The Capital Issue

April - May 2016

There is always room for improvement. That’s the underlying theme in the April-May edition of The Capital Issue, as we explore several ways those in our sectors are striving to constantly move forward and work toward a common goal‒better care and housing.

In the feature, we describe key elements of the Protecting Access to Medicare ACT (PAMA), particularly the introduction of a value-based payment system for skilled nursing facilities (SNFs). Relatedly, our hospital article details how the Center for Medicare and Medicaid Innovation (CMMI) is shifting health care away from a fee-for-service (FSS) model and toward a system that rewards quality care. In our senior living article, we learn how idea-sharing across borders can help senior living providers in all countries improve their facilities. As for housing providers, they should find plenty to like about the recent MAP Guide update and mortgage insurance premium (MIP) rate reductions, as both will make it easier for them to obtain financing to improve their properties. Finally, our After the Financing article profiles Resthave Home, an assisted living (AL) and nursing home that used a combination of funding sources to expand and improve its services.

If you have any questions or comments, please don’t hesitate to reach out to the authors as well as our bankers.


Nick Gesue, CEO

A Shift in Care: Protecting Access to Medicare Act

A Shift in Care: Protecting Access to Medicare Act

The Protecting Access to Medicare Act (PAMA), like a lot of legislation, is based on a noble intention and is full of trade-offs, benefits and drawbacks. Overall, the Act aims to move the health care industry toward one that pays for results as opposed to services. Getting there, of course, is the tricky part.

Planning for the Unknown: Triple Aim

Planning for the Unknown: Triple Aim

 “In preparing for battle I have always found that plans are useless, but planning is indispensable.” This quote attributed to Dwight Eisenhower is good advice for strategizing in an environment where one knows that the conditions will change. Such is the case with the future of revenue for health care providers in America.

Beyond Our Borders: International Collaboration and Care

Beyond Our Borders: International Collaboration and Care

In an increasingly interconnected and global environment, governments and businesses are reaping benefits from the cross-pollination of ideas and adoption of best practices. Given this natural progression, it is only appropriate that the seniors housing and care industry seeks to take advantage of the same trend of idea-sharing across borders. 

Improving FHA Financing: MAP Guide Update and MIP Fee Reduction

Improving FHA Financing: MAP Guide Update and MIP Fee Reduction

The last time the U.S. Department of Housing and Urban Development (HUD)/Federal Housing Administration (FHA) updated its Multifamily Accelerated Processing (MAP) Guide in 2011, it consolidated all of its program changes and guidance into one document with the ultimate goal of reducing application processing time while appropriately balancing risk to the FHA mortgage insurance portfolio. With its 2016 MAP Guide update just released, HUD hopes to build on that progress as part of its continued efforts to improve and streamline underwriting standards for FHA-insured loans, bring FHA programs to industry standards, promote the development and preservation of affordable housing and further reduce processing time.

Expanding and Enhancing Care: Resthave Home

Expanding and Enhancing Care: Resthave Home

Making the decision to transition a loved one to a nursing home or assisted living (AL) facility is often times a challenging one. Seniors may be reluctant to move from the home they’ve always known to begin a new chapter. 

The Capital Issue: December 2015 - January 2016

Senior Living
The Fiduciary Focus