Investing in Rural Healthcare: Impact of Private Equity Acquisition on Financial and Utilization Outcomes of Rural Hospitals
by Amanda He
Abstract
Private equity investment in the healthcare sector has risen considerably in recent decades, yet the impact of private equity ownership in rural hospital markets is largely unknown. Existing research points to a correlation between private equity acquisition and increased hospital incomes and charges. Rural hospitals, however, are structurally and operationally different from their urban counterparts, with lower occupancy rates and higher susceptibility to financial distress. This paper seeks to (1) characterize the types of rural hospitals acquired by private equity firms and (2) examine the changes in rural hospital financial, utilization, and survivability outcomes following private equity ownership. Using a 15-year panel of Medicare data, I estimate the impact of 352 private equity deal-hospitals across nine financial and utilization outcomes. Additionally, I estimate the impact of private equity on hospital closures. I find that private equity acquisition improves profitability for both urban and rural hospitals, but the magnitude is smaller for rural hospitals. My results suggest that private equity-owned hospitals increase profits by reducing operating expenses. Among rural hospitals, private equity ownership is associated with fewer discharges and lower occupancy rates, which may be a concern for long-term viability. I find a statistically significant negative correlation between private equity acquisition of rural hospitals and an increased likelihood of closure. PE-acquired hospitals have a negative spillover effect on other hospitals within the same hospital referral region, leading to a higher probability of closing.
Professor Ryan McDevitt, Faculty Advisor
Professor Michelle Connolly, Faculty Advisor
Professor Grace Kim, Faculty Advisor
JEL classification: G23, G33, G34, I10, I11
Last Second Comebacks: Examining Influencers of Bankruptcy Success
by Eric Junzhe Zhang
Abstract
The American bankruptcy system allows for companies to file for Chapter 11 bankruptcy to protect their assets from creditors and reorganize their business operations to continue operating after going through bankruptcy court. While the process is meant to help improve the financial health and business operations of companies after they exit the bankruptcy process, supposedly remedied firms will often find themselves filing again for bankruptcy despite the drastic changes they underwent to avoid such a fate. As such, it is difficult to determine what exactly makes a bankruptcy successful, as oftentimes a company with one metric that deems the bankruptcy successful may have another conflicting metric that deems it unsuccessful. This thesis seeks to contribute to prior knowledge on bankruptcy analysis by examining what in-court factors and company metrics drive bankruptcy success, with the change in debt-to-asset ratio and refiling likelihood post emergence being used as measures of bankruptcy success. Probit regression is used to analyze the change in the debt-to-asset ratio from bankruptcy filing to emergence while multivariable regression analysis is used to analyze the likelihood of refiling post-bankruptcy emergence. Explanatory variables which will be examined across these two variables will be the time spent in bankruptcy court, whether there was forum shopping to Delaware or New York, size of assets / EBIT of the firm, hedge fund presence, CEO turnover, whether a case was prepackaged, unionization rate, prime rate at filing and emergence, whether there was a 363 asset sale, whether a firm remained public following emergence, and debtor in possession financing. Results suggest that likelihood of refiling is a better measure of bankruptcy success than relative change in debt-to-asset ratio, which faces issues with the significance of its variables and their explanatory power.
Professor Connel Fullenkamp, Faculty Advisor
Professor Michelle Connolly, Faculty Advisor
JEL Codes: G33, K22, G34
What Affects Post-Merger Innovation Outcomes? An Empirical Study of R&D Intensity in High Technology Transactions Among U.S. Firms
by Neha Karna
Abstract
High levels of global M&A activity have characterized the past decade, making the policy debate over the impact of mergers on innovation even more pertinent. Innovation is a significant driver of economic growth and therefore a negative effect of mergers on innovation outcomes may have detrimental consequences. Nevertheless, the existing literature demonstrates mixed results leaving it unclear whether the overall effect is positive or negative. This paper contributes to existing literature on the relationship between mergers and innovation and examines the effects of M&A on the subsequent innovative activity of acquiring firms that operate in high technology (high-tech) industries. I construct a sample of U.S.-based public-to-public deals from 2010-2019 involving high-tech acquiring firms. Using multivariable regression with robust considerations, I analyze factors that may explain post-merger R&D intensity defined as the merged entity’s R&D expenditure divided by its total assets one year after deal completion. I consider firm characteristics of the target and acquirer, including size, industry, and age, and industry competition. I find potential positive impact of relative target size on post-merger R&D intensity and significant interaction effects between relative target size and firm age, relative target size and industry relatedness, and target industry competition and industry relatedness. My results suggests that beyond the occurrence of a merger, specific deal characteristics may affect postmerger innovation outcomes.
