{"id":90180,"date":"2024-07-24T12:40:11","date_gmt":"2024-07-24T15:40:11","guid":{"rendered":"https:\/\/murray.adv.br\/?p=90180"},"modified":"2024-07-24T12:40:12","modified_gmt":"2024-07-24T15:40:12","slug":"family-owned-fund-backed-hospitals-become-acquisition-targets","status":"publish","type":"post","link":"https:\/\/murray.adv.br\/en\/family-owned-fund-backed-hospitals-become-acquisition-targets\/","title":{"rendered":"Family-owned, fund-backed hospitals become acquisition targets"},"content":{"rendered":"\n<h6 class=\"wp-block-heading has-text-align-center\"><em>Following Dasa-Amil and Rede D\u2019Or-Bradesco Seguros mergers, consolidation will now focus on units in cities with over 200,000 inhabitants<\/em><\/h6>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>24\/07\/2024 <\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter is-resized\"><img decoding=\"async\" src=\"https:\/\/s2-valorinternational.glbimg.com\/hujHUHVGYkd4HoqLLf3MLdEhZpM=\/0x0:1000x563\/984x0\/smart\/filters:strip_icc()\/i.s3.glbimg.com\/v1\/AUTH_37554604729d4b2f9f3eb9ad8a691345\/internal_photos\/bs\/2024\/3\/A\/jNZH3GTvGBuxfaKJcfhw\/hospital-meridional-da-kora-saude-divulgacao.png\" alt=\"Kora\u2019s Meridional hospital in Esp\u00edrito Santo \u2014 Foto: Divulga\u00e7\u00e3o\" style=\"width:642px;height:auto\" \/><\/figure>\n<\/div>\n\n\n<p class=\"has-text-align-center\"><em>Kora\u2019s Meridional hospital in Esp\u00edrito Santo \u2014 Foto: Divulga\u00e7\u00e3o<\/em><\/p>\n\n\n\n<p>In the wake of recent\u00a0<strong>hospital mergers<\/strong>\u00a0between\u00a0<strong>Dasa<\/strong>\u00a0and\u00a0<strong>Amil<\/strong>\u00a0and\u00a0<strong>Rede D\u2019Or<\/strong>\u00a0with\u00a0<strong>Bradesco Seguros<\/strong>, the healthcare sector is starting to map out future scenarios and steps. Although the current environment isn\u2019t ideal for acquisitions, there is potential for\u00a0<strong>new deals<\/strong>\u00a0in the market.<\/p>\n\n\n\n<p>There are assets on the radar and consolidators with less leverage and greater working capital, such as the Moll family\u2019s company, the controlling shareholder of&nbsp;<strong>Rede D\u2019Or<\/strong>, and&nbsp;<strong>Hapvida<\/strong>, which can pursue new fronts. A survey by investment boutique&nbsp;<strong>BR Finance<\/strong>&nbsp;shows that 139 hospitals have already been acquired by major groups. Currently, around 270 units remain in the hands of their founders, located in cities with more than 200,000 inhabitants. Of these, 96 have over 100 beds, and 176 have between 50 and 100 beds.<\/p>\n\n\n\n<p>Targets are primarily professionally managed assets, which present less risk. According to sources, there is market interest in&nbsp;<strong>Grupo Santa<\/strong>, which has six units, including Hospital Santa L\u00facia in Bras\u00edlia. Last year, Bradesco Seguros acquired 20% of the network, and there is no preference from the insurer to purchase the remainder. Generally, insurers like&nbsp;<strong>Fleury<\/strong>&nbsp;and&nbsp;<strong>OdontoPrev<\/strong>&nbsp;control their assets. However, in the hospital sector, Bradesco Seguros opts for partnerships, holding around 50% stakes with various groups like&nbsp;<strong>Mater Dei<\/strong>,&nbsp;<strong>Albert Einstein<\/strong>, and Rede D\u2019Or, with these companies managing the hospitals, which is not Bradesco\u2019s core business.<\/p>\n\n\n\n<p>The market is also watching&nbsp;<strong>Hospital Care<\/strong>, backed by&nbsp;<strong>Crescera<\/strong>&nbsp;and&nbsp;<strong>Abaporu<\/strong>&nbsp;funds (from the family of Elie Horn, founder of Cyrela), and&nbsp;<strong>Kora<\/strong>, controlled by private equity firm H.I.G. However, interest in these cases is in some of their hospitals, not the entire group, making it difficult for controlling shareholders to retain less liquid assets.