Acquiring a private hospital: establishment approval, operating approval and medical director

The buyer should map the hospital in an approval matrix. In Salzburg, the provincial government identifies the building approval, the hospital-law establishment and operating approvals and the workplace approval for a hospital with beds or an independent outpatient facility. X-ray equipment can require additional radiation-protection approvals. The Salzburg hospital building regulation adds requirements for the building and equipment.

Each approval should be supported by the decision, conditions, evidence of compliance and open proceedings. The range of services must correspond to the approved scope. Changes to the purpose, organisation, premises or substantive equipment can require a notification or a new decision. Section 14 of the Salzburg Hospital Act 2000 therefore matters even for an existing operation.

The matrix separates three questions: may the premises be operated in this form, are the technical and professional conditions met and will the status survive the proposed acquisition? A general corporate review does not answer these questions by itself.

In a share deal, the legal entity generally remains the operator. This supports the allocation of existing decisions, but it does not remove the review of change of control, directors, financing and continuing conditions. The purchase agreement should state whether the provincial law requires a notification or authority consent for the planned change.

An asset deal or transfer of the operation to another legal entity raises a different central issue. The approval belongs to the legal entity and the approved operation. Salzburg authority guidance identifies the transfer or lease of a hospital to another legal entity as requiring approval by the provincial government. The same applies to the transfer or lease of independent parts of a hospital.

The buyer must therefore keep the economic handover separate from the transfer of the hospital-law status. Before signing, decide on the deal structure, competent authority and required applications. The SPA then needs information duties, cooperation, an approval condition and a clear closing mechanism.

The establishment approval concerns more than building plans. Salzburg procedure guidance requires applicants to describe the purpose, legal entity, site, catchment area, range of services, staffing and social-insurance reimbursement status. The file also includes company-register data, building and operating descriptions, evidence of ownership or use and the building approval.

A need review takes place before approval. The project must produce a substantial improvement in healthcare provision in the catchment area. If the range of services is covered by the Regional Structural Plan for Health, the project is assessed against that plan. Other projects may require an expert opinion on need. In an acquisition, the buyer must establish whether the existing approval covers the current operation or whether later extensions created a new need issue.

A mismatch between the decision and the actual operation needs special attention. Other departments, new large medical devices, relocation or an expanded range of services can qualify as a material change. These deviations belong in the issue list and should not be hidden by a broad contractual warranty.

The operating approval is required before operations begin. Salzburg authority guidance links it to compliance with the conditions in the establishment approval. The medical equipment and technical facilities required for immediate operation must also be available and the operating facility must comply with safety and public-health rules.

For the buyer, technical documents and certificates are as important as the completion notice, hospital rules, staffing list and liability insurance under section 20a of the Salzburg Hospital Act 2000. The medical director must be identified in the operating approval procedure. The required education and training records belong in the file. Salzburg guidance also states that appointing or removing senior doctors may require approval by the provincial government.

The function should not be treated as a simple personnel matter in the SPA. A hospital needs secured medical leadership and clear operational responsibilities. The agreement should state who holds the function on the effective date, how the handover works and how a change is communicated to the authority.

Alongside medical leadership, the hospital needs technical and organisational safety functions. Section 29 of the Salzburg Hospital Act 2000 requires a technical safety officer. This person monitors medical-technical equipment and technical facilities, arranges inspections and informs medical and administrative management about defects and their remediation.

The function begins during planning. The technical safety officer must be involved in new construction, extensions and alterations and in purchasing medical-technical equipment. The data room should therefore contain inspection records, defect lists, maintenance evidence and the appointment of the responsible person.

Hospitals are treated as dangerous operating areas under section 92(2) of the Employee Protection Act and require a workplace approval. Changes to the workplace can require an amendment under section 92(5) of that Act. The buyer should compare alterations, new equipment, storage, fire protection and the number of employees present at the same time with the existing approval.

The purchase agreement should treat the approval review as its own workstream. It should contain a complete approval schedule, warranties on the service scope, disclosure of open proceedings and a duty to cooperate with authorities. In a legal-entity transfer, specify which approval must exist before closing and which documents will be updated afterwards.

A closing condition needs verifiable content. It can refer to a particular decision, written authority confirmation or compliance with defined conditions. The agreement should also address a long-stop date, the consequences of conditions and responsibility for transition services. The buyer should accept the hospital rules and the functions of medical, nursing, hygiene and technical management by reference to the effective date.

Notifications and ongoing duties do not disappear after closing. Changes to the range of services, organisation, equipment or workplace require a fresh review. A responsibility plan with decision, person, deadline and evidence prevents the operation from entering an unclear status after the acquisition.