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“The shift to the outpatient is continuing. It’s unclear how much technology will allow us to continue to do that. But there is growth opportunity there.”
“Most Americans sitting here in this room don’t get their indicated care at the rate that they should. That is a quality opportunity. It’s a growth opportunity for company like us under a fee for service reimbursement model. And that in the outpatient setting, as well as what’s precipitated as a result of that is a growth opportunity. And obviously with Healthcare Reform, we have a cohort that has not previously been insured or at least underinsured. There’s a general belief of somewhere in the range of 1% to 3% at least by our view of increased utilization among that cohort wants to have insurance and a fair amount of that’s going to be in the outpatient setting as well. So we clearly have our eyes on access strategies, on everything from urgent care and retail to the emergency room to solve their acute problems, as well as continued growth in our ambulatory surgery centers and other ambulatory constructs to capture that.”
“what we’re seeing is this declining physician take-home compensation. And so we see physicians looking for income stability. That’s got 2 sides to it. The obvious side is the declining physician professional reimbursement, as well as the fairly historically lucrative reimbursement around diagnostics in the outpatient setting. That has really declined more than the evaluation of management fees. But on top of that, the expense base for the physicians has been growing, not just from the standpoint of labor, but the IT initiatives, the electronic health record, has rarely perhaps resulted in core operational efficiencies, but certainly has added overhead and initial costs, as well as an initial drag during implementation where there’s typically a 30% or 40% production loss for a period of time. You put all those things together and the net result is in the small practices, you end up seeing declines.”
“mom and pop practices that have not been perhaps as deeply operationally managed. They’ve not had the leverage of scale, whether in their contracts, their supplies, their labor or understanding what best practice can look like. So in many cases, we’ve been able to pull this together, operate it at market level integrate them into larger practices, larger footprints and create some pretty important efficiences that might have otherwise, stabilized them. So as we look forward, we see growth in employment, but I don’t necessarily see the same trajectory of cost growth.”