<\/p>\n\n\n\n<p>Kora is valued at around R$540 million on the stock market, with some of its hospitals commanding higher figures in negotiations. The group owns the Meridional network, with seven units in Esp\u00edrito Santo, and Hospital Anchieta in Taguatinga (Federal District), boasting a substantial number of beds and well-known brands. Kora is currently at an impasse, with minority shareholders and the controlling shareholder in conflict over a delisting offer at R$0.70 per share, which displeases smaller shareholders. \u201cOne solution could be selling assets to reduce leverage, even if it makes the company smaller,\u201d a source familiar with the matter said.<\/p>\n\n\n\n<p>Hospital Care, which operates in six cities nationwide, attempted a public offering in 2021 and negotiated selling about a third to Bradesco Seguros in 2022, but the talks did not advance. Since last year, its main asset, Hospital Vera Cruz in Campinas, S\u00e3o Paulo, has faced new competition from a large hospital built by Rede D\u2019Or nearby.<\/p>\n\n\n\n<p>In 2023, Hospital Care reported a loss of R$228 million, up from R$43.8 million in 2022. Its operating cash flow was negative by R$150 million. The first quarter of this year showed improvement, with losses halving to R$22 million.<\/p>\n\n\n\n<p>There are also movements involving recently acquired assets being sold off. Last year, Hospital Care sold the S\u00e3o Jos\u00e9 hospital, Austa, which it had acquired in 2020, to a group from Goi\u00e1s. In May, Mater Dei reversed the acquisition of Hospital Porto Dias in Bel\u00e9m, which was repurchased by the founders. This operation, incorporated in 2021, faced working capital difficulties, negatively impacting Mater Dei\u2019s balance sheet.<\/p>\n\n\n\n<p>\u201cMany assets acquired during the last M&amp;A wave have not yet captured synergies or integrated fully in a market that has undergone significant changes in recent years,\u201d said Luiza Mattos, a partner at Bain &amp; Company.<\/p>\n\n\n\n<p>Fernando Kunzel, a partner responsible for mergers and acquisitions at JGP, stated that the healthcare sector\u2019s chessboard is moving but awaiting a less intense wave compared to the pandemic period when dozens of operations took place. He anticipates a valuation disconnection, potentially delaying some transactions. \u201cThere are buyers for hospitals, but the numbers aren\u2019t adding up. Some hospitals were acquired at up to 12 times EBITDA, and now offers are around six times,\u201d he said.<\/p>\n\n\n\n<p>Renata Rothbarth, a partner at Machado Meyer, noted that today\u2019s healthcare landscape is quite different from 2021, when there was an acquisition boom. \u201cConsolidators are now very attentive to hospitals\u2019 credentialing agreements with health plan operators,\u201d the lawyer said. Currently, one of the biggest problems for hospitals is working capital due to extended payment terms from health insurance plans.<\/p>\n\n\n\n<p>Other assets that may draw interest are those excluded from the Amil and Dasa merger. Sources indicate that there are interested buyers for&nbsp;<strong>Klinikum<\/strong>&nbsp;hospital in Fortaleza and&nbsp;<strong>Promater<\/strong>&nbsp;in Recife, both owned by Jos\u00e9 Seripieri Filho. There are also Dasa units not included in the deal, and the Bueno family\u2019s company has indicated the possibility of divestment. These include hospitals in Bahia, S\u00e3o Domingos in Maranh\u00e3o, and the AMO oncology clinic network in Bahia.