瑞银美股医疗保健行业瑞银医院业务量追踪201932923页

GlobalResearch29March2019UBSHospitalVolumeTrackerUBSEvidenceLabinside:LargeBifurcationGrowingInsideMed/SurgVolumesfor1Q191Q19hospitalmedvolumeslookingsoft,expectverystrongacuity/pricingOurpreliminaryreviewofUBSEvidenceLab'sFebdataincludes53%ofthenormal500-600hospitalsample.Medicalcasescontinuetodeterioratewithsurgicalcasesdemonstratingremarkablestrength.WeseetruebifurcationgrowinginsideourdatasetwhichsupportsourSellsonCYHandMD(althoughMDissettinguplessbad).Strongsurgicalend-marketsenhanceamoreconstructiveoutlookonmed-tech,THC'sUSPIsegmentandSGRY.WefeelconfidentinourSSrevforecastsforHCAandUHSashighercomplexsurgicalgrowth,flucompanddeclinesinlow-acuitymedicalcasesarelikelytodriveextremelystrongpricing/acuitygainsin1Q19.Medicalcaseslookverychallenged;SurgicallooksverystrongThefollowingrepresentourmonthlyhighlightsfromworsttobest:(1)NewbornPDs(-5.7%);(2)EDvisits(-4.3%);(4)Births(-1.7%);(5)IPadmits(-1.6%);(6)OPvisits(-0.5%);(7)IPSurgeries(+1.0%);(8)TotalSurgeries(+2.8%);(9)OPSurgeries(+3.7%);(10)Observationvisits(+9.6%).QTDtrendsdirectionallyarenottoodissimilarbutwe'dhighlightOPSurgerieshaveinflectedtothehighesty/yincreaseinoverayear.Payermixremainschallenged;PublicshistoricallyfarebetterFebdatasuggestscontinuedweaknesspersistedacrossCommercial(-2.5%),Medicare(-1.4%)andMedicaid(-1.1%).Medicaidadmitshavedeclinedeverysinglemonthforoverayear.Self-payadmitsdidincrease+4.7%whichisnotablylessofanincreasevs.priormonths(double-digits).Ourcoveragehasperformed~100bpsbetteronIPadmittrendsvs.ourtrackerw/HCAandUHSaveraging~300bpsabove(whichimpliesQTDbothareflaty/y).ThereisverystrongpredictivevalueinourTracker.Surgicalvolumescontinueimprovement(+2.8%);EncouragingforMedTechThelatestsurgerydatabodeswellfor1Q19MedTechvolumes,andconfirmsstrongtrendsfromcompaniesthathavereported4Q18results.BothoutpatientandinpatientsurgeriesgrewandimprovedoverJanuarygrowthrates.Trendsy/ywerebetterinFebruarythanJanuaryforbothoutpatient(+3.7%vs+3.0%)andinpatientsurgeries(+1.0%vs-1.4%).Wecontinuetoforecast~6%organicy/ygrowthintheAmericasforourlargecapnamesin1Q19(~6%WW).1Q19(Jan/Feb)Trendsvs.4Q18TrendsSource:UBSEvidenceLab,DATABANK,UBSResearch4Q18Jan/Feb8.7%3.3%2.1%-0.4%-1.6%-0.7%-2.0%-3.0%-6.8%4.3%1.7%0.5%-1.9%2.4%-3.0%-0.3%-1.4%-2.1%ObservationVisitsOutpatientSurgeriesTotalSurgeriesInpatientSurgeriesOutpatientVisitsBirthsPatientDaysInpatientAdmitsEmergencyV[e-mail][phone]MatthewTaylor,[e-mail][phone]NathanLeiphardt,[e-mail][e-mail][phone]YiCheng,[e-mail][phone]UBSHospitalVolumeTracker29March20192UBSMonthlyHospitalVolumeTracker–ExecutiveSummary1Q19(Jan/Feb)Trendsvs.4Q18Trends•Otherthansurgeries,mostvolumemetricsdeterioratedinJan/Febvs.4Q18.•Mostimportantly,inpatientadmitsdeclined3.0%(vs.-1.4%in4Q18)andoutpatientvisitsdeclined0.7%(vs.+2.4%in4Q18).•ObservationvisitsremainelevatedwhileEDvisitssignificantlydecelerated(toughcompduetoflu)andbirths,whileimproved,remainweak.Calendar-AdjustedMonthlyTrends•Onacalendar-adjustedbasis,y/ygrowthmodestlyimprovedacrosseverymetricsvs.thepriormonth.Theonlymetricstopostcalendar-adjustedgrowthinFeb.wereobservationvisitsandsurgeries.•Weestimatethattherewerenoy/ycalendarimpactsinFebruaryforanyofthevolumemetrics.•EDvisitshadthelargestdeltavs.thepriormonth(Feb.-4.3%y/yvs.Jan.-8.7%y/y).PayerMix•PayermixhascontinuedaslightunfavorableshiftasMedicare,Medicaidandself-paymixwereupwhilecommercialmixwasdowninFeb.•Medicaidadmissiongrowthimprovedto-1.1%andwasup10bpsy/yasa%oftotaladmissions.•Medicareadmissionsgrew-1.4%(vs.-5.1%inJan.)andwasup10bpsy/yasapercentageofinpatientadmissionsinFeb.CommercialAdmissions•Commercialadmitsdeclined2.5%inFebruary,largelysimilartorecenttrends,thoughbetterthanJanaury'sgrowthof-4.5%.•Januarywasaparticularlydifficultcompforcommercialadmissionsgivenlastyear'sgrowthof+4.3%y/y.Compswilleasethroughouttheyear.Sourceforexhibitsabove:UBSEvidenceLab,DATABANK,UBSResearch4Q18Jan/Feb8.7%3.3%2.1%-0.4%-1.6%-0.7%-2.0%-3.0%-6.8%4.3%1.7%0.5%-1.9%2.4%-3.0%-0.3%-1.4%-2.1%Observ.VisitsOPSurgeriesTotalSurg.IPSurgeriesOPVisitsBirthsPatientDaysIPAdmitsEDVisits9.6%3.7%2.8%1.0%-0.4%-0.5%-1.6%-1.7%-4.3%-10%-5%0%5%10%15%Obser.VisitsOPSurgTotalSurgIPSurgPtDaysOPVisitsIPAdmitsBirthsEDVisitsFebruaryJanuary-1.0%-0.5%0.0%0.5%1.0%1.5%11/1701/1803/1805/1807/1809/1811/1801/19Y/YChangeinDischargeMixbyPayerMedicaidMedicareCommercialSelf-Pay3.5%0.7%4.3%0.0%-2.1%1.1%1.1%-0.8%-0.6%-0.8%-3.4%-0.5%-1.8%-2.6%-4.5%-2.5%-5%-4%-3%-2%-1%0%1%2%3%4%5%11/170