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Quarterly Industry Report

Issue: 1/2019

Trend: Hospital Mergers Grow in Value - The average value of mergers involving US hospitals rose in 2018, a year that saw continued consolidation among major industry players. The average transaction size has increased at a compound annual rate of nearly 14% since 2008 to reach $409 million in 2018, and seven transactions involved sellers with more than $1 billion in revenue, according to a new report from Kaufman Hall. Major mergers include combinations between Bon Secours and Mercy Health; LifePoint and RCHH HealthCare; Atrium Health and Navicent Health; Western Connecticut Health and Health Quest Systems; and Baylor, Scott & White and Memorial Hermann Health. Overall, hospitals announced some 90 transactions in 2018, down 22% from 115 in 2017. Among states, Texas had the most transactions, with 8, followed by Florida (7), Pennsylvania (6), Louisiana (5), and Tennessee (5).

Industry Impact - Health systems are consolidating to acquire strategic assets, increase efficiencies, and expand into adjacent service territories. The growth in large-scale health systems is changing the landscape of the health care industry.

Critical Issues

Health Care Reform - Government health reform efforts are changing how medical care is acquired and paid for in countries around the globe. In the US, the Affordable Care Act (ACA) aims to make health coverage available to all Americans and to keep health care costs low. Provisions of the law include health insurance exchanges, expansion of Medicaid, more medical training, and the establishment of health care technologies that improve efficiencies. In an effort to cut Medicare costs, the ACA requires hospitals to decrease their hospital readmission rates, a key factor in high hospital bills. Hospitals that don't succeed in cutting rates are being penalized. In Europe, some governments are working to control costs by cutting health budgets and reducing payments for providers, pharmaceuticals, and devices.

Shortage of Physicians and Nurses - More than one-third of US doctors will be 65 years old or older in the next 10 years and approaching retirement, according to a study by IHS for the Association of American Medical Colleges. About 55% of nurses are 50 and older, and more than 1 million will retire in the next 10 to 15 years, according to the American Association of Colleges of Nursing. Some experts predict shortages of about 90,000 nurses by 2020 and up to 105,000 doctors by 2030, a problem compounded by health reform and demographics. Other analyses, however, say that shortages are regional rather than countrywide and may be met with incentives for providers to practice in rural and other underserved areas.

Business Challenges

Containing Rising Costs - Prescription drug prices, aging populations that require more care, and the increasing cost of medical technology have contributed to the rising cost of health care in recent years. Countries around the globe are working to control costs through proposals including the adoption of electronic health records, more focus on quality and efficiency, emphasis on less-expensive preventive care over more expensive services, and government regulation to keep insurance premiums and treatment payments low.

Dependence on Reimbursement Rates - Most medical bills are paid by various third-party health care insurers, and health providers are dependent on gaining competitive managed care contracts with payers. Exclusion from provider lists and reductions in reimbursement rates could have a significant effect on revenues. The consolidation of third-party payers in the past decade has produced a number of large payers that frequently follow Medicare's lead in setting rates. Large hospital organizations such as Tenet deal with thousands of managed care contracts, which can make it difficult to efficiently bill and process accounts.

Medical Errors - The incidence of medical errors resulting in patient death is an issue of critical importance to the health care industry. A 2013 study published by the Journal of Patient Safety estimated that medical errors cause between 210,000 and 440,000 deaths each year. To encourage hospitals to improve care quality, Medicare has established penalties for hospitals with high rates of preventable medical errors, such as catheter-associated urinary tract infections. Hospitals are looking at ways to reduce patient deaths, including electronic medication tracking, procedural checklists, and safety training.

Malpractice Insurance - Malpractice insurance costs are significant for health care practitioners. Providers are subject to legal action that can involve significant defense costs and large monetary claims. Facilities typically purchase professional, general, and umbrella liability insurance coverage to protect against excessive claims. A rise in premiums or claims may lead doctors to practice defensive medicine, such as by ordering more tests. Many doctors support tort reform, which would reduce or limit jury awards for damages. Several states impose caps on awards, which state officials say help them retain and recruit physicians. However, some states have reversed caps in recent years.

Disclosure Rules - Under the US Sunshine Act, manufacturers of covered drugs, medical devices, biological products, and medical supplies have to report to Medicare any payments to physicians and teaching hospitals, such as investment interests, ownership, or other transfers of value. The law took effect in 2014, requiring manufacturers to compile the information annually. The Sunshine Act is designed to make transactions between manufacturers and physicians transparent to patients and others.

Business Trends

Increasingly Informed Patients - Consumers are more aware of their health status and appropriate diagnostic care. Many patients use the Internet to access websites such as WebMD to research diseases and symptoms, and join online communities to discuss health issues and concerns. With insurance companies limiting doctor office visits to as little as five minutes, many patients are now taking it upon themselves to increase their medical knowledge, unwilling to rely solely on the advice of hurried medical professionals.

