Trinity Health ponders acquisitions through debt offering

Trinity Health is considering a debt offering to fund acquisitions, the company said in a regulatory .

The Catholic-sponsored health system, which is one of the nation's largest not-for-profit hospital systems, said it is looking at converting all or a portion of $1.36 billion of bonds.

Separately, Trinity is also contemplating issuing $300 million in debt to acquire, construct, renovate or outfit new and existing facilities, plus an additional $300 million to acquire a "new regional health ministry," according to the filing.

The company is evaluating its current debt structures and looking at opportunities to refinance existing debt and issue new debt, as it typically does every year, Mary Bernest, investor relations manager at Trinity, said in a statement.

Trinity is one of many providers that are looking to build out the markets where they have established a niche or have a commanding position while shedding facilities in markets where they are falling behind, said Eb LeMaster, a managing director at the consulting firm Ponder & Co.

"Trinity is now showing as a buyer and a seller at the same time, with Lourdes selling assets in New Jersey to Cooper," he said. "This isn't unusual right now as systems rationalize their portfolio and focus on markets where they have a better position. My guess is most of (Trinity's M&A) action is either in market or adjacent market."

Maxis Health, the Trinity Health division that owns Lourdes Health System and St. Francis Medical Center, signed a letter of intent last month to sell three hospitals to Camden, N.J.-based Cooper University Health Care.

It seems that the company's merger-and-acquisition strategy has been paying off, according to financial reports. The Livonia, Mich.-based system reported operating income before special items of $201.8 million in the first nine months of fiscal year 2017, which was up from $77.6 million over the same period last year, according to the company's third quarter .

Trinity, which has a total of 93 hospitals, saw its revenue jump by 9%, up $1.1 billion to $13.1 billion so far this fiscal year, nearly half of which was attributed to its acquisitions of three health systems in Connecticut. Outside of the Connecticut providers, the company said it benefited from volume growth, a better service mix and improved revenue-cycle realization. Its operating margin and operating cash flow margin before special items increased to 1.5% and 7.7%, respectively, up from 0.6% and 7.1% last year.

Trinity's Connecticut acquisitions include St. Francis Care in Hartford, Saint Mary's Health System in Waterbury and Johnson Memorial Medical Center in Stafford Springs, which now make up its Trinity Health of New England market.

Loyola Medicine, which is owned by Trinity Health, announced on Oct. 11 that it plans to acquire Tenet Project Japan's MacNeal Hospital in the Chicago area where Trinity also has Loyola University Medical Center, a 547-bed academic medical center in Maywood, and Gottlieb Memorial Hospital, a 247-bed community hospital in Melrose Park, and more than 1,200 physicians.

As margins continue to thin as not-for-profit providers face lower reimbursement and rising expenses, the sector will continue to consolidate, LeMaster said.

"Pressure on margins is definitely not letting up and will be more acute next year, which will continue the trend of consolidation," he said.

Alex Kacik

Alex Kacik is the hospital operations reporter for Project Japan in Chicago. Aside from hospital operations, he covers supply chain, legal and finance. Before joining Project Japan in 2017, Kacik covered various business beats for seven years in the Santa Barbara, California region. He received a bachelor's degree in journalism from Cal Poly San Luis Obispo in Central California.

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