Wednesday, September 6, 2023

NextGen Healthcare to Go PEU


NextGen Healthcare will be taken private by Thoma Bravo in a $1.8 billion deal, including debt.  Thoma Bravo bills itself as "a leading private equity investment firm building on a 40+ year history." 

NextGen's long term debt (convertible notes) will soar from $267 million to what?   Sponsor deal fees, additional interest expenses and annual management fees add how much to the expense side?  Those items were left out of the press release as was the following recent news (June 2023):

NextGen settled with the Justice Department for $31 million. 

 ...the government alleges that NextGen relied on an auxiliary product designed only to perform the certification test scripts, which concealed from the certifying entity that NextGen’s EHR lacked critical functionality. 

...the government contends that, notwithstanding this prohibition, NextGen knowingly gave credits, often worth as much as $10,000, to current customers whose recommendation of NextGen’s EHR software led to a new sale. The government alleges that other remuneration, including tickets to sporting events and entertainment, was also provided to induce purchases and referrals. 

Fraud and bribery are longtime features of private equity underwriters (PEU).  Thank heaven so many billionaire PEU founders now own professional sports teams to facilitate illicit activities.

As for our obscenely expensive healthcare it just gets crappier.  Primary care physicians are quitting in droves.  "Patient centered care" turned into "profit centered care" as PEUs bought large hospital companies, nursing homes, hospices, specialty pharmaceutical companies, physician staffing companies, dental practices and specialty physician groups.

Consider what an Emergency Room physician wrote in Time:

 We are burned out and overwhelmed. Violence against healthcare workers is a regular occurrence. We are worn down by the daily roadblocks set up by intransigent health insurers, error-promoting electronic health records, and C-suite executives with little understanding of the boots-on-the-ground perspective.

People are dying that would not be dying, if we (physicians) only had the time and resources to do our jobs as we were trained to.

The Thoma Bravo press release stated:

“We look forward to partnering with the NextGen Healthcare team to further accelerate product investments to better support the increasingly complex needs of ambulatory providers and ultimately improve patient outcomes.”

Uncle Sam's wallet funds much of our national healthcare non-system.  The greed and leverage boys have bleed it for huge profits for decades.  To see what the PEU boys do to turbocharge complexity simply look at the corporate structures set up for any one deal. 

One Thoma said in 2012:

"Somewhere along the way it got to be about ‘private equity is about people getting rich.’”

A PEU founder would know.  It's about getting rich and not paying your fair share of taxes.  Crappifying healthcare is a spinoff effect.

Update 9-11-23:  PEU healthcare bankruptcies are way up this year.  Lawmakers ignored private equity's advances into healthcare over the last two decades.  Nearly every former Medicare Chief became a PEU.  Congress couldn't undertake the wildly popular action of eliminating private equity's preferred "carried interest" taxation.  How are they going to get them to turn over more information?