The way you do that, again, is through consolidation. Once these hospitals are combined into a system, the object of the exercise is to reduce redundant services, thereby lowering the cost of operations. Then that system negotiates from strength, not weakness, with the local managed care payors. Universal hasn't made an acquisition since January 1998. HMA certainly has dry powder.
Province has a little bit of dry powder, but they're more leveraged.
A review of management performance at 9 Health Care-Acute Care Hospitals asked market insiders about the ability of management teams to create shareholder value. Many management teams disappoint, particularly regarding their ability to actually operate acute care hospitals and to do more than make deals, but a few CEOs receive accolades. He is probably the best CEO in the hospital sector. But several other sector CEOs are specifically chided for lacking operational focus or skills. Analyst Interview on Healthcare Service Providers' Stocks, A.J. Rice of Merrill Lynch examines the Prospective Pay System, impact of the Columbia investigation on the entire sector, niche businesses, outlook for spin-offs, BBA Medicare cuts and the outlook for the sector.