Regulatory Shifts, Deal Market Trends, and Strategic Focus in Healthcare with Holly Buckley of McGuireWoods LLP 8-5-25

Summary

Becker Private Equity & Business Podcast: Detailed Summary

Episode Title: Regulatory Shifts, Deal Market Trends, and Strategic Focus in Healthcare with Holly Buckley of McGuireWoods LLP
Host: Scott Becker
Guest: Holly Buckley, Chair of the Healthcare Department at McGuireWoods LLP
Release Date: August 5, 2025

---

In this insightful episode of the Becker Private Equity & Business Podcast, host Scott Becker engages in a comprehensive discussion with Holly Buckley, a leading authority in the intersection of healthcare, private equity, and business. The conversation delves into recent regulatory changes, current trends in the deal market, and strategic priorities shaping the healthcare sector for the remainder of the year.

1. Regulatory Updates in Healthcare and Private Equity

Holly Buckley begins by outlining significant legislative developments affecting the healthcare and private equity landscape.

• Major Legislation and Deficit Spending:
  At [00:46], Holly states, "In July, the one big beautiful bill was signed into law, and with that, we saw the CBO score was finalized with an estimated $3.4 trillion in new deficit spending and 10 million Americans projected to lose health insurance."
  This highlights the substantial financial implications of the new legislation, particularly the projected increase in the national deficit and the alarming number of Americans potentially losing their health coverage.

• Tax Changes and Medicaid Cuts:
  The legislation introduces sweeping tax changes and significant Medicaid cuts, which are poised to reshape the financial landscape for healthcare providers and private equity investors alike.

• Medicare Enhancements:
  Holly notes at [02:00], "We did see within that legislation a 2.5% increase coming in 2026 for Medicare physician payments."
  This increase aims to support healthcare providers by enhancing reimbursement rates, potentially improving the financial viability of medical practices.

• Rural Hospital Fund:
  At [02:15], Holly explains, "We have the new Rural Hospital Fund, which despite its name, is a $50 billion fund designed to support a range of rural health initiatives, not just hospital-related, including clinics and telehealth providers."
  This fund is expected to stimulate growth and innovation in rural healthcare, expanding access to essential services through clinics and telehealth solutions.

• CMS Policy Shifts:
  Emphasizing cost-efficiency, the Centers for Medicare & Medicaid Services (CMS) is implementing site-neutral payment policies and proposing the elimination of the inpatient-only list for surgeries. Additionally, more outpatient procedures are being considered for reimbursement under Ambulatory Surgical Centers (ASCs).
  Holly remarks at [02:45], "CMS is doubling down on site neutral payment policies proposing to eliminate the inpatient-only list for surgeries."

• Proposed Rules Affecting Providers:
  There are proposed reductions in reimbursement for skin substitutes, which could significantly impact wound care providers. Moreover, the home health and Durable Medical Equipment (DME) sectors are facing proposed changes related to payment updates, quality reporting, and face-to-face encounter policies.

• Government Enforcement Priorities:
  The reactivation of the False Claims Act Task Force signals a renewed focus on healthcare enforcement. At [04:10], Holly states, "The DOJ and HHS has relaunched their False Claims Act Working Group, which signals a renewed focus on healthcare enforcement."
  Key areas of scrutiny include Medicare Advantage managed care fraud, kickbacks, and pricing practices for drugs and biologics, mirroring the aggressive enforcement stance of the previous administration.

2. Industry Reactions to Legislative Changes

Scott Becker probes deeper into the industry's perception of the new legislation.

• Negative Sentiment Among Providers:
  At [03:25], Scott observes, "When I hear from industry, they were overwhelmingly very negative about this, including the physicians, the ASCs, and others."
  Providers express significant concern over Medicaid cuts, fearing increased strain on healthcare systems. The projected loss of insurance coverage for 10 million Americans is anticipated to lead to higher patient volumes in emergency rooms and exacerbate costs for hospitals and health systems.

• Impact on Rural Healthcare:
  While the Rural Hospital Fund is a positive development, Holly indicates that "the rural health aspect is seen as a little bit of a distraction, but not necessarily an equalizer for the potential damage from the loss of coverage."
  This suggests that despite targeted funding, the broader negative financial impacts of the legislation may overshadow these benefits.

