Specialist
Former senior executive at Envision Healthcare Corp
Agenda
- Trends and developments in the physician, radiologist and anaesthesiologist staffing markets, reviewing impact of NSA (No Surprises Act) implementation
- Reimbursement landscape and outlook, considering indicators from CMS (Centers for Medicare and Medicaid Services)
- Competitive landscape and differentiation across Envision Healthcare, TeamHealth and Sound Inpatient Physicians, noting payer-provider friction
- Labour and pricing dynamics, highlighting industry-wide staffing shortages
- Margin preservation tactics and H2 2022 industry outlook, including key priorities underpinning prospective turnaround strategies
Questions
1.
What are some of the major trends and drivers you’ve been following recently in the physician staffing market that might better inform our Interview today?
2.
How are you viewing overall care utilisation and acuity mix as we enter the latter stages of the pandemic? How is overall acuity trending and what’s the trickle-down impact or corollary effect on reimbursement?
3.
What’s your updated perspective on how physician staffers will fare under the implementation of the NSA [No Surprises Act]? What’s the more specific impact from the regulatory development on commercial reimbursement via arbitration?
4.
What’s your government reimbursement outlook for some of the main provider segments such as radiology, anaesthesia and ER for 2023? How are you viewing the risk of further reductions in reimbursement from CMS [Centers for Medicare & Medicaid Services]?
5.
How are you viewing current payer-provider relations in the industry post NSA? Envision and UnitedHealth are both engaged in simultaneous lawsuits alleging unethical patient risk coding, as well as excess claim denial or underpayment. Where do you see these disputes headed and what does this payer provider friction mean for the industry longer term?
6.
Is there a good outcome for Envision tangling with United? How would you compare the net-net of a favourable ruling in some of these lawsuits vs the cost of a drawn-out legal battle from a financial perspective, especially considering the existing leverage profile?
7.
Do you see any kind of breaking point from policymakers in Washington if regulatory and reimbursement dynamics continue to hurt physician groups? What actions could we expect from regulators if provider burnout accelerates?
8.
How do Envision Healthcare, TeamHealth, Sound Physicians and others stack up in terms of negotiation leverage with payers, physician compensation structure and business models? What are some key differences to note in company strategies as they look to weather industry challenges?
9.
Could you break down the relative revenue contribution and margin profile within the physician services segment in Envision Healthcare?
10.
How is Envision’s reimbursement mix trending? To what extent are we seeing a higher proportion of patients on government insurance, and could you quantify the financial impact of that kind of shift?
11.
How do the unit economics for staffers differ between inpatient and outpatient settings? To what extent does this shift for ASCs [ambulatory surgery centres] owned by health systems vs independent?
12.
What balance do you think staffers might strike between raising comp and containing labour costs in the wake of reimbursement haircuts? What are some of the trade-offs and offsets there?
13.
What happens when you have a contract but don’t have adequate staff to fulfil those obligations? How detrimental is that to a business?
14.
Could you discuss the importance of securing a pipeline of students and other staff coming out of school? How do you assess this as a lever to alleviate some staffing pressures?
15.
Could you elaborate on Envision’s JV with HCA Healthcare? What are some advantages for both entities from this collaboration, perhaps considering volume gains from referrals or even increased revenue from partnering with a health system with more reimbursement leverage?
16.
How do you assess Envision’s speciality mix and efforts to grow that footprint? To what extent could it increase exposure to areas or procedures with more favourable reimbursement to alleviate some of the margin pressures in ER, radiology and anaesthesia segments?
17.
What does a turnaround strategy look like for an Envision or a TeamHealth? What are the 2-3 priorities that need addressing to shore up the financials and position the companies for future success?
