Showing posts with label services. Show all posts
Showing posts with label services. Show all posts

Monday, 9 September 2013

University General Health Services: A More Bullish Update

In this article I would like to provide an update to my previous article on University General Health Services (UGHS.OB). In the first article I suggested that issues in getting audited and filing a 10-K/Q with the SEC were troubling. While I still believe that these issues are pertinent, I would like to provide an update to my first article.

Overview

This is the business model as described by the company.

A diversified, integrated, multi-specialty health care provider that delivers concierge physician and patient oriented services providing timely and innovative health solutions that are competitive, efficient and adaptive in today's health care delivery environment. The UGHS business model anticipates the acquisition of acute care "host" hospitals and the development and operation of regional health networks within a defined radius of each host hospital that can provide services under the Company's acute care licenses. Such regional health networks and ancillary services will reflect a vertically integrated, diversified system, which will include provider-based "Hospital Outpatient Departments" (HOPDs) of the host hospitals and may consist of Ambulatory Surgical Centers, Free-Standing Emergency Rooms, Free-Standing Procedure Facilities, Diagnostic Imaging Treatment Facilities, HBOT/Wound Care Centers, and/or other ancillary service provider."

UGHS went public in 2011 by a reverse merger. On March 10, 2011 UGH Partnerships was acquired by SeaBridge Freight Corp., which was a Nevada corporation. At the same time SeaBridge changed its name to University General Health Systems, Inc. The newly named UGHS immediately divested itself of the freight transport service between Port Manatee in Tampa, Florida and Brownsville, Texas.

UGHS has not filed a 2012 annual report (10-K) and has not filed 10-Qs for the first and second quarter this year. UGHS has had problems getting an audit after switching auditors and has since returned to its original auditor. The information from UGHS we have currently is this presentation from the company website posted this June. The next slides are from this presentation.


(Click to enlarge)

The occupancy rates are well above the industry average and the unique and profitable business model has higher margin than more traditional models as well as lower operating costs.

Ecosystem


(Click to enlarge)

The ecosystem provided by the three separate business segments. The hospital segment, the senior living segment, and the support services segment.

Red Flags Remain

I still have concerns about this company, and due to the limited amount of publicly available information is a concern. Obviously the company needs the auditors blessing before it can file 10-K and 10-Q. Still, the company has made some moves recently that should be concerning. UGHS has paid NBT Equities Research to promote the stock. Granted there have been no hard mailers, but you can see the sponsored research here. Here is the disclaimer from the research article.


(Click to enlarge)

Update

In my first article on of the biggest red flags for me was the quote in the OTC Journal article in which Larry Isen, the author of OTC Journal, claimed that he had spoken with the CEO.

"I've interviewed the CEO, and he assured me all their filings would be brought up to date by the Q2 deadline. This means the company has to file its 2012 annual 10k, Q1'13 March quarterly numbers, and Q2'13 June quarterly numbers- all by August 15th."

When I saw that no filings came on the Q2 deadline, this raised a red flag for me. I have since spoken with several people at the company, and they do not believe the quote to be accurate. As such, part of the basis for my argument against UGHS is now invalid, I believe.

The company released a market update for the second quarter today by this press release. It announced certain preliminary information regarding the quarter ended June 30, 2013. The company reported that Average Daily Census ("ADC") levels at its flagship hospital in Houston increased by approximately 20%, when compared with the prior-year quarter, while occupancy rates continued to improve at University General Hospital - Dallas, which was acquired in December 14, 2012. Surgical volumes at University General Hospital in Houston rose approximately 28% relative to the second quarter of 2012, while the Dallas hospital reported approximately 53% increase in surgical volumes relative to the month of December 2012.

"We are very pleased to announce that ADC levels and surgery volumes at our flagship Houston hospital have continued to post consistent growth, year-over-year and quarter-over-quarter, for ten consecutive quarters," stated Hassan Chahadeh, M.D., Chairman and Chief Executive Officer of University General Health System, Inc. "We would expect this to be evident in our financial performance for the second quarter and first half of 2013."

UGHS also said that they are planning to file with the SEC as soon as possible. Given that I cannot verify if the quote regarding Q2 filing in the OTC Journal is accurate, it no longer plays into my short thesis and therefore I have changed my view. While I still have concerns about the 10-Q/K filings, I would no longer recommend a short.

Disclosure: I have no positions in any stocks mentioned, and no plans to initiate any positions within the next 72 hours. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article. (More...)


View the original article here

Thursday, 5 September 2013

Mental health care overlooked by NHS review of emergency services

Inner city Emergency mental health care plays a vital role, especially in inner city areas where demand is greater. Photograph: David Levene

NHS England's large scale review of all emergency services, partly driven by the premature mortality rates across hospitals, seems to have made a significant omission by overlooking mental health emergency care.

While the evidence accompanying the consultation suggests that 4,400 lives a year could be saved if weekend services were as good as those during the weekdays, there is a chance that those experiencing mental ill health could fall through the upgraded safety net.

The emergency review does not mention mental health services, the conditions leading to emergency presentations, or the role of the police, housing and mental health problems. Yet emergency mental health care plays a vital role, especially in inner city areas where demand is greater due to high levels of poverty and other social determinants of ill health and inequalities such as ethnicity, gender and age.

For example, we know there is a higher incidence of schizophrenia in inner city areas, especially among black African and Caribbean people and other ethnic minority groups, particularly in London.

The recent report by Lord Victor Adebowale on policing and mental health concluded that the presence of offending behaviour by someone experiencing mental illness, which can lead them to have contact with the police, is an emergency pathway which needs to be made safer.

