Shadow health musculoskeletal assessment

- This addition adds up to the objectives and goals of the hospital of providing highest quality health and continuum care. This is due to the higher quality care that would be offered compared to the service offered at a tradition al hospital.

Reasons for board disapproval:

-cost of the project: the cost would be the $15 million loan. it is vital to evaluate the hospital's financial state via its bond rating to cover their financial commitments. This is due to the inverse relation between the ratings and cost of debt, as the lower the rating the higher the cost of debt. When it comes to valuating the project, the board's main objective is to maintain the rating of AA. Moreover, retaining this credit rating allowed the hospital to maintain a low borrowing cost and to compete effectually for debt dollars in future.

-low utilization rate: it is expected for the LTAC facilities to have an increase in capacity to 26% in the upcoming year till the Medicare Certification is approved. Moreover, the usage of facility is essential for maintaining the hospital and for matching it with the costs of the project.

- Hospital's reputation: in the case of the patient's increased reside time for more than the 25 days, would concern and worry patients that the hospital may not extend their time. Therefore, the hospital's reputation may be imperiled.

-Gross Profit Margin- the board wants to achieve a 5% profit margin within the star up of the project, and this may not reach it and thus they may not be able to cover their costs.

Question 2: What are the differences between nonprofit institutions and for-profit institutions? For example, how would a for-profit hospital approach the LTAC decision?

A nonprofit institution is more advantageous than the for-profit institution because they do not respond to shareholders as its objectives are focust on stakeholders’ interests and not the goals of its owners.

Difference between Non-profits and For-profits institutions:

Non-profits:

· The institutional culture is service-driven.

· There is no tax burden; however they should cover the borrowing cost.

· Requires a low margin while managing to meet the objectives of providing clinical care. They need to maintain the bond rating at the investment rate.

· Funded by the government, private sector, or corporations that have a CSR policy.

· Non-profit hospitals’ main priority is the heath and not the profits. This improves the society overall.

· They are less likely to generate profits from operations.

· Aims towards the overall well-being of the society by supporting the poor and unprivileged.

For-profits:

· The institutional culture is business-driven.

· There is property and income taxes. They must cover tax expenses and the equity cost of capital.

· Requires a pre-tax profit margin of 15% for a capital investment.

· As any other business, expansion and growth is a strategic objective.

· Their main intention is generating profits, which harms the society indirectly.

· The main purpose is to add value and generate a return for shareholders. They need to meet the investors’ expectations.

· Aims towards the highest quality of services and products to customers in the market, especially for niche members.

For-profit hospital approach to the LTAC Decision

Since the For-profit institutions’ main purpose is to generate profits, increase shareholder value and to increase the quality, the LTAC is a great opportunity as they would add more beds, increase the revenue, and decrease the costs associated with treatments. Moreover, the hospital would be able to increase the capacity of patients in rolled into the hospital. The critical cases would be transferred to the LTAC facility as a critical patient takes more than 25 days to recover while a normal patient takes an average of 5 days to recover. Thus, for-profit hospitals should approach the LTAC facility as that would add overall value to their organization. Furthermore, the LTAC has beneficial financial drivers. The hospital could charge the insurance company for their services; and if the patient is to be transferred to the LTAC, then they could bill for the special treatment provided to the patient during his stay.

In order to know how much profits the LTAC must earn to be accepted, we must have a positive NPV that is greater than zero. That would cover all the expenses, as well as give a sufficient ROE. NPV is calculated based on cost of capital upon which both the cost of debt and equity reflect. Other financials that would support the board of directors’ decision would be the projected cash flows, net present value, internal rate of return and the payback period. Through using the WACC, it has been indicated that the NPV is positive, and so the nonprofit entity should rest assured that the investment is creating value. Finally, if the investment meets the for-profit required return, it should easily meet all the financial requirements of a non-profit.

Q3. What is the average cost of capital of the for-profit hospitals provided in case Exhibit 3? Would this serve as a reasonable discount rate to analyze a set of for-profit LTAC facility cash flows? Should Fitzgerald use this number to discount the U.V.A. LTAC facility’s cash flows?