<\/p>\n\n\n\n<p>These assets are expected to become acquisition targets since standalone hospitals without a network lack scale and profitability. Hospitals with fewer than 150 beds are not considered profitable; most hospitals in the country have less than 50 beds.<\/p>\n\n\n\n<p>\u201cCurrently, there are few transformational combinations, and most significant hospitals have already been acquired by consolidators,\u201d said Ms. Rothbarth of Machado Meyer.<\/p>\n\n\n\n<p>Additionally, movements from Alian\u00e7a, controlled by businessman&nbsp;<strong>Nelson Tanure<\/strong>, are anticipated after an unsuccessful bid for Amil. About two months ago, Oncocl\u00ednicas announced the entry of Banco Master, which frequently collaborates with Mr. Tanure.<\/p>\n\n\n\n<p>Enrico De Vettori, CEO of Gest\u00e3o Hospitalar Ltda and a partner at HSI, said the sector is now adjusting post-pandemic. \u201cWe are observing two movements: companies merging to improve efficiency and balance sheets and those seeking alternatives without merging,\u201d he said. This includes asset sales and sale-leaseback transactions.<\/p>\n\n\n\n<p>Maximo Lima, CEO of HSI, noted this trend follows a market cycle where capital costs were very low, leading to an expansionist phase for many groups through acquisitions. \u201cThis industry is transforming, moving from a tough period [financial restructuring] to reorganization,\u201d he said.<\/p>\n\n\n\n<p>Grupo Santa declined to comment on its partnership with Bradesco due to confidentiality clauses. Hospital Care and Kora did not respond to Valor\u2019s request for comment.<\/p>\n\n\n\n<p>*Por Fernanda Guimar\u00e3es, Beth Koike\u00a0\u2014 S\u00e3o Paulo<\/p>\n\n\n\n<figure class=\"wp-block-embed\"><div class=\"wp-block-embed__wrapper\">\nhttps:\/\/valorinternational.globo.com\/\n<\/div><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>Following Dasa-Amil and Rede D\u2019Or-Bradesco Seguros mergers, consolidation will now focus on units in cities with over 200,000 inhabitants 24\/07\/2024 Kora\u2019s Meridional hospital in Esp\u00edrito Santo \u2014 Foto: Divulga\u00e7\u00e3o In the wake of recent\u00a0hospital mergers\u00a0between\u00a0Dasa\u00a0and\u00a0Amil\u00a0and\u00a0Rede D\u2019Or\u00a0with\u00a0Bradesco Seguros, the healthcare sector is starting to map out future scenarios and steps. Although the current environment isn\u2019t ideal [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8106],"tags":[25321,25319,25320],"class_list":["post-90180","post","type-post","status-publish","format-standard","hentry","category-murray-news","tag-become-acquisition-targets","tag-family-owned","tag-fund-backed-hospitals"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Family-owned, fund-backed hospitals become acquisition targets - Murray Advogados<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/murray.adv.br\/en\/family-owned-fund-backed-hospitals-become-acquisition-targets\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Family-owned, fund-backed hospitals become acquisition targets - Murray Advogados\" \/>\n<meta property=\"og:description\" content=\"Following Dasa-Amil and Rede D\u2019Or-Bradesco Seguros mergers, consolidation will now focus on units in cities with over 200,000 inhabitants 24\/07\/2024 Kora\u2019s Meridional hospital in Esp\u00edrito Santo \u2014 Foto: Divulga\u00e7\u00e3o In the wake of recent\u00a0hospital mergers\u00a0between\u00a0Dasa\u00a0and\u00a0Amil\u00a0and\u00a0Rede D\u2019Or\u00a0with\u00a0Bradesco Seguros, the healthcare sector is starting to map out future scenarios and steps. 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