Lord Adebowale's findings emphasised the failures of NHS services and police knowledge, as well as emergency communications, in meeting the needs of people with mental illness. These findings have been reinforced in the latest Care Quality Commission (CQC) reports on the emergency removal of people suspected of having a mental illness to a place of safety (under section 136 of the Mental Health Act). These reports found unacceptable emergency practices leading to deaths in police custody, mentally ill people being transported in caged ambulances and suicides on the railways and transport hubs.

The statistics show why urgent attention is required. In January of 2013, the CQC announced there were 48,631 detentions in 2011/2012, an increase of 5% on the previous year. Community treatment orders rose by 10% to 4,220. The commission also reported growing concern about cultures of coercion and containment rather than treatment and support. Around 15% of detained patients said they were not allowed to play a part in the shared decision-making while 4% of decisions were called into question on legal grounds.

The use of section 136 by the police rose to 14,902, 5.6% higher than in 2011/12. The CQC data along with data published by the NHS Information Centre and independent researchers, all point to higher rates of detention for some ethnic groups, yet these differences are still not being tackled.

These unsettling findings suggest emergency services must take account of mental health and ethnicity. If more care is to be provided away from accident and emergency departments, then additional homecare and specialist advice services at the time of critical decisions are necessary.

What is required is not a 9am to 5pm specialist service, but 24/7 home treatment and crisis responses and a better use of social networks, and shared care plans for existing patients to protect their dignity and autonomy. Understanding patients' personal stories and remedying the real fears people have about the quality of NHS care is as important as providing a safe emergency response for the most vulnerable.

For people experiencing mental illness who make contact with hospitals, what is needed is an emergency psychiatric response team staffed by medical and psychiatric specialists, a service model that has been abandoned by commissioners in the recent past. The entire public health system needs an agreed emergency care pathway to be commissioned across the police, mental health providers and local government.

To do this effectively any NHS review has to include the responses of the police and acknowledge the presence of ethnic inequalities in mental health services in its recommendations. If not, the new proposals will fall short of aspirations and will not remedy past failures.

Professor Kamaldeep Bhui is professor of cultural psychiatry and epidemiology at the Wolfson Institute of Preventive Medicine, and is director of the Cultural Consultation Service, Queen Mary, University of London

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.


View the original article here

Monday, 2 September 2013

University General Health Services: A More Bullish Update

In this article I would like to provide an update to my previous article on University General Health Services (UGHS.OB). In the first article I suggested that issues in getting audited and filing a 10-K/Q with the SEC were troubling. While I still believe that these issues are pertinent, I would like to provide an update to my first article.

Overview

This is the business model as described by the company.

A diversified, integrated, multi-specialty health care provider that delivers concierge physician and patient oriented services providing timely and innovative health solutions that are competitive, efficient and adaptive in today's health care delivery environment. The UGHS business model anticipates the acquisition of acute care "host" hospitals and the development and operation of regional health networks within a defined radius of each host hospital that can provide services under the Company's acute care licenses. Such regional health networks and ancillary services will reflect a vertically integrated, diversified system, which will include provider-based "Hospital Outpatient Departments" (HOPDs) of the host hospitals and may consist of Ambulatory Surgical Centers, Free-Standing Emergency Rooms, Free-Standing Procedure Facilities, Diagnostic Imaging Treatment Facilities, HBOT/Wound Care Centers, and/or other ancillary service provider."

UGHS went public in 2011 by a reverse merger. On March 10, 2011 UGH Partnerships was acquired by SeaBridge Freight Corp., which was a Nevada corporation. At the same time SeaBridge changed its name to University General Health Systems, Inc. The newly named UGHS immediately divested itself of the freight transport service between Port Manatee in Tampa, Florida and Brownsville, Texas.

UGHS has not filed a 2012 annual report (10-K) and has not filed 10-Qs for the first and second quarter this year. UGHS has had problems getting an audit after switching auditors and has since returned to its original auditor. The information from UGHS we have currently is this presentation from the company website posted this June. The next slides are from this presentation.


(Click to enlarge)

The occupancy rates are well above the industry average and the unique and profitable business model has higher margin than more traditional models as well as lower operating costs.

Ecosystem


(Click to enlarge)

The ecosystem provided by the three separate business segments. The hospital segment, the senior living segment, and the support services segment.

Red Flags Remain

I still have concerns about this company, and due to the limited amount of publicly available information is a concern. Obviously the company needs the auditors blessing before it can file 10-K and 10-Q. Still, the company has made some moves recently that should be concerning. UGHS has paid NBT Equities Research to promote the stock. Granted there have been no hard mailers, but you can see the sponsored research here. Here is the disclaimer from the research article.


(Click to enlarge)

Update

In my first article on of the biggest red flags for me was the quote in the OTC Journal article in which Larry Isen, the author of OTC Journal, claimed that he had spoken with the CEO.

"I've interviewed the CEO, and he assured me all their filings would be brought up to date by the Q2 deadline. This means the company has to file its 2012 annual 10k, Q1'13 March quarterly numbers, and Q2'13 June quarterly numbers- all by August 15th."

When I saw that no filings came on the Q2 deadline, this raised a red flag for me. I have since spoken with several people at the company, and they do not believe the quote to be accurate. As such, part of the basis for my argument against UGHS is now invalid, I believe.

The company released a market update for the second quarter today by this press release. It announced certain preliminary information regarding the quarter ended June 30, 2013. The company reported that Average Daily Census ("ADC") levels at its flagship hospital in Houston increased by approximately 20%, when compared with the prior-year quarter, while occupancy rates continued to improve at University General Hospital - Dallas, which was acquired in December 14, 2012. Surgical volumes at University General Hospital in Houston rose approximately 28% relative to the second quarter of 2012, while the Dallas hospital reported approximately 53% increase in surgical volumes relative to the month of December 2012.

