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A unique rural-academic partnership has enabled a critical access hospital to significantly expand access to services. At the same time, careful financial planning has supported debt issuance for a state-of-the-art facility for the community.

Hospitals seeking funds for capital needs are facing several challenges, which is driving interest in non-traditional financing structures, often involving real estate. Synthetic leases are one alternative, but they require a careful assessment of both their benefits and considerations that may make them a less attractive option.

Favorable execution levels for basis swaps can emerge quickly, and last for a short period of time. Health systems that have laid the groundwork for execution of a basis swap are positioned to promptly take advantage of what may be a short-lived opportunity.

A changing interest rate environment has reopened the opportunity to consider terminating an organization’s swap position. Organizations should take a measured approach in determining whether this is an opportunity they wish to pursue.