• Private Equity Perspective:
  The reaction within the private equity sector is mixed. Holly explains at [04:50], "Some sectors are negatively impacted, while others see opportunities that the cuts are going to bring."
  Investors are exploring innovative solutions to support states in meeting new requirements, potentially identifying lucrative investments in areas like back-to-work programs and support systems for healthcare providers.

3. Current Trends in the Private Equity Deal Market

Transitioning to the deal market, Holly provides an optimistic outlook.

• Increased Activity in the Second Half of the Year:
  At [05:31], Holly states, "The second half of the year is getting really busy, which is terrific. We've been very active heading into the second half of the year."
  Both platform buy-side and sell-side deals are experiencing robust activity, indicating a healthy and dynamic market environment.

• Platform Deals and Sell-Side Robustness:
  The platform deal market is showing significant upticks, with sell-side opportunities remaining strong throughout the year. This balance between acquisitions and divestitures suggests a vibrant marketplace with ample opportunities for strategic investments and exits.

4. Strategic Focus for the Remainder of the Year

Looking ahead, Holly outlines the strategic priorities for her team.

• Expansion of FDA and Life Sciences Group:
  At [06:17], Holly emphasizes, "We continue to look at building out and growing our FDA and life sciences group. We've had tremendous growth and success with that group in the last 18 months and we're continuing to build that out and take that group to market."
  This focus reflects the growing importance of regulatory expertise and specialized knowledge in navigating the complexities of life sciences and FDA-related matters.

• Client Execution and Talent Development:
  Ensuring effective execution for clients as market activity increases is paramount. Additionally, expanding the talent pool to support ongoing and future initiatives remains a key priority.
  Holly summarizes, "It's really just doubling down to make sure that as our clients are getting more active for the second half of the year that we're able to really execute on that and continue to develop and build our talent pool."

Conclusion

In this episode, Holly Buckley provides a nuanced analysis of the current regulatory landscape, highlighting both challenges and opportunities arising from recent legislative changes. The discussion underscores the importance of adaptability and strategic foresight in navigating the evolving healthcare and private equity sectors. With increased deal activity and targeted strategic initiatives, stakeholders are well-positioned to capitalize on emerging trends while addressing the complexities introduced by regulatory shifts.

---

Notable Quotes:

• "In July, the one big beautiful bill was signed into law, and with that, we saw the CBO score was finalized with an estimated $3.4 trillion in new deficit spending and 10 million Americans projected to lose health insurance." — Holly Buckley [00:46]

• "CMS is doubling down on site neutral payment policies proposing to eliminate the inpatient-only list for surgeries." — Holly Buckley [02:45]

• "The DOJ and HHS has relaunched their False Claims Act Working Group, which signals a renewed focus on healthcare enforcement." — Holly Buckley [04:10]

• "Some sectors are negatively impacted, while others see opportunities that the cuts are going to bring." — Holly Buckley [04:50]

• "We continue to look at building out and growing our FDA and life sciences group." — Holly Buckley [06:17]

This comprehensive summary encapsulates the key discussions from the podcast episode, providing valuable insights for listeners interested in the intersections of healthcare, private equity, and business strategy.

Transcript

[A]

This is Scott Becker with the Becker Private Equity in the Becker Business podcast. I'm thrilled today to joined by Holly Buckley. Holly chairs the healthcare department McGuire Woods. She also works and lives at the intersection of health care and private equity and business. She's going to talk to say about three quick subjects. First, some regulatory updates that she's watching in the private equity health care world. Second, what's going on in the deal market and third, where she and her team are most focused for the remainder of this year. Holly, let me turn it to you.

[B]

Thank you. And Scott, congratulations on your Apple podcast rankings. Just amazing success and congrats on being top of the chart.

[A]

Thank you so much. Truly a labor of love. Thank you. Holly, let me turn it back to you, but thank you very very much.