"We are very pleased to announce that ADC levels and surgery volumes at our flagship Houston hospital have continued to post consistent growth, year-over-year and quarter-over-quarter, for ten consecutive quarters," stated Hassan Chahadeh, M.D., Chairman and Chief Executive Officer of University General Health System, Inc. "We would expect this to be evident in our financial performance for the second quarter and first half of 2013."

UGHS also said that they are planning to file with the SEC as soon as possible. Given that I cannot verify if the quote regarding Q2 filing in the OTC Journal is accurate, it no longer plays into my short thesis and therefore I have changed my view. While I still have concerns about the 10-Q/K filings, I would no longer recommend a short.

Disclosure: I have no positions in any stocks mentioned, and no plans to initiate any positions within the next 72 hours. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article. (More...)


View the original article here

Saturday, 31 August 2013

Are social enterprises fit for the future of public services?

david haye fight Spin outs need investment to compete for contracts against organisations with more financial muscle. Photograph: Johannes Eisele/AFP/Getty Images

Social enterprises are playing a growing role in the health and social care sectors in the UK. Major growth is coming from spin-outs – organisations leaving the NHS to become independent social enterprises. Primarily as a result of the previous government's Right to Request programme and its successors, by the end of 2011 spin-outs were delivering £886m worth of health services and that figure is growing.

Social Enterprise UK (SEUK)'s 2013 State of Social Enterprise survey, The People's Business, reported both an increase in the percentage of social enterprises that have the public sector (in general) as their main source of income (23% compared to 18% in 2011) and that 15% of social enterprises trading for three years or less are operating in healthcare compared to 5% of older social enterprises.

Discussions at SEUK's Fit For the Future conference on social enterprise in health and social care in June illustrated there are at least two groups of social enterprises currently operating in health and social care.

One is spin-outs, many of whom are competing for large contracts worth tens or in some cases, hundreds of millions of pounds. Another is those social enterprises whose starting point is similar to traditional voluntary sector organisations and who are looking to win relatively small locally-based contracts.

Both groups face new challenges and opportunities as result of changes to the NHS following the implementation of the Health and Social Act 2012. Speaking at Fit for the Future, Andrew Burnell, chief executive of Hull-based spin out City Healthcare Partnership CIC noted that: "We've worked really hard to demonstrate our differentiation from the SERCOs. How are others in the sector doing that? We are, in part, open to being picked off."

Burnell's comments illustrate two of the key challenges currently facing spin-outs: to demonstrate why they're different and better to alternative providers from both private and public sectors and to ensure they can both keep existing contracts and win new ones in an increasingly competitive market place. Both of these points are partially addressed in Spin-Out, Step Out, a new SEUK report that looks at the challenges faced by spin outs in raising finance to develop and grow.

The report, which is based on a survey of 27 existing health spin-outs, said: "the respondents were not very strong in articulating their social impact. Some of the organisations surveyed are known to have produced relatively robust social impact reports but this did not come through in the survey for the spin-outs as a whole."

There is clearly a need for spin-outs to get better at explaining what it is they offer that's demonstrably better than what their competitors can provide, however the primary focus of Spin-Out, Step Out is on how spin outs can find the investment that will enable them to compete for contracts against organisations with more financial muscle.

The report quotes one spin out leader talking about the difficulty of bidding against private sector competitors: "I saw how they worked. There is absolutely no way my organisation can compete with them… They were prepared to invest to make sure they won the contract…We can compete with Serco [on delivery] but we just don't have the [bidding] resources."

It would be easier for spin-outs to compete with private sector, if they could attract investment for social investors. Unfortunately, despite spin-outs being relatively large businesses by social enterprises standards – with a median turnover of £2.9m compared, more than 15 times the median UK social enterprise turnover of £187,000 - only 1 of 27 spin-outs surveyed had done so.

The report claims this is partly because social investors are wary of investing in spin-out, based on the fact that: "these businesses are sometimes perceived negatively to have a limited track record as new entities, just one or two contracts, a lack of assets, to be operating in a highly unpredictable market environment with highly aggressive, professional and well capitalised competitors."

A video made at Fit for the Future conference by Pioneers Post suggests that social investors concerns may be based more on myth than reality.

Unfortunately, even if social investors were prepared to put their money into spin-outs, there is still a problem that the money they provide is too expensive and many spin outs have been surprised that the fact they deliver positive social outcomes, doesn't mean investors will offer them a better financial deal: "where social return is taken into account it does not necessarily influence the investment terms in a way that makes them any more generous than finance provided by purely financially motivated commercial investors. Yet the spin-outs, like many other social enterprises, interpret the rhetoric around social return and social investment to suggest that there could be a good generous offer on the table."

Beyond the world of large scale spin-outs and direct competition with SERCO, Virgin Care and others, smaller local social enterprises are trying to work out how to navigate the NHS landscape.

Earlier in the year SEUK and IVAR produced The Power of Partnerships, a resource to promote better working between new local health structures - Clinical Commissioning Groups (CCGs) and Health and Wellbeing Boards (HWBs) – and local charities and social enterprises based on work in four local areas in England.

At Fit for the Future, commissioners and social enterprise leaders involved in the project discussed ways that social enterprises can build relationships with commissioners in CCGs in local authorities.

A key message for social enterprises looking to engage with new NHS structures is that its important to find out what is going on in your area because every area will be different. As Dr Johnny Marshall, Policy Director at the NHS Confederation, told the conference: "There's already an old adage: when you've met one CCG, you've met one CCG."

David Floyd is managing director of Social Spider CIC. He writes the blog Beanbags and Bullsh!t.

This content is brought to you by Guardian Professional. To join the social enterprise network, click here.


