◆ For lenders, owners & receivers
The P&L won’t tell you the building is one tag away from immediate jeopardy.
Pre-acquisition clinical due diligence for hospice and skilled nursing assets.
We will — before you close. A clinical risk assessment that reads the charts, the survey history, and the staffing reality, and prices the exposure your financial diligence cannot see.
Financial diligence tells you what the asset earned. Clinical diligence tells you whether it gets to keep earning it.
What financial diligence misses
A census looks healthy right up until the day the referral sources stop calling. A margin looks defensible right up until the payroll that produced it turns out to be an agency line that cannot be sustained. The clinical risks that reprice a deal do not appear on a balance sheet:
- Survey history with a pattern — repeat tags in the same area, which is what drives escalated enforcement rather than a routine letter.
- An open plan of correction with a revisit still ahead of it, inherited at close along with the consequences.
- Documentation that will not survive an audit. Hospice eligibility narratives that describe a stable patient are a UPIC referral waiting to happen, and that liability follows the asset.
- Staffing built on agency and overtime, where the real cost of a compliant schedule is materially above what the trailing financials show.
- Leadership about to leave. A DON who has already checked out is a survey risk with a start date.
- Quality measures trending the wrong way, which is tomorrow’s referral problem showing up early.
What you get
- A clinical risk assessment covering survey and enforcement history, chart review, staffing and leadership stability, and quality trajectory.
- Findings ranked by dollar exposure — what it costs to fix, what it costs not to.
- Deal-relevant conclusions: what to reprice, what to escrow, what to make a condition of close, and where to walk.
- A first-90-days clinical plan for whoever takes the keys, so day one is not spent discovering the same things over again.
Who this is for
- Lenders and capital partners underwriting a hospice or skilled nursing asset.
- Receivers and asset managers who have just inherited an operating problem alongside a property.
- New operators and acquirers buying their first, third, or thirtieth building.
Topsail works this channel directly, including onsite pre-acquisition clinical risk assessment for capital-side clients. The work is done by a nurse executive who ran these buildings before assessing them — which is why the report tells you what will actually happen, not what the binder says should.