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Healthcare Acquisitions and Divestitures During the COVID-19 Pandemic

Client Alert

It seems as though all aspects of our personal and professional lives have been impacted in one way or another by the COVID-19 public health emergency. Healthcare acquisitions and divestitures are no exception. Although the ramifications depend on the specific circumstances of each transaction, we are noticing certain common threads woven among recently closed and currently in progress transactions in the healthcare industry. Here are a few of the questions that often arise as we work with clients to navigate the current business landscape both during and after the COVID epidemic. 

  • Valuations. It’s no secret that numerous businesses are experiencing financial distress. Some of the country’s largest financial institutions are ramping up hiring in their bankruptcy and distressed credit divisions, indicating the players in the best position to know believe that rates of financial distress and delinquencies will continue to rise in the near term. How should the financial performance of the business during the pandemic (which may include recent business interruption, decline in revenue or increase in costs) be taken into consideration when determining the overall value of the business? How should buyers price in the risk created by COVID-induced uncertainty? Most commentators note that the COVID-19 pandemic has shifted deal dynamics in favor of buyers, creating a buyers’ market. How should buyers and sellers change their “deal playbook” and/or negotiation strategy in response to these market forces? 
  • Earnouts. It’s important to each transaction party that it ultimately receives the benefit of its bargain. What is the likelihood that the seller will receive the earnout in whole or in part? Are the earnout targets based upon pre-pandemic figures and economic assumptions? Should more of the purchase price be shifted to the earnout to mitigate risk for the buyer? Can the earnout measurement period be extended in an effort to mitigate the impact to the seller of a potential future short-term economic decline?  
  • Escrow. The parties may be aware of certain contingent liabilities attributable to pandemic-related contractual disputes, litigation or regulatory non-compliance. How much of the purchase price should be placed in escrow given potential COVID-19 related risks identified in diligence?  
  • Employment Law Considerations. It’s been a busy year for employment attorneys and businesses implementing related compliance requirements. Are there potential governmental enforcement actions or employee lawsuits on the horizon for the seller? Has the seller complied with recent employment law changes and cumbersome but crucial workplace health and safety requirements? Have members of the seller’s workforce tested positive for COVID-19? 
  • Litigation and Other Disputes. It is no secret that the public health emergency has resulted in substantial supply chain disruption and payment defaults. If applicable, what is the seller’s likelihood of success under force majeure, termination and other key contractual provisions.  Has the pandemic resulted in current or potential litigation with landlords, vendors, insurers, customers, lenders, employees or others?  
  • Compliance Requirements. The federal government has made it clear that certain recipients of SBA PPP loans and HHS Provider Relief Fund payments will be subject to governmental audit and scrutiny. Has the seller received SBA loans or grants or Provider Relief Funds?  If so, is the seller complying with the related attestation, documentation and forgiveness requirements? Does the seller have the proper Provider Relief Fund policies and procedures in place?  
  • Cybersecurity. Governmental authorities have identified increased cybersecurity risks to businesses during the pandemic. Does the seller have an active and robust data privacy and security program? Has the seller experienced any recent breaches and, if so, were they addressed appropriately?  
  • Purchased Assets and Assumed Contracts. What will happen if the pandemic results in a material adverse change in the seller’s business between the date when the purchase agreement is signed and the date of the closing? What if the business isn’t operating in the ordinary course in accordance with past practice and/or historical financial results?  Is the buyer required to proceed with the closing? Will there be an adjustment to the purchase price? Is the seller in compliance with all of its representations, warranties, covenants and other obligations in the primary transaction agreement(s)? Will the seller be liable for related damages?  
  • Representations and Warranties Insurance. Having comprehensive representation and warranty insurance in place can benefit both parties to the transaction. Will the insurer exclude representation and warranty claims related to the COVID-19 pandemic from the insurance coverage? It may be important for buyers to reach out to several insurers and compare the coverage available.

As the pace of deal activity within the health care space continues to increase, our firm’s attorneys are working daily with clients to further develop and adjust their strategies to respond to changes and uncertainty in today’s environment. Please let us know if we may assist you to brainstorm potential transaction structures and “best practices” to mitigate business and regulatory risk during this time, while maximizing transaction value. We’d be delighted to discuss with you further. For additional information, please contact Kate Hickner at kehickner@bmdllc.com or Kevin Saunders at rksaunders@bmdllc.com. 


Valley National Bank/Trulieve Loan: A Big Step Out of the Shadows

In a late December press release, Trulieve announced that it had secured a $71.5 million commercial bank loan. In addition to the amount of the loan, which may be the largest commercial bank loan to date to a cannabis company, the release prominently identified Valley Bank and featured both a quote from Valley’s Senior Vice President, John Myers, and a description of the Bank’s service platform and commitment to the cannabis industry.

The End of Non-Competes? The Impact It Will Have on the Healthcare Industry

On January 5, 2023, the Federal Trade Commission (“FTC”) announced a proposed rule that, if enacted, will ban employers from entering into non-compete clauses with workers (the “Rule”), and the Rule would void existing non-compete agreements. In their Notice, the FTC stated that if the Rule were to go into effect, they estimate the overall earnings of employees in the United States could increase by $250 billion to $296 billion per year. The Rule would also require employers to rescind non-competes that they had already entered into with their workers. For purposes of the Rule, the FTC has defined “worker” to also include any employees, interns, volunteers, and contractors.”

2022 Healthcare Recap and 2023 Healthcare Check-Up

As the country begins to return to a new “normal” following the COVID-19 pandemic, there are many healthcare rules changing on both the federal and state levels as a result. Thus, it is important for healthcare providers and their employers to be aware of these changing rules, and any implications they may have on their practice. Look back on healthcare in 2022 and find a checklist for 2023.

Direct Support Professional Retention Payments

On December 15, the Ohio Senate and House passed House Bill 45, which authorizes the Department of Developmental Disabilities (DODD), in conjunction with the county boards of developmental disabilities, to launch their initiative to issue retention payments to Direct Support Professionals (DSPs). These retention payments will be distributed quarterly to participating home and community-based waiver providers to address the workforce crisis in the direct provider sector. Governor DeWine needs to sign the Bill to begin the payments, but he is expected to do so by the end of 2022.

Real Estate Investors Position for 2023 Opportunities

Real estate investors weathered another year in a post-pandemic world, with the year closing with yet another interest rate increase coupled with both uncertainty and heightened interest carrying into 2023. Just last Wednesday, the Federal Reserve raised its benchmark interest rate 0.50 percentage points, shifting the target range to 4.25% to 4.50%. The new level is the highest the fed funds rate has been since December 2007 and marks the seventh rate hike this year. So what does this mean to investors, brokers, lenders, and others in the real estate world? Read a few perspectives below from stakeholders familiar with our BMD clients and the markets in which they do business.