View the original article here

Thursday, 29 August 2013

Are social enterprises fit for the future of public services?

david haye fight Spin outs need investment to compete for contracts against organisations with more financial muscle. Photograph: Johannes Eisele/AFP/Getty Images

Social enterprises are playing a growing role in the health and social care sectors in the UK. Major growth is coming from spin-outs – organisations leaving the NHS to become independent social enterprises. Primarily as a result of the previous government's Right to Request programme and its successors, by the end of 2011 spin-outs were delivering £886m worth of health services and that figure is growing.

Social Enterprise UK (SEUK)'s 2013 State of Social Enterprise survey, The People's Business, reported both an increase in the percentage of social enterprises that have the public sector (in general) as their main source of income (23% compared to 18% in 2011) and that 15% of social enterprises trading for three years or less are operating in healthcare compared to 5% of older social enterprises.

Discussions at SEUK's Fit For the Future conference on social enterprise in health and social care in June illustrated there are at least two groups of social enterprises currently operating in health and social care.

One is spin-outs, many of whom are competing for large contracts worth tens or in some cases, hundreds of millions of pounds. Another is those social enterprises whose starting point is similar to traditional voluntary sector organisations and who are looking to win relatively small locally-based contracts.

Both groups face new challenges and opportunities as result of changes to the NHS following the implementation of the Health and Social Act 2012. Speaking at Fit for the Future, Andrew Burnell, chief executive of Hull-based spin out City Healthcare Partnership CIC noted that: "We've worked really hard to demonstrate our differentiation from the SERCOs. How are others in the sector doing that? We are, in part, open to being picked off."

Burnell's comments illustrate two of the key challenges currently facing spin-outs: to demonstrate why they're different and better to alternative providers from both private and public sectors and to ensure they can both keep existing contracts and win new ones in an increasingly competitive market place. Both of these points are partially addressed in Spin-Out, Step Out, a new SEUK report that looks at the challenges faced by spin outs in raising finance to develop and grow.

The report, which is based on a survey of 27 existing health spin-outs, said: "the respondents were not very strong in articulating their social impact. Some of the organisations surveyed are known to have produced relatively robust social impact reports but this did not come through in the survey for the spin-outs as a whole."

There is clearly a need for spin-outs to get better at explaining what it is they offer that's demonstrably better than what their competitors can provide, however the primary focus of Spin-Out, Step Out is on how spin outs can find the investment that will enable them to compete for contracts against organisations with more financial muscle.

The report quotes one spin out leader talking about the difficulty of bidding against private sector competitors: "I saw how they worked. There is absolutely no way my organisation can compete with them… They were prepared to invest to make sure they won the contract…We can compete with Serco [on delivery] but we just don't have the [bidding] resources."

It would be easier for spin-outs to compete with private sector, if they could attract investment for social investors. Unfortunately, despite spin-outs being relatively large businesses by social enterprises standards – with a median turnover of £2.9m compared, more than 15 times the median UK social enterprise turnover of £187,000 - only 1 of 27 spin-outs surveyed had done so.

The report claims this is partly because social investors are wary of investing in spin-out, based on the fact that: "these businesses are sometimes perceived negatively to have a limited track record as new entities, just one or two contracts, a lack of assets, to be operating in a highly unpredictable market environment with highly aggressive, professional and well capitalised competitors."

A video made at Fit for the Future conference by Pioneers Post suggests that social investors concerns may be based more on myth than reality.

Unfortunately, even if social investors were prepared to put their money into spin-outs, there is still a problem that the money they provide is too expensive and many spin outs have been surprised that the fact they deliver positive social outcomes, doesn't mean investors will offer them a better financial deal: "where social return is taken into account it does not necessarily influence the investment terms in a way that makes them any more generous than finance provided by purely financially motivated commercial investors. Yet the spin-outs, like many other social enterprises, interpret the rhetoric around social return and social investment to suggest that there could be a good generous offer on the table."

Beyond the world of large scale spin-outs and direct competition with SERCO, Virgin Care and others, smaller local social enterprises are trying to work out how to navigate the NHS landscape.

Earlier in the year SEUK and IVAR produced The Power of Partnerships, a resource to promote better working between new local health structures - Clinical Commissioning Groups (CCGs) and Health and Wellbeing Boards (HWBs) – and local charities and social enterprises based on work in four local areas in England.

At Fit for the Future, commissioners and social enterprise leaders involved in the project discussed ways that social enterprises can build relationships with commissioners in CCGs in local authorities.

A key message for social enterprises looking to engage with new NHS structures is that its important to find out what is going on in your area because every area will be different. As Dr Johnny Marshall, Policy Director at the NHS Confederation, told the conference: "There's already an old adage: when you've met one CCG, you've met one CCG."

David Floyd is managing director of Social Spider CIC. He writes the blog Beanbags and Bullsh!t.

This content is brought to you by Guardian Professional. To join the social enterprise network, click here.


View the original article here

Wednesday, 28 August 2013

University General Health Services: A Good Short

University General Health Systems (UGHS.OB) is a regional multi-specialty health care provider that is based in Houston. While I believe that the UGHS business model once showed promise, issues have plagued the company. UGHS is currently trading at $.56/share and has a market cap of $185 million. At these levels, I don't believe that the market has priced in the issues facing UGHS properly, leaving it overvalued.

Business Model

The UGHS business model is as follows:

"A diversified, integrated, multi-specialty health care provider that delivers concierge physician and patient oriented services providing timely and innovative health solutions that are competitive, efficient and adaptive in today's health care delivery environment. The UGHS business model anticipates the acquisition of acute care "host" hospitals and the development and operation of regional health networks within a defined radius of each host hospital that can provide services under the Company's acute care licenses. Such regional health networks and ancillary services will reflect a vertically integrated, diversified system, which will include provider-based "Hospital Outpatient Departments" (HOPDs) of the host hospitals and may consist of Ambulatory Surgical Centers, Free-Standing Emergency Rooms, Free-Standing Procedure Facilities, Diagnostic Imaging Treatment Facilities, HBOT/Wound Care Centers, and/or other ancillary service provider."

