/Blue Shield operator in Delaware, Maryland, Washington D.C., and Northern Virginia serving 3.1 million members.

      Trigon is Virginia's largest provider with 2 million people covered under its plans and has expressed a desire to buy other BlueCross/Blue Shield operators.

      Thousand Oaks, California-based WellPoint, however, is taking away what was a potential partner for Trigon, which covers the area adjacent to CareFirst. WellPoint also already owns Cerulean, the Blue Cross/Blue Shield operator in Georgia.

      "Trigon is in a tough place and this deal makes it even in a tougher place," Prudential Securities analyst David Shove said. He said Trigon may need to make a rival bid for CareFirst or buy another firm in the Southeast to expand.

      Brooke Taylor, vice president for corporate communications at Trigon, said there are no plans to make a bid for CareFirst and that the company continues to have a regional strategy. "In the next several years, we think our significant competitive advantage provides us with opportunities for growth here (in Virginia) and also toward the establishment of a strong regional health plan," Taylor said. Taylor declined to say where the company would make an acquisition, but she said a regional approach to managed health care is the best approach.

      UBS Warburg analyst said WellPoint's deal is a "wake-up call" to Trigon and could renew pressure to buy a company outside Virginia, McKeever said. "The game is late, but it is not over," McKeever said about acquisitions among Blue Cross/Blue Shield providers. Trigon has opportunities to expand into the Carolinas or to other portions of the Southeast to fulfill its goal of becoming the leading regional health plan, he said.

      Trigon shares fell 56 cents to $64.74, while Mid Atlantic Medical Services Inc. (NYSE:MME - news), a CareFirst rival that is not a Blue Cross/Blue Shield plan, rose 54 cents to $20.68. Mid Atlantic Medical insures 1.8 million people in Maryland, Washington, D.C., Delaware, North Carolina, Pennsylvania, and West Virginia. McKeever said in a research note that the deal puts Mid Atlantic at a slight disadvantage, but the company may be able to get higher prices for its plans in Maryland and also gain enrollment from employers over uncertainty from the merger. Back to TOC