Bristol Purchases Hope Hospice in Missouri

Bristol Hospice has acquired Missouri-based Hope Hospice for an undisclosed sum in the company’s first deal of the year. This follows nine acquisitions during 2020 and 14 in total since private equity firm Webster Equity Partners purchased the agency in 2017.

Hope Hospice in St. Louis was established in the early 2000s. Discussions of a possible sale began in late 2020 with its M&A advisors Agenda Health. The deal reflects the growing importance of established community relationships and reputation when it comes to hospice M&A, according to Alex Veach of Agenda Health. 

The deal marks Bristol’s entry into the Missouri market.

“Especially for a new market acquisition, I think it’s essential. I’ve had several sellers tell me that their caregivers are actually the best marketers, and when you have a good set of caregivers that emphasize quality of care, it builds a brand for the agency in the area,” Veach told Hospice News. “It allows you to establish your hospice as one that puts the quality of the care and the value of the patient over profit, which every patient is going to prioritize.”

Bristol is a large multi-regional player that has grown seven times larger since Webster acquired the company. The hospice operates more than 45 locations across 13 states, and its EBITDA exceeds $70 million, according to PE Hub.

Hospice buyers have been showing more interest in Missouri in the past couple of years due to favorable demographic trends.

The proportion of seniors older than 65 in Missouri’s population is expected to reach 19.1% by 2025, up from 13.5% in 2000 and 13.6% in 2008, according to the U.S. Census Bureau.

Hospice utilization in Missouri reached 50.2% among Medicare decedents in 2018, which is in line with that year’s national average, according to the National Hospice and Palliative Care Organization. Utah leads the nation in utilization at 60.4%.

After consideration and diligence process, Hope Hospice felt it had found a good match as it divested its business. 

“We worked [with Hope Hospice] to just find the right partner and find the right time for them to enter the marketplace,” Veach said. “When the time was right, we kind of initiated our process of introducing them to buyers that we felt would mirror the culture that they wanted. The Bristol folks ended up being a great fit for that.”

Bristol has been an active acquirer in the space.

Bristol Hospice in December purchased two California providers from the same owner — A Plus Hospice and NorCal Hospice. Financial terms were undisclosed.

The deal came as companies tried to complete their transactions before year’s end, due to the potential for capital gains tax hikes in 2022.

Bristol’s PE backers, Webster Equity Partners, are reportedly seeking buyers for the large hospice asset. A second round of bids began in March, with dollar amounts reaching as high as $1 billion, PE Hub reported.