UGHS operates through three separate business segments; the Hospital segment, the Senior Living segment, and the Support Services segment. UGHS seeks to acquire smaller (50-150 beds) acute care hospitals. These hospitals have lower capital costs, lower operating costs, and higher margins. While these are positives, the negatives that I will highlight below far outweigh the positives.

In an article on the website OTCJournal.com, the author suggests that he has had contact with the CEO and that the audited numbers are close to coming out.

I've interviewed the CEO, and he assured me all their filings would be brought up to date by the Q2 deadline. This means the company has to file its 2012 annual 10k, Q1'13 March quarterly numbers, and Q2'13 June quarterly numbers- all by August 15th. The stock appears to me to behaving as if the audited numbers are close to coming out, and the market will know the company is back on track. This stock could go considerably higher- likely a reverse split would occur followed by an immediate up-listing. It's quietly creeping higher, and as you know- my theme is to get you in before the breakout. I believe the numbers will show a company delivering about $200 million in annual revenues and world class profits.

The submission deadline for filing a 10-Q on time was August 9th, and the deadline for late filing was August 14th.

(click to enlarge)

UGHS has missed the SEC filing deadline, which has been a common occurrence for this company as of late.

Unable To Get An Audit

UGHS has late filing with the SEC because of the struggles UGHS has had with auditing. From a Notification of Late Filing filed with the SEC on August 16th. Here is what the management had to say.

"The Company has not yet completed its financial statements for the year ended December 31, 2012 due to an ongoing audit and review of the accounting treatment of certain non-operating items related to 2012 acquisitions and federal income tax calculations. The Company requires additional time to complete the Form 10-K for the fiscal year ended December 31, 2012 and the Form 10-Q for the quarter ended June 30, 2013. The Company anticipates filing its Form 10-K and Form 10-Q as soon as practicable."

Because of the inability to get an audit, UGHS has not filed a current 10-K or 10-Q since November 15th of last year. In that 10-Q which was for the third quarter of 2012, UGHS restate numbers.

(click to enlarge)

To be fair, the issue did not drastically affect the company. Here is what was changed.

The correction of the errors decreased originally reported assets by $0.3 million and mezzanine equity by $0.6 million, and increased originally reported shareholders' equity by $0.3 million at September 30, 2012. In addition, other expense increased by $0.3 million, direct investor expense increased by $0.9 million, derivative expense decreased by $0.6 million, and net income attributable to the Company decreased by $0.6 million for the three months ended September 30, 2012. For the nine months ended September 30, 2012, other expense increased by $0.4 million, direct investor expense increased by $5.5 million, derivative expense decreased by $1.7 million and net income attributable to the Company decreased by $4.2 million. Basic and diluted earnings per share remained unchanged at $0.01 for both the three and nine months ended September 30, 2012

Because of that the only real information that we have gotten from the company is this presentation, which unfortunately provides no real insight into the current state of the company. It is simply a glossy overview of the business potential. The lack of auditing is a serious concern. A press release published on April 16th, UGHS highlighted the reasons for the delay in getting a 10-K out.

University General stated that the delay if filing the Form 10-K was associated with an earlier change in auditors; completion of the accounting treatment of certain non-operating items related to 2012 acquisitions, including the acquisition of University General Hospital - Dallas in December 2012; the calculation of derivative liabilities associated with the Company's Series C preferred stock; and federal income tax calculations. The Company requires additional time to complete the Form 10-K and to announce fourth quarter and full year 2012 financial and operating results.

In a similar report from the OTC Journal, the author states that the company has faced delays because the previous auditor was unable to understand the business and UGHS has since returned to its previous auditor.

"Chronicles the difficulty they've had getting their audit for 2012 done. It was due several months ago. They changed auditors, only to discover the new auditor was incapable of understanding their business, and changed back to their original auditor. Hence, the delay and temporary lack of interest in the stock."

Some of the issues have arisen from the companies acquisitions. One acquisition I would like to focus on is the acquisition of the South Hampton Community Hospital in December of 2012. According to a press release the hospital, which will be re-branded as University General Hospital-Dallas in 2013, was purchased for $30 million and will also receive a $1 million cash infusion. The hospital, however, was the only hospital in North Texas to receive an "F" rating from the Leapfrog Group.

Will It Get An "E" It Already Has A "F"?

A big red flag for me is the "Yield" sign on the OTC Markets website.

(click to enlarge)

According to OTC Markets, these are some of the potential reasons for having a yield sign (Which signifies limited information) next to a companies name.

Limited Information

Designed for companies with financial reporting problems, economic distress, or in bankruptcy to make the limited information they have publicly available. The Limited Information category also includes companies that may not be troubled, but are unwilling to provide disclosure pursuant to OTC Pink Basic Disclosure Guidelines.

Source: OTC Markets

Given that UGHS has not filed a 10-Q or 10-K in so long, it is at risk of having an "E" put on to the end of its ticker. On the OTC Market, an "E" as the last letter of the ticker signifies that the company is delinquent in filings. From the OTCBB FAQ section:

What does a fifth character "E" indicate for an OTCBB security?

The fifth character "E" on an OTCBB trading symbol indicates that FINRA does not have information which demonstrates that the issuer of the security is compliant with the filing requirements of Rule 6530, either because the issuer is delinquent in the required filings, has filed an incomplete filing, or, for non-EDGAR filers, such as banks filing with the Office of the Comptroller of the Currency and certain insurance companies where FINRA has not been provided a copy of the most recent filing. The purpose of appending an "E" to the security symbol is to alert all interested parties that the security will be removed from the OTCBB unless evidence of compliance is provided prior to the end of the applicable grace period (30 days for EDGAR filers, 60 days for non-EDGAR filers). Anyone possessing evidence of compliance with Rule 6530 may provide that information by contacting the OTCBB Issuer Filings Department

The OTJ Journal report suggested that it was possible that this would happen to UGHS:

Here's what might happen. At some point, the stock might get the dreaded "e" at the end of their symbol, signifying the company has gone past its reasonably allotted time to file its 10-K. That would happen around the end of the month. The stock would then trade under the symbol "UGHSE".

