Issue link: https://beckershealthcare.uberflip.com/i/324690
53 Transaction & Valuation Issues may be paid. However, the investment bank must be capable, qualified and driven to do a great transaction for the board. Other hospital-focused in- vestment banks include Juniper Advisory, Newpoint Healthcare Advisors, Raymond James, AMB, Stroudwater Associates, KeyBanc, Duff & Phelps and many others. 5. The board must spend a lot of time deciding what it wants from the transaction. Is it looking for a merger where it remains in par- tial control? Is it looking for management help only? Is it looking to fully sell the hospital? Is it looking for an acquirer who will retain the facility as an acute-care hospital? Is it looking for capital to expand or rebuild? What are the long-term goals? Overall, what does the board ultimately want to get out of the transaction? These questions, among many others, must be considered upfront and not during the frenzy of negotiations. 6. Internal diligence must be conducted. Different types of internal issues can derail or interfere with a transaction, and they should be discov- ered early so that they can be managed more easily. For example, hospital boards must consider self-disclosure or working through any potential Stark Law or Anti-Kickback Statute issues, and they should review physician re- lationships, HIPAA compliance, medical staff credentialing and compliance within billing, coding and the revenue cycle. 7. A letter of intent does not mean the deal is closed. Discontinued M&A deals are not uncommon in the healthcare space: Last year, Livonia, Mich.-based CHE Trinity Health and St. Joseph's Hospital Health Center in Syracuse, N.Y., decided to not move forward with their proposed affiliation. This past January, Winfield, Ill.-based Cadence Health and Rockford (Ill.) Health System also ended merger discussions. A letter of intent is only part of the battle, and a deal is from over once the LOI is signed. Board members and hospital leaders must remain vigilant about the hospital business while they work on concluding the transaction. They also should be prepared with a plan B in case the transaction does not close. 8. Understand the workings of transactions short of a merger or sale. The board should fully know what they expect and whether there are means to terminate the relationship. 9. Anticipate obstacles early. The most successful hospital transactions are those in which board members and executives have a clear plan and lay out their options in the event something goes awry. Foresight in hospital leaders is worth its weight in gold. n