Employment Continues to Rise - Despite a pending shortage of doctors and nurses in the coming decade, employment in the US health care sector increased more than 20% over the past 10 years. Employment in the sector is expected to increase about 18% by 2026 (from 2016), with the strongest growth expected in health care support occupations, health care practitioners, and technical occupations.

Consolidation - Changing reimbursement practices and other reform measures have spurred unprecedented consolidation in the health care industry, altering the competitive landscape. Hospitals have been buying competitors, independent physician groups, and insurance companies, all to get a better handle on cost containment, patient care data, and revenue streams. Physicians are joining group practice organizations or affiliating with hospitals to gain efficiencies and reduce risk. Participation is growing in accountable care organizations (ACOs), which are networks of hospitals, physicians, and other providers that coordinate patient care.

Outsourcing Services - To lower operating costs, hospitals and clinics are increasingly outsourcing services to third-party providers. Food service, housekeeping, laundry, IT, pharmacy, inpatient care management, and ER services can be outsourced to independent contractors, boosting margins and increasing efficiencies.

Industry Opportunities

Health Information Technology (HIT) - Health information technology (HIT) integrates electronic health records, decision support systems, and computerized physician order entry for medications. Hospitals and physicians that invest in HIT may be able to improve scheduling, lower nurse administrative time, improve drug use, and lower the risk of adverse drug reactions. The US government has put financial incentives in place to encourage the adoption of HIT as a way to ultimately improve medical care and lower costs. However, hospitals have found that development of HIT is complex and expensive and may outweigh eventual cost savings. Interoperability among providers is a barrier to success, as companies may use software programs that don't speak to each other.

Aging US Population - The aging US population both strains and presents opportunities for the American health care system over the next decade. Health care spending per person for those over 65 is about three times as much as for the rest of the population. The US population 65 and older is expected to increase by about 49% between 2016 and 2030, compared to a 10% increase in the population as a whole.

Personalized Medicine - Personalized medicine uses a person's genetic profile to identify potential risk for diseases such as cancer, diabetes, heart disease, and kidney failure. Since the 2003 sequencing of the human genome, scientists and physicians have begun to identify treatments and strategies for complex conditions that can be tailored to individuals.

Preventive Medicine - Medical advances show that many disorders can be prevented or delayed through early intervention, such as lowering cholesterol. Insurers and employers that provide health care benefits have a vested interest in promoting less-expensive preventive care to avoid expensive surgical procedures. This may benefit physicians who actively manage their patients' overall health. Hospitals are hiring professionals tasked with overseeing a patient's stay and providing preventive care counseling to reduce readmissions, length of stay, and errors.

Telemedicine - Doctors are accustomed to using videoconferencing and online technology to consult with other doctors; now they are using the same technology to treat patients. Telemedicine allows doctors to consult with and treat patients who live in rural areas. It also lets patients see specialists who may be unavailable in a local market. Insurance companies are rolling out telemedicine consultations to their networks as a way to increase access to care and control costs.

Handheld Technology - Handheld devices such as GE’s Vscan portable ultrasound will let doctors and emergency responders gather medical data in the field and transmit it to a hospital or emergency room. Other devices such as smartphones and health applications are making inroads into the health care field as well. However, the FDA has determined that certain smartphone health apps (those that could put patients at risk if they don't work properly or that impact the functionality of traditional devices) are to be classified as medical devices requiring approval.

Growth of Noninsurance Practices - Some doctors are seeing fewer patients, but charging them more, with the bulk of the cost paid for by the patient rather than a third-party payer. So-called concierge practices may serve only 300 patients rather than the typical 1,000, but charge each an annual fee of $1,500 to $2,000 for regular checkups and advice. At the other end of the spectrum, doctors are offering similar services to patients who can’t afford health insurance and who may pay between $15 and $75 per month. Though the costs are low, doctors can recoup expenses because they avoid complex insurance billing systems.


Copyright 2019, Hoover's Inc., All Rights Reserved. This data cannot be copied, sold, or distributed in any manner without the written permission of First Research.

Industry Growth Rating

Demand: Driven by medical advances and demographics

Need efficient use of labor and equipment

Risk: Healthcare reforms and limited coverage from insurers

Healthcare Industry Growth Rating Scale - Medium

Industry Forecast

Revenue (in current dollars) for US healthcare, a sector that includes physicians, dentists, hospitals, home healthcare, nursing homes, and daycare services, is forecast to grow at an annual compounded rate of 6 percent between 2019 and 2023. Data Published: January 2019


Healthcare Industry Forecast Bar Graph
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