While I can't say with certainty whether or not this will happen, but it is possible. According to FINRA Rule 6530, which covers eligible OTC securities, companies that have failed to file an annual or quarterly report three times in a two-year period are not eligible to be quoted on the OTC market. The rule says.

Notwithstanding the foregoing paragraphs, a member shall not be permitted to quote a security if:

(A) while quoted on the OTCBB, the issuer of the security has failed to file a complete required annual or quarterly report by the due date for such report (including, if applicable, any extensions permitted by SEA Rule 12b-25) three times in the prior two-year period.

The last time that UGHS filed a quarterly report was for the third quarter last year. It filed a 10-Q on May 30th of this year, however, that was the report that restated the 2012 third quarter numbers. UGHS has failed to file an annual report for 2012, and has failed to file quarterly reports for Q4 2012, Q1 2013, and Q2 2013. While I don't believe it will be delisted, I think that there is a real possibility that quotes will be suspended due to lack of filings.

Why Is The Stock Up During All Of This?

One would think that given the lack of SEC filings and lack of information coming from the company, the stock would be down this year. UGHS is actually up 46% this year.

(click to enlarge)

So why is the stock up? UGHS has paid research firms to cover the stock. I hesitate to call this company a pump and dump, as it is not a typical pump; it has assets, a real (as much as I could verify) business. However, I believe that when the company could not get audited numbers to file with the SEC, it turned to stock promotion to keep the share price up. While the reasons are conjecture, the fact is that UGHS has paid firms to publish "research" about it. NBT Equities Research, which was involved with the Polar Petroleum promotion (halted by the SEC). NBT Equities Research has published several articles about UGHS, which you can view here. As always, check the disclaimer:

(click to enlarge)

You can see it right there: "NBT Equities Research has been compensated $50,000 for sponsored equity research and market awareness advertising by University General Health Services." Whatever the reason for the promotion, it is clear to me that it has inflated the price artificially.

Shorting OTC Stocks

While I believe that UGHS is a real company and is in a solid industry, until UGHS can a) get audited numbers and b) file those numbers with the SEC, the downside risk far outweighs the upside. It is always risky shorting OTC stocks, but shares are currently available to short through Interactive Brokers and firms that clear through them such as PlaceTrade.

Summary

My main concern is that it releases positive audited numbers and the stock rises. If it does not release these numbers soon, however, the stock could risk becoming unquoted. As per SEC requirements:

To be listed initially, a company must meet minimum financial and non-financial standards. Among other things, the standards cover total market value, stock price, and the number of publicly traded shares and shareholders a firm has. After a company's stock starts trading on an exchange, it usually is subject to other, less stringent requirements; if it fails to meet those, the stock can be delisted. As with listing requirements, the standards for delisting shares are not uniform; each exchange has its own requirements. You can find the initial and continued listing requirements on the websites of the New York Stock Exchange and the Nasdaq Stock Market. Neither the OTC Markets Group(f/k/a Pink Sheets) nor the OTC Bulletin Board has listing standards, although the SEC requires companies to be current in their filings before their stock can be quoted on the OTCBB.

It is impossible to know when or if the SEC or FINRA will act, but I believe that it is possible that UGHS will be halted. To profit from a short, however, it is not necessary for the SEC or FINRA to act. Most all stocks that are promoted eventually crash, and I suspect that UGHS will be no different. Usually in the case of promotions you have to go through a tangled web of promoters. In this case, however, it is clear that the company itself has paid NBT Equity Research to "generate awareness" for the company.

Disclosure: I am short UGHS.OB. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article. (More...)

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Tuesday, 27 August 2013

Are social enterprises fit for the future of public services?

david haye fight Spin outs need investment to compete for contracts against organisations with more financial muscle. Photograph: Johannes Eisele/AFP/Getty Images

Social enterprises are playing a growing role in the health and social care sectors in the UK. Major growth is coming from spin-outs – organisations leaving the NHS to become independent social enterprises. Primarily as a result of the previous government's Right to Request programme and its successors, by the end of 2011 spin-outs were delivering £886m worth of health services and that figure is growing.

Social Enterprise UK (SEUK)'s 2013 State of Social Enterprise survey, The People's Business, reported both an increase in the percentage of social enterprises that have the public sector (in general) as their main source of income (23% compared to 18% in 2011) and that 15% of social enterprises trading for three years or less are operating in healthcare compared to 5% of older social enterprises.

Discussions at SEUK's Fit For the Future conference on social enterprise in health and social care in June illustrated there are at least two groups of social enterprises currently operating in health and social care.

One is spin-outs, many of whom are competing for large contracts worth tens or in some cases, hundreds of millions of pounds. Another is those social enterprises whose starting point is similar to traditional voluntary sector organisations and who are looking to win relatively small locally-based contracts.

Both groups face new challenges and opportunities as result of changes to the NHS following the implementation of the Health and Social Act 2012. Speaking at Fit for the Future, Andrew Burnell, chief executive of Hull-based spin out City Healthcare Partnership CIC noted that: "We've worked really hard to demonstrate our differentiation from the SERCOs. How are others in the sector doing that? We are, in part, open to being picked off."

Burnell's comments illustrate two of the key challenges currently facing spin-outs: to demonstrate why they're different and better to alternative providers from both private and public sectors and to ensure they can both keep existing contracts and win new ones in an increasingly competitive market place. Both of these points are partially addressed in Spin-Out, Step Out, a new SEUK report that looks at the challenges faced by spin outs in raising finance to develop and grow.

