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Becker’s Healthcare Podcast
Scott Becker - 12 Healthcare Trends & Issues We Are Following 1-12-26
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This is Scott Becker with the Becker Healthcare Podcast. Today's discussion is 12 Healthcare Trends and issues that we're watching. And I'll tell you the first person that responds to this with comments and thoughts on what they like about this talk, what they hate about this podcast. I'd love to send to you a 100Amazon gift certificate, so you'll have to text Scott Becker at 773-766-5322. Again, this is 12 issues and trends in healthcare. First, we see in healthcare massive supply and demand issues. There's about 1.1 million doctors that are out there, which 900,000 to a million are practicing. We have about 345 million plus people in our country and the ratio is getting worse. This ratio that's getting worse leads to lack of availability in primary care and lots of subspecialties and lots of places where the depth is very shallow in terms of being able to get the right doctor for the right person. Increasingly, this supply demand imbalance is leading us to struggle on all three parts of the triple aim. Costs are going up, quality is getting worse and access is increasingly a real challenge. We have to know somebody to get into the right person. An incredible challenge. Second, we have incredible payer strength compared to our providers in the country. Four of the payers from the 20 largest companies in America buy revenue. This includes United Healthcare and CVS Aetna which are two of the top five companies in the country by revenue, right after Walmart and Amazon and also Cigna and Elevance which are also in the top 20. This payer imbalance makes it very hard for small and mid sized providers to negotiate with the payers. And it means again softening and slowing reimbursement for providers while they're still facing escalating cost. And we'll talk about that in a little bit. Third, currently in the country there's about 6,100 or so hospitals, 5,100 or so acute care hospitals, 6,500 Medicare certified surgery centers, about 10,000 to 12,000 surgery centers in total. That includes a lot of surgery centers that are not Medicare certified, sort of individually owned plastic surgery centers, all kinds of other surgery centers that provide services that aren't Medicare certified. There's also about 14,000 plus urgent care centers in the country. Again with hospitals and health systems more and more consolidation and we'll talk in a moment. There's more haves and have nots amongst both hospitals and health systems as well as amongst consumers and patients. The fourth talking point we've got this morning is there remains a ton of private equity investment across lots of healthcare areas. There's less now than practice management areas. In practice management, it's estimated that about 7 to 8% of physicians are employed by a private equity sponsored company. That's 7, 8%. 7 to 8% in total out of about the 1.1 million physicians. There is a ton of private equity investment across a whole range of areas. And again, with private equity, it's not monolithic. It's really the good, the bad and the ugly in terms of results, in terms of what's happening. Fifth, amongst providers, there's increasingly the sense there are haves and have nots. There's 60% of health systems. We'll talk about this in a moment, that have some margin, 40% don't. Again, it's similar with surgery centers, with practices, there's very much increasingly winners and losers. Providers in lower reimbursement specialties getting crushed, providers in good reimbursement specialties with lots of demand doing very well for patients. We also have increasingly the multi tiering of the healthcare system. It used to be that you could divide it between commercially insured patients, government insured patients and indigent patients. Now you've got more and more lines and tiers all the way across. You've got commercial patients, but even with commercial patients, you've got more and more concierge services. So there's an upper 1%, an upper 10%, that special access, special quality and concierge used to be sort of relegated to primary care. Now you're seeing it across increasing ranges of specialties. Then you've got a whole other set of people in commercial plans that are struggling to find the right provider at the right time. Then once you get to indigent, Medicare, Medicaid, it's even worse. And in fact, about half a government, about half of health care is now funded through government. Sixth, as we said a moment ago, 60% of health systems have some margin. About 40% do not. For those 40%, a lot of them struggling to figure out how do they survive, how do they thrive, what services do they provide, do they need to find a dance partner and align with a much larger system? Seventh, we're still seeing the growth in healthcare services in midsize and larger metro areas. However, we're seeing very challenging to no growth in rural and remote areas. Eighth, there are still huge, monumental amounts of dollars flowing into health care. The system, the healthcare system is half or more government funded, funded and essentially needs massive government spending to continue this in the big scheme of things, even though there's changes at the edges is not likely to change anytime soon. Ninth, margin issues remain very critical for all kinds of healthcare providers. Reimbursement is quite slow to grow and staff and other costs keep rising. Tenth, we continue to see more investment by health systems, again in those specialties where there is real need certainly, but also that really pay the bills. So you're seeing more developments in oncology centers, orthopedic centers and cardiovascular specialty centers, hospitals and systems again investing in these areas and in technology. And of course we'll talk in a moment about AI and technology. 11 Technology has cascading use cases in more and more places where it's having an impact. Originally it was largely relegated to administrative help, revenue cycle help and other kinds of areas. Now increasingly it has a big impact on in clinical and diagnosis areas as well. I'm a big believer that at the end of the day we're going to need both technology and an increased labor force of nurses and doctors to really provide health care to our very large country of 345 to 350 million people. Well, I'll make one comment on pharmaceuticals and research. Tremendous improvement in pharmaceuticals over the last decade, decades. So, so important. We should have most favored nation pricing. We're not paying more than they're paying in other countries for the same drugs. Some diseases, pancreatic cancer, brain cancer, and a whole host of others remain super challenging to fight. Again, these are 12 quick trends and issues that we're watching in healthcare. I'd love your feedback on this, but of course with the supply and demand issue, it should go without saying in the tiering of healthcare that health equity gets crushed. Under those circumstances, we need to fix that as well. Thank you for listening to the Becker's Healthcare podcast again. Feel free to text Scott Becker 773-766-5322 with any comments or questions that you have. Thank you so much for listening.