Issue link: https://beckershealthcare.uberflip.com/i/1479669
27 CEO / STRATEGY 12 hospital deals called off in past year By Ayla Ellison T here were several hospital mergers, acquisitions, affiliations and partnerships that, at some point in their lifetime, were called off in the past year. Below are 12 hospital deals called off since August 2021. • Elkins, W.Va.-based Davis Health System and Morgantown, W.Va.-based WVU Medicine ended an affiliation in August over Davis Health System's EHR vendor choice. • Tucson, Ariz.-based TMC Health ended its bid in early June to buy Santa Cruz Valley Regional Hospital in Green Valley, Ariz. e hospital closed June 30. • Nashville, Tenn.-based HCA Healthcare and Dallas-based Steward Health Care System abandoned their proposed deal involving five Utah hospitals in June. e decision came 13 days aer the Federal Trade Commission challenged the transaction. • Two New Jersey health systems — Saint Peter's Healthcare System and RWJBarnabas Health — terminated a definitive agreement to merge in June. Leadership of New Brunswick-based Saint Peter's Healthcare System and West Orange-based RWJ Barnabas Health agreed to call off the deal aer the Federal Trade Commission filed a lawsuit to block the transaction. • Lebanon, N.H.-based Dartmouth Health and Manchester, N.H.-based GraniteOne Health canceled their proposed merger in May aer the state Attorney General's Office said the move would violate the New Hampshire constitution. • Edison, N.J.-based Hackensack Meridian Health and Englewood (N.J.) Health ended their merger plans in April. e Federal Trade Commission challenged the deal in 2020, arguing it would give Hackensack Meridian control of three of the six hospitals in Bergen County and raise healthcare costs. • e boards of Lifespan and Care New England — both based in Providence, R.I. — withdrew their merger application aer the Federal Trade Commission made an announcement Feb. 17 it would file suit to block the deal. • Hoag Memorial Hospital Presbyterian in Newport Beach, Calif., and Providence, a Catholic health system based in Renton, Wash., announced in January that they would end their affiliation. • Trinity Health Mid-Atlantic abandoned its plan in January to buy West Reading, Pa.-based Tower Health's Chestnut Hill Hospital in Philadelphia. • St. Louis-based SSM Health and Brentwood, Tenn.-based Quorum Health backed out of a potential deal in October for Quorum to acquire one of SSM Health's hospitals and its associated medical group. e organizations ended talks nearly a year aer entering into a letter of intent to explore the sale. • Ascension and AdventHealth announced in October that they are unwinding their Amita Health partnership aer working together for nearly seven years. Amita Health, a joint venture providing healthcare services to the greater Chicago area, comprises 15 acute care hospitals, four specialty hospitals and immediate and outpatient care centers. Aer St. Louis-based Ascension and Altamonte Springs, Fla.-based AdventHealth unwind their partnership, each organization will operate their hospitals and care sites in the Chicago area. • West Reading, Pa.-based Tower Health called off a deal in December to sell two hospitals to Canyon Atlantic Partners, a hospital management firm based in Austin, Texas. n • In patients undergoing hemorrhoidectomy, a total of 266 mg (20 mL ) of EXPAREL was diluted with 10 mL of saline, for a total of 30 mL, divided into six 5 mL aliquots, injected by visualizing the anal sphincter as a clock face and slowly infiltrating one aliquot to each of the even numbers to produce a field block. Local Analgesia via Infiltration Dosing in Pediatric Patients The recommended dose of EXPAREL for single-dose infiltration in pediatric patients, aged 6 to less than 17 years, is 4 mg/kg (up to a maximum of 266 mg), and is based upon two studies of pediatric patients undergoing either spine surgery or cardiac surgery. Regional Analgesia via Interscalene Brachial Plexus Nerve Block Dosing in Adults The recommended dose of EXPAREL for interscalene brachial plexus nerve block in adults is 133 mg (10 mL), and is based upon one study of patients undergoing either total shoulder arthroplasty or rotator cuff repair. Compatibility Considerations Admixing EXPAREL with drugs other than bupivacaine HCl prior to administration is not recommended. • Non-bupivacaine based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more. • Bupivacaine HCl administered together with EXPAREL may impact the pharmacokinetic and/or physicochemical properties of EXPAREL, and this effect is concentration dependent. Therefore, bupivacaine HCl and EXPAREL may be administered simultaneously in the same syringe, and bupivacaine HCl may be injected immediately before EXPAREL as long as the ratio of the milligram dose of bupivacaine HCl solution to EXPAREL does not exceed 1:2. The toxic effects of these drugs are additive and their administration should be used with caution including monitoring for neurologic and cardiovascular effects related to local anesthetic systemic toxicity. • When a topical antiseptic such as povidone iodine (e.g., Betadine ® ) is applied, the site should be allowed to dry before EXPAREL is administered into the surgical site. EXPAREL should not be allowed to come into contact with antiseptics such as povidone iodine in solution. Studies conducted with EXPAREL demonstrated that the most common implantable materials (polypropylene, PTFE, silicone, stainless steel, and titanium) are not affected by the presence of EXPAREL any more than they are by saline. None of the materials studied had an adverse effect on EXPAREL. Non-Interchangeability with Other Formulations of Bupivacaine Different formulations of bupivacaine are not bioequivalent even if the milligram dosage is the same. Therefore, it is not possible to convert dosing from any other formulations of bupivacaine to EXPAREL and vice versa. Liposomal encapsulation or incorporation in a lipid complex can substantially affect a drug's functional properties relative to those of the unencapsulated or nonlipid-associated drug. In addition, different liposomal or lipid-complexed products with a common active ingredient may vary from one another in the chemical composition and physical form of the lipid component. Such differences may affect functional properties of these drug products. Do not substitute. CLINICAL PHARMACOLOGY Pharmacokinetics Administration of EXPAREL results in significant systemic plasma levels of bupivacaine which can persist for 96 hours after local infiltration and 120 hours after interscalene brachial plexus nerve block. In general, peripheral nerve blocks have shown systemic plasma levels of bupivacaine for extended duration when compared to local infiltration. Systemic plasma levels of bupivacaine following administration of EXPAREL are not correlated with local efficacy. PATIENT COUNSELING Inform patients that use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly. Advise patients or caregivers to seek immediate medical attention if they or someone in their care experience the following signs or symptoms: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue. Pacira Pharmaceuticals, Inc. San Diego, CA 92121 USA Patent Numbers: 6,132,766 5,891,467 5,766,627 8,182,835 Trademark of Pacira Pharmaceuticals, Inc. For additional information call 1-855-RX-EXPAREL (1-855-793-9727) Rx only March 2021