Professor Grace Kim, Faculty Advisor
Professor Kent Kimbrough, Faculty Advisor
JEL Codes: G3; G34; L40; O31; O32;
After The Mega-Buyout Era: Do Public-to-Private Transactions Still Outperform?
By Bryn Wilson
Abstract
This thesis contributes to existing knowledge of the private equity asset class by examining whether public-to-private leveraged buyouts outperform public peers before and after the mega-buyout era (2005 – 2007). This paper considers the impact of four groups of value drivers on both market- and peer-adjusted returns. These value drivers include operational improvements, leverage, multiple expansion and market timing, and management and corporate decision making. I analyze how these factors change over time, aiming to determine whether public-to-private target firms improve profitability, return on assets, and investment more than peers. I also examine how employment changes at target firms relative to peers. Multivariable regression analysis is used to quantify the impact of operating performance changes, leverage, multiple expansion, credit market conditions, GDP growth, and management and corporate decisions on market- and peer-adjusted returns. The paper constructs a sample of 227 public-to-private transactions from 1996 – 2013 and analyzes 74 transactions with post-buyout financial information available. Results suggest that private equity ownership post-buyout does not lead to significant operational improvements relative to peers, but that improving profitability and ROA are crucial to outperforming the market and peers.
Professor Connel Fullenkamp, Faculty Advisor
JEL Codes: G3; G34; G32; G11
Bang for Your (Green) Buck: The Effects of ESG Risk on US M&A Performance
by Richard Chen
Abstract
Mergers & Acquisitions (M&A) is a fundamental corporate activity that has not received much attention from an environmental, social, and governance (ESG) perspective. In this paper, I analyze how buyer and target ESG risks affect US M&A performance in both the short and long run as measured by deal valuations and changes in buyer operating metrics, respectively. I utilize a sample of 341 transactions from 2007-2020 with a cumulative value over $3 trillion from Capital IQ where both the buyer and target have available ESG data provided by RepRisk. Utilizing OLS, my results suggest that higher ESG risk causes buyers to pay more and targets to receive less. In the long run, buyer ESG risk is an important determinant of performance. When examining the components of ESG, governance is the most consistently significant, followed by social, then environmental – though it becomes more significant in the long run. Additionally, all three components appear to have some non-linear impacts on M&A performance.
Professor Connel Fullenkamp, Faculty Advisor
Professor Grace Kim, Faculty Advisor
JEL Codes: G34, G14, M14
Private Equity Buyouts and Strategic Acquisitions: An Analysis of Capital Investment and the Timing of Takeovers in the United States
By Anthony Melita
This paper investigates how motivational differences between agents who execute private equity buyouts and those who execute strategic (corporate) acquisitions may influence the timing of capital investment via takeovers. This paper synthesizes prominent merger theories to inform macroeconomic variables that may drive acquisitions. I find a significant negative expected effect of volatility on capital investment via takeover for each buyer type, a negative expected effect from valuation multiples on capital investment from PE buyouts, and a positive expected effect from debt capacity (EBITDA-CAPEX) on capital investment from PE buyouts.
