Waring is seeing a definite pickup in requests for financing around IT projects these days, especially given the meaningful use requirements under the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act. He also cites the recent “Oppenheimer 2010 Hospital CEO/CFO Survey” (released last month), which found that while “The average capital expenditure budget for respondents in our survey this year has been flat with fiscal 2009's…Looking forward, the hospital managements in our survey are expecting a slight improvement in fiscal 2011.” That survey found that 54 percent of survey respondents expected growth in their budgets in fiscal year 2011, versus 46 percent who saw flat or reduced budgets in 2011. Waring's organization currently works with 2,000 hospitals nationwide, across a spectrum of financing mechanisms, including leasing, tax-exempt financing, and others.
Waring spoke recently with HCI Editor-in-Chief Mark Hagland regarding the developments he is seeing in hospital capital financing, particularly with regard to healthcare IT investments.
Healthcare Informatics: Have you seen a shift recently in hospital and health system capital financing patterns?
Randy Waring: Yes. We'll finance pretty much any financial need a hospital has; but we're seeing greater investment in IT now. Probably half of what we do is to finance imaging equipment; but the rest is financing IT, as well as brick-and-mortar projects.
HCI: So perhaps a third of your activity involves financing IT now?
Waring: I don't know, but it's definitely a significant component.
HCI: What are the biggest trends you're seeing, overall, right now?
Waring: We're definitely seeing an increase in interest in financing of IT projects; and the investments we're seeing run all the way from a $2 million departmental IT project, to $100 EMR implementations. The main method we're seeing now is private-placement tax-exempt financing, which involves tax-exempt bonds, where the investor doesn't have to pay any federal tax on the interest income they receive. And what makes the private-placement option advantageous is that you don't have to go through the extra time, hassle, and expense involved in a public finance offering.
We're seeing an increase in that type of financing now for a couple of reasons. One is that the public bond market has been tougher to access in the last few years, and the covenants and provisions involved are tougher than they used to be.
WE'RE DEFINITELY SEEING AN INCREASE IN INTEREST IN FINANCING OF IT PROJECTS; AND THE INVESTMENTS WE'RE SEEING RUN ALL THE WAY FROM A $2 MILLION DEPARTMENTAL IT PROJECT, TO $100 EMR IMPLEMENTATIONS.
And there's also a new alternative that came in through the federal ARRA. And as part of ARRA, they provided a special stimulus for tax-exempt entities to be able to borrow from banks. It's an expansion of what was called the bank-qualified rule; a longstanding provision in the tax code to allow banks to invest in tax-exempt municipal bonds, in small quantities. But they liberalized the rule and made it so that qualified hospitals can access bank-qualified financing for projects up to $30 million. And that helps a lot. Most of the IT projects that we're seeing are under that, though there are some very large ones. But most of what we see comes under that ceiling, and would be eligible. Now, the rule was set to expire at the end of this year, 2010; it's been hung up in Congress now. There are a lot of people lobbying for its extension, but we don't know if it will be extended or not. Right now, that window of opportunity is set to close on December 31.
IN SOME CASES IS THAT WE'VE STRUCTURED OUR FINANCING SO THAT THE PAYMENT SCHEDULE COINCIDES WITH THE FEDERAL GOVERNMENT'S REIMBURSEMENT PLANS. WE'VE STRUCTURED THAT PROJECT SO THAT FOR THE FIRST COUPLE OF YEARS, THEY WON'T PAY US BACK ANYTHING, UNTIL THEY'VE DEMONSTRATED MEANINGFUL USE.