Specialist
Former SVP at Envision Healthcare Corp
Agenda
- Envision Healthcare update and industry overview
- Post-earnings outlook – reported losses and potential revenue growth opportunities
- Surprise billing and government interaction in the industry
- 2020 forecast and key trends
Questions
1.
What key trends and themes are you following in the physician staffing space?
2.
How would you say Envision’s story has played out over the last 1-2 years?
3.
Would you identify any broad trends with RFPs [requests for proposals] and contract retention rates?
4.
What has been the trend in allowables for out-of-network benefits in the recent past, and what do you think is the difference to the provider today between yield on in-network and out-of-network charges?
5.
How would you characterise insourcing-outsourcing trends, particularly in relation to who is winning the contracts that Envision and other major staffing service companies have been losing? Has the trend towards insourcing been tangible enough to carve out some of Envision or TeamHealth’s past market share?
6.
What are the differentiators that would make a hospital choose one physician services provider over another? How significant a value-add are the ancillary services such as recruiting, clinical oversights and RCM [revenue cycle management] that Envision and others may provide?
7.
Could you share your commentary on surprise billing around these staffing companies and the Lower Health Care Costs Act? What timeline would you expect here, and what proposals do you think are most likely?
8.
If surprise billing legislation were to be enacted, do you anticipate insurance companies would approach staffers and potentially want to renegotiate rates? What is the potential size of the liquidity hit from insurers potentially backing out of agreements to renegotiate?
9.
What is the typical number of days to collect on receivables for in-network vs out-of-network and do you expect those dynamics to potentially shift with any surprise billing legislation?
10.
If the Lower Health Care Costs Act gets passed in some form, how would you expect it to affect Envision, TeamHealth and others’ abilities to hire doctors? You suggested a point of differentiation is often that premium above Medicare that they could get for their providers. How do you foresee those dynamics potentially shifting?
11.
Do you anticipate differing levels of impact between specialities – anaesthesiology, radiology, women’s and children’s services, emergency medicine, etc? I understand anaesthesiology has typically garnered the largest premium above Medicare. Do you think the magnitude of impact might be higher there?
12.
What proportion of Envision’s revenues would you say come from rented networks such as MultiPlan?
13.
In terms of the continue YoY bottom-line declines that we’ve been seeing, could you maybe walk us through the role of understanding managed care and how that may be affecting earnings?
14.
Do you have any insight into working capital or cost reduction opportunities within the company? If there is opportunity left there, have you noted tangible efforts at the company so far?
15.
Why do you think physician comp and labour cost continue to increase so much given the sluggish top-line growth? Who is bidding up provider costs at dilutive margins or is it perhaps a supply-demand exercise, where the supply of physicians is relatively limited at this point?
16.
Are collections from patients trending towards more patient responsibility in terms of total cost? You mentioned the likes of Envision and TeamHealth are trying to capture more of that yield, but do you anticipate that starting to translate into tangible top-line improvements? How long do you think before that begins to be implemented and a significant increase in yield happens?
17.
Is there anything else you think would be important to highlight?
18.
What factors would you monitor to gauge performance over the next 12-18 months? Does it start with that yield in terms of collecting from patients?