[B]

Jumping in on some regulatory updates. So in July the one big beautiful bill was signed into law and with that we saw the CBO score was finalized with estimated 3.4 trillion in new deficit spending and 10 million Americans projected to lose health insurance. And also we've seen with the legislation sweeping tax changes, Medicaid cuts and a host of other health care policies. We did also see within that a 2.5% increase coming in 2026 for Medicare physician payments. And then also we have the new Rural Hospital Fund which despite Its name is 50 billion dollar fund designed to support a range of rural health initiatives, not just hospital related, including clinics and telehealth providers. So that should bring about some interesting developments on the rural front. In addition to the physician fee schedule increased, we're also seeing ASD and hospital outpatient payments improve whereas the government is more focused on moving care to less costly settings. So CMS is doubling down on site neutral payment policies proposing to eliminate the inpatient only list for surgeries. And CMS is also adding more outpatient procedures, those that can be reimbursed in an asd. We're seeing a proposed rule looking to reduce reimbursement for skin substitutes which is going to pose a major concern for wound care providers. And then also there's a home health and DME Post proposed rule which addresses payment updates, quality reporting and face to face encounter policy changes. So just a fair amount of activity on the legislative front. And then in addition we're seeing the government enforcement priorities kind of come back front and center with the False Claims Act Task Force. The DOJ and HHS has relaunched their False Claims Act Working Group which signals a renewed focus on health care enforcement. And we're going to see likely attention on Medicare Advantage managed care fraud kickbacks and drugs and biologics pricing practices. And so we think that this is going to be pretty consistent with the last Trump administration administration and Trump's plan to aggressively enforce the False Claims Act. We're also likely to see focused on remote patient monitoring. So, so lots of activity there.

[A]

Let's touch for one second there one bit further. It seems like as you talk about all these things in the bill, it doesn't sound that bad. But when I hear from industry, they were overwhelmingly very negative about this, including the physicians, the ASCs and others and health systems, of course, and very worried about Medicaid cuts. What's your overall take from the health system industry or the provider industry as well as from the private equity industry on the, on the one big beautiful bill, as it's called?

[B]

Yeah, I mean, I think from hospitals and health systems and providers in general, I think there's a lot of trepidation about the Medicaid cuts. I think it's going to put a lot of strain on the system. I think all of the 10 million Americans who are going to lose insurance coverage, they're going to still need to get health care and that's going to put a lot of stress, especially on hospitals and health systems and post Covid flooding back into emergency rooms and providers of last resort really having to deal with the massive increase in volume and those costs are going to go somewhere and it will really impact providers. And so I do think that the rural health aspect is seen as a little bit of a distraction, but not necessarily an equalizer for the potential damage from the loss of coverage. I think on the private equity front, I think it's mixed. There's going to be some sectors that are negatively impacted. I think some other sectors or some other investors are looking at opportunities that the, the cuts are going to bring. So for example, we're seeing some investors looking at how can they focus on the back to work requirements and develop systems to support states in those areas. So I think there's definitely some, some who see opportunity, but I think amongst the provider community, I think it is viewed very negatively Howie, thank you so much.

[A]

That was my take from the provider side. Give us a sense the private equity deal market and what you're most focused on this last few months of the year.

[B]

Yeah. So as reported the last time we chatted, it does feel like the second half of the year is getting really busy, which is terrific. We've been very active, I'd say, heading into the second half of the year. And as the second half of the year gets underway. We're seeing some really nice platform buy side deals. We're seeing the platform deal market also picking up and sell sides continuing to remain relatively robust for the year. And so I think we're expecting the back half of 2025 to be to be strong.

[A]

Thank you. What do you see as the big priorities for the group and the team that you lead for the next several months? Where do you see the top priorities and where you most focused?

[B]

You know, we continue to look at building out and growing our FDA and life sciences group. We've had tremendous growth and success with that group in the last 18 months and we're continuing to build that out and take that group to market. So that will continue to be a focus for us. And that group focuses both on know servicing the kind of the life sciences market as well as assisting investors and lenders with their activities in the market as well. And so that's just been a very, a very fun area and one that we'll continue to focus in. I think other than that, it's really just doubling down to make sure that as our clients are getting more active for the second half of the year that we're able to really execute on that and continue to develop and build our talent pool. So bucking and tackling and more of the same.

[A]

No, you're doing an incredible job how again, thank you for sharing with us the regulatory updates, the deal outlook as well as the focus for the rest of the year, including the FDA and life sciences efforts. Thank you so much for joining us today on the Becker Private Equity and the Becker Business Podcast. Thank you very, very much.

[B]

Thank you, Scott.