The report, which is based on a survey of 27 existing health spin-outs, said: "the respondents were not very strong in articulating their social impact. Some of the organisations surveyed are known to have produced relatively robust social impact reports but this did not come through in the survey for the spin-outs as a whole."

There is clearly a need for spin-outs to get better at explaining what it is they offer that's demonstrably better than what their competitors can provide, however the primary focus of Spin-Out, Step Out is on how spin outs can find the investment that will enable them to compete for contracts against organisations with more financial muscle.

The report quotes one spin out leader talking about the difficulty of bidding against private sector competitors: "I saw how they worked. There is absolutely no way my organisation can compete with them… They were prepared to invest to make sure they won the contract…We can compete with Serco [on delivery] but we just don't have the [bidding] resources."

It would be easier for spin-outs to compete with private sector, if they could attract investment for social investors. Unfortunately, despite spin-outs being relatively large businesses by social enterprises standards – with a median turnover of £2.9m compared, more than 15 times the median UK social enterprise turnover of £187,000 - only 1 of 27 spin-outs surveyed had done so.

The report claims this is partly because social investors are wary of investing in spin-out, based on the fact that: "these businesses are sometimes perceived negatively to have a limited track record as new entities, just one or two contracts, a lack of assets, to be operating in a highly unpredictable market environment with highly aggressive, professional and well capitalised competitors."

A video made at Fit for the Future conference by Pioneers Post suggests that social investors concerns may be based more on myth than reality.

Unfortunately, even if social investors were prepared to put their money into spin-outs, there is still a problem that the money they provide is too expensive and many spin outs have been surprised that the fact they deliver positive social outcomes, doesn't mean investors will offer them a better financial deal: "where social return is taken into account it does not necessarily influence the investment terms in a way that makes them any more generous than finance provided by purely financially motivated commercial investors. Yet the spin-outs, like many other social enterprises, interpret the rhetoric around social return and social investment to suggest that there could be a good generous offer on the table."

Beyond the world of large scale spin-outs and direct competition with SERCO, Virgin Care and others, smaller local social enterprises are trying to work out how to navigate the NHS landscape.

Earlier in the year SEUK and IVAR produced The Power of Partnerships, a resource to promote better working between new local health structures - Clinical Commissioning Groups (CCGs) and Health and Wellbeing Boards (HWBs) – and local charities and social enterprises based on work in four local areas in England.

At Fit for the Future, commissioners and social enterprise leaders involved in the project discussed ways that social enterprises can build relationships with commissioners in CCGs in local authorities.

A key message for social enterprises looking to engage with new NHS structures is that its important to find out what is going on in your area because every area will be different. As Dr Johnny Marshall, Policy Director at the NHS Confederation, told the conference: "There's already an old adage: when you've met one CCG, you've met one CCG."

David Floyd is managing director of Social Spider CIC. He writes the blog Beanbags and Bullsh!t.

This content is brought to you by Guardian Professional. To join the social enterprise network, click here.


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Gap in perinatal mental health services needs urgent attention

Postnatal depression blood test breakthrough Three thousand women a year develop postpartum psychosis, with a further 40,000 suffering depression and post traumatic stress disorder related to their pregnancy. Photograph: Catchlight Visual Services / Ala/Alamy

"I had some sleeping tablets, and went to two different chemists to buy paracetamol. Then I ran to an area of the city which was really secluded," recalls Hannah. "I got a bottle of vodka and one of gin too: at that moment I felt this was the most loving thing I could do – I was no good to my baby, so it would be better like this. And I discovered that I could sit, very calmly, peacefully, and take the paracetamol and sleeping tablets, and wash them down with the alcohol."

Hannah, then 29, had given birth to her son Elijah in London three months previously. She was staying with him at her parents' house in the north of England when she made her suicide attempt.

She'd experienced periods of anxiety requiring counselling at her GP practice before her pregnancy, she explains, but had successfully held down several professional jobs after graduating from university, and becoming pregnant was a planned and joyous event for her and her long-term partner.

Hannah was only discovered after she had lain at the bottom of a steep bank, close to death, for two nights and three days. Her partner and parents were frantic. A police search had been underway. As she was taken to hospital, it was clear to everyone that a twelve-week old baby had nearly lost his mother.

The most shocking part of Hannah's story is that her desperate mental state was very well known to a phalanx of health professionals who had been involved in her care at home in London, both antenatally and in the weeks and months after she gave birth.

Yet no-one had the specialist expertise in perinatal mental health that allowed them to diagnose this young mother as having developed a serious, pregnancy-related psychotic illness. Several weeks earlier, while still in London, she had agreed to be admitted to a general mental health ward. But her baby could not accompany her, and her repeated pleas to be referred to a mother and baby unit (MBU) with expertise in perinatal mental healthcare – available in her neighbouring borough, but not her own – had been fobbed off on the grounds that it cost £600 a day and was unlikely to be passed by the funding panel.

"A recurring theme is that professionals such as midwives sometimes refer to very serious illnesses as 'a bit of post-natal depression,' and women sometimes die as a result," says Dr Alain Gregoire, the consultant who heads up the mother and baby unit in Winchester, and chairs the Maternal Mental Health Alliance. "The general services do not understand these risks. Psychotic illnesses become extremely severe extremely quickly. The suffering is so gruesome that women want their lives to end. And that is extremely rare, even in cancer or other life threatening illnesses. There are people killing themselves every day and among them are mothers of young children."

The three-yearly confidential review of maternal deaths backs this up: mental ill-health has been consistently at or near the top of the list of factors leading to maternal death in the last four that have been published.