Advisors: Professor Grace Kim | JEL Codes: G3, G34, G29
Determining the Drivers of Acquisition Premiums in Leveraged Buyouts
By Peter Noonan
This thesis analyzes factors that determine acquisition premiums paid by private equity firms in public to private leveraged buyouts. Building off of established literature that models the acquisition premiums paid in corporate mergers and acquisitions (M&A), this paper considers factors that influence a private equity firm’s willingness to pay (referred to as reservation price) and the bargaining power dynamic between a target company and acquirer in leveraged buyouts. Specifically, multivariable regression analysis is used to quantify the impact of a target company’s trading multiple, profitability, stock price as a percentage of its annual high, and number of competitors, a private equity firm’s deal approach and payment method, and the financial market’s 10-year US Treasury yield and high-yield interest rates at the time a transaction was announced. A sample of 320 public to private leveraged buyout transactions completed from 2000 to 2020 is constructed to perform this paper’s regression analysis. Using 2008 as an inflection point, this thesis then applies the same regression model to the subperiods from 2000–2008 and from 2009–2020 to examine how these drivers have changed as a result of industry trends—increased competition, low interest rates, and new value creation investment strategies—as well as the 2008 financial crisis and US presidential election—two crucial events that caused tremendous change in the financial system and intense scrutiny of the private equity industry. From the same original transaction screen, a second sample of 659 transactions is used to perform a difference of acquisition premium means t-test to analyze how the absolute magnitude of leverage buyout acquisition premiums have changed across these two subperiods. The second sample consists of more transactions due the t-tests less data-demanding nature as a result of its fewer variables. Results of this paper’s baseline model suggest that acquisition premiums are driven by a target company’s…
Advisors: Professor Ronald Leven, Professor Michelle Connolly | JEL Codes: G3, G11, G34
Investigating Underpricing in Venture-Backed IPOs Using Statistical Techniques
By Michael Tan
This paper concerns applying statistical methods to investigate under-pricing in VC-backed technology Initial Public Offerings (IPOs) since the great recession. In particular, firm, market, and IPO-specific variables were explored to determine if there were any significant relationships to under-pricing. The paper focused on the Bank Preference theory of under-pricing, where under-pricing is said to occur because investment banks running IPO processes are incentivized to under-price to decrease the risk that they will not be able to allocate all the issuance to price-sensitive public markets investors.
Advisors: Professor Daniel Xu, Professor Shawn Santo, Professor Grace Kim| JEL Codes: G3, G33, G24
Where Did the Money Go? Impact of the ECB’s Corporate Sector Purchase Program on Eurozone Corporate Spending
By Tina Tian
Slow corporate growth and a lack of corporate investment has plagued European markets for the past decade. As a response, the ECB began the Corporate Sector Purchase Program (CSPP) in 2016 to provide liquidity to corporate debt markets through bond purchases. Four years after the start of the program, this paper assesses its impact by looking at how companies spent this money on a micro level. In particular, it looks at the impact of long-term debt on five expenditures (fixed assets and R&D, cash balances, short-term debt, cash to shareholders, and share buybacks). We test these hypothesized expenditures based on financial statement panel data from a selection of European firms whose bonds were purchased by the ECB. The results show an increase in financial expenditures including cash balances and short-term debt and a decrease in productive investment expenditures such as fixed assets and R&D. This indicates a lack of efficacy of the corporate bond purchase program as excess liquidity provided by the ECB went towards eurozone companies refinancing existing debt rather than investing in growth ventures.
Advisors: Professor Connel Fullenkamp, Professor Kent Kimbrough | JEL Codes: G3, O16, E58
Leverage and Varying Metrics of Firm Performance
By Preston Jiateng Huang
This paper sets out to examine the effect of leverage on company performance. Drawing on the methodology of key prior research, this study finds that leverage has a consistent negative effect on firm growth; by contrast, no such negative impact was found on return on equity. Importantly, such patterns hold throughout the entire period under study (1970-2017), during which several disruptive economic events have occurred. These results highlight the importance of selecting appropriate company performance measures when studying the effect of debt load on a firm as well as the misalignment of incentives for policymakers and company management. Other implications are also discussed.
Advisor: Professor Kyle Jurado | JEL Codes: G24; G31; G32
