Operating Plan to Turn Around Lab Company

Our latest assignment is to provide strategic consulting services to a lab company doing business nationwide.  The lab industry has changed drastically in recent years, resulting in substantially lower reimbursements and increased regulatory pressures. These industry circumstances has caused this lab company to shrink down to about a $12 million run rate, running at about breakeven on an EBITDA basis. The CEO retained us to examine his operations and financials.  Employees knew that I’d been retained to help the CEO and an am independent third-party advisor.  We have spent the last several weeks talking and drilling down to the fundamentals of the business with all business department heads, assisting in a potential acquisition and developing an operating plan to improve operations and profitability. This industry reminds me of the home health business back in 1998-2000.  Reimbursement changes from Medicare caused about 1/3 of all home health businesses to close.  The other 2/3rds held on but were badly damaged. Today the lab business is dominated by Lab Corp & Quest.  Most smaller  labs have closed, or been acquired, or are struggling to find significance within this huge industry. Mr. Villwock is working with this company’s CEO to become one of the …

Living Life to the Fullest

Far too often executives give up their lives as they are building a company, or climbing the corporate ladder. And for almost all of us who are successful, the reality is that there is a good amount time required in order to gain the success that we desire.  Whether success is measured in dollars, or title, or accomplishment, success takes time, vision, focus and a lot of hard work. But for each of us, a day comes when we truly have a choice – and my sense is that a lot of us are either blind to the choice we have, or choose not to choose. This choice is to form a new vision of our future, and to decide and take action to begin a transition to this new vision. In my career & life, I started making this transition two years ago.  In my case, the transition consists of two pieces:  1) to migrate my business towards assisting CEO’s in taking their companies to the next level and to assist in achieving a higher rate of growth and higher value for the business; and 2) begin a lifestyle transition that will allow me to spend half of the …

Economic Question of a Generation

This past weekend I had the privilege of attending an investor conference in San Diego hosted by John Mauldin and Altegris Investments.  The line up of speakers was exceptional — in addition to John, whom I consider one of the best minds in the country in understanding the economic events of the day, the speakers included John Paulson, Marc Faber, David Harding of Winton Capital, the editor of the Bank Credit Analyst and others. The room was filled with nearly 500 investors all asking essentially the same question.  What is the implication of a Federal Reserve balance sheet that looks like an Apollo moonshot … a federal fiscal deficit that has doubled the debt of the United States in a very short period of time, and if not abated,will easily have the United State’s debt in excess of 150% of GDP — only once in world history has a country survived with a debt restructuring over this level … having a country like Japan already with debt at 200% of GDP with a declining population and declining working population coupled with a savings rate that in a few short years will be negative as the Japanese start being a net …

Accountable Care Organizations

Today I’m going to focus on Accountable Care Organizations (ACO’s).  This past week, CMS announced their initial rules and regs for ACOs. Start with the basic:  what is an ACO?  It is an organization to be formed by hospitals, doctors and ancillary service providers to better manage the care of Medicare patients.  Think of the Mayo Clinic among a set of providers without common ownership.  The goal is to actually manage the care of a patient (boy does that sound familiar!!) in order to get the optimal outcome at the lowest cost.  The ACO then shares in a portion of that cost savings. This is yet another experiment in trying to find out how to insure that patients get the care they need in a system that pays providers for every time they provide care.   The system we have gives every healthcare provider the incentive to provide services, whether needed or not.  The system also gives incentives to get MRIs, use drugs and do a large variety of things that adds profits to someone’s bottom line, but doesn’t necessarily improve and may in fact reduce the quality of health care. CMS has been trying to figure out why healthcare might …

Tenet & Community Health

I don’t mind going out on a limb – so some projections regarding Community Health & Tenet. #1 – Tenet is history as a stand alone company.  Trading volume Friday was more than half the capitalization of the company.  The arbs and hedge funds are loading up in a big way and they will get to vote.  Company is gone. #2 – The price is probably in the $7.50-8.00 per share range, but could be higher.  The synergies and margin upside is so great in this company that CYH can use more stock and others can use cash to buy Tenet.  Tenet has a bloated infrastructure and bloated bureaucracy that can be rationalized. #3 – Other bidders could emerge.  Let’s run through the possibilities: HCA – unlikely.  They want to go public.  If they wanted the company, they could pay as much as CYH, or more since they are private. HMA, UHA & LifePoint – no way.  Bill Schoen doesn’t like big transactions at HMA.  LifePoint too small.  Alan Miller just bought Psyc Solutions and he really prefers the psyc business to the acute care business. Vanguard.  I’m certain that Charlie Martin would love to own Tenet.  Two ways to …