Perinatal mental illnesses affect at least 10% of women, says a recent report from the NSPCC's Prevention in Mind – Spotlight on Perinatal Mental Health, "and if untreated, can have a devastating impact on them and their families. When mothers suffer from these illnesses it increases the likelihood that children will experience behavioural, social or learning difficulties and fail to fulfil their potential."

The charity estimates that there are 3,000 women a year who develop postpartum psychosis, with a further 40,000 suffering serious depression and post traumatic stress disorder related to their pregnancy. But despite the numbers needing specialist care, half the health trusts in the UK have no perinatal mental health services. And three quarters of maternity services have no specialist mental health midwife. This is something of an irony, given that the UK has led research in this area, Gregoire says: where specialist services do exist here, they are among the best in the world.

The NSPCC is now seriously concerned about the detrimental impact of poor maternal mental health for the young babies who are trying to form attachments to the person who should be closest to them – their mothers. "There's a lot of evidence that even fairly mild perinatal mental illness can affect how women interact with their babies," says the charity's development manager Sally Hogg, who authored the NSPCC's report. "Women can withdraw or be hostile to their babies: how they interact in those early months is really lasting effect on the babies' emotional and social development."

This means that a mother might recover her mental health, but her inability to respond to her baby in the critical early weeks and months of life, before the correct treatment reaches her, can have far reaching effects, because the baby's poor attachment to its mother won't always automatically get fixed. This, says Hogg, "is solvable, but it needs someone to come in and work with the mum and baby to help [nurture] that bond."

NICE, meanwhile, states that all women with a child under one year who need psychiatric admission should be offered a place in a specialist mother and baby unit.

The UK's current capacity of 12 mother and baby units, where this kind of expertise is available alongside psychiatry services, simply isn't enough however, believes the NSPCC. And indeed, it's estimated by the joint commissioning panel for mental health that the country is 50 beds short.

It's not just more beds that are needed, says Hogg, but "a strategic mapping of where those beds need to be."

This is because there is enormous strain for a family where a new mother is being treated far from home. Hannah was finally sent as a crisis admission to a mother and baby unit 200 miles from London. It meant that for the five months she was an inpatient, her partner was only able to visit her and their child at weekends. This type of scenario creates exhaustion, stress and expense for families who have already been through a lot. And it happens all too often, because even if a woman's health authority is willing to pay for the bed, there may be no provision near home.

There was, however, huge relief for Hannah and her family when she finally was admitted to the MBU.

"When I met the perinatal psychiatrist that first day, she said 'you have a severe post natal depression: you will go home: you won't be on any of these drugs – and you won't believe a word I'm saying,'" laughs Hannah. "And I didn't. But it was true."

For Hannah, the road to recovery was a long one because she was, by the time she was finally admitted, gravely ill. Given the transformative effects of specialist care, her situation could, she knows now, have been very different. "There is very good evidence that we can prevent women becoming ill at all, reverse the anxiety of women who are fearful of it, nip in the bud when it starts to manifest, and relieve the suffering of women who do become ill," says Gregoire. "And there is also evidence that the non-specialist services do not do it."

The costs of poor treatment are significant: Hannah suffered from post traumatic shock and she and her partner have since decided that they will never be able to take the risk of having another child. This makes her both sad, and angry. She's angry, too, that nothing has changed for women in her part of north London.

"I came back from the MBU thinking they'd redo all their policies – after all they almost had someone die on them," she says. "But no. When I last saw the commissioners, a year ago, they hadn't changed anything. And I know that our borough still has no contract with the neighbouring mother and baby unit."

Many opportunities were missed, she says, despite her repeatedly asking for specialist support. "And I know that many women don't speak out – I was one who told everybody," she remembers. "So even if you're shouting from the rooftops, you don't get listened to. I only got help when I nearly died, so clearly something is not working. And if I'd died, Elijah wouldn't have had a mum. His dad loves him to bits, but he's not his mum. He'd have had a completely different life."

If you have been affected by the issues raised in this article, for information and support visit the Maternal Mental Health Alliance

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.


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Friday, 16 August 2013

Few survivors of head and neck cancer utilizing mental health services despite depression

Main Category: Cancer / Oncology
Also Included In: Depression;  Mental Health
Article Date: 15 Aug 2013 - 13:00 PDT Current ratings for:
Few survivors of head and neck cancer utilizing mental health services despite depression
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Mental health services appear to be underutilized despite depression among survivors of head and neck cancer, according to a study published Online First by JAMA Otolaryngology-Head & Neck Surgery.

The long-term physical effects of radiation therapy (RT) for head and neck cancer have been well described but few studies have examined psychosocial functioning, including depression, among patients, according to the study background.

Allen M. Chen, M.D., of the University of California, Davis, and now of the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues examined the prevalence of self-reported depression among survivors of head and neck cancer returning for follow-up after RT treatment.

The study included 211 patients with squamous cell carcinoma of the head and neck, who had been treated and were disease-free with at least one year of follow-up. A questionnaire was used to analyze rates of depression.

The proportion of patients who reported their mood as "somewhat depressed" or "extremely depressed" was 17 percent, 15 percent and 13 percent at one, three and five years, respectively. Among the patients who reported their mood as either "somewhat depressed" or "extremely depressed," at one, three and five years, respectively, the proportion of patients using antidepressants was 6 percent, 11 percent and 0 percent, respectively. The proportion of patients actively undergoing or seeking psychotherapy and/or counseling was 3 percent, 6 percent and 0 percent, respectively, according to study results.

"Despite a relatively high rate of depression among patients with head and neck cancer in the post-RT setting, mental health services are severely underutilized," the study concludes.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cancer / oncology section for the latest news on this subject.

JAMA Otolaryngol Head Neck Surg. Published online August 15, 2013. doi:10.1001/jamaoto.2013.4072.

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