international keynote uncovering the outlook for … · 2020-05-29 · 14 a-line staffing solutions...

© 2013 Crain Communications Inc

Uncovering the Outlook for Healthcare Staffing

Barry Asin, President, Staffing Industry Analysts

OCT 24 | 8:30 AM

INTERNATIONAL

KEYNOTE


Agenda

The Big PictureWhere We’ve BeenKey Trends and IssuesThe Outlook AheadQuestions


US Healthcare Spending Growing at Historically Slow Rates,

Source: National Health Expenditure Projections, Health Affairs, October 2013

But Outlook Improving


0

0.1

0.2

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0.6

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0.9

1

-20

-10

0

10

20

30

40

50

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Recession Monthly Job Growth 6 month average

Healthcare Industry Monthly Job Growth(000)

Source: U.S. Bureau of Labor Statistics (September 2013) and Staffing Industry Analysts

Healthcare Industry Job Growth


Most Growth not in a Hospital Setting

Source: U.S. Bureau of Labor Statistics (September 2013) and Staffing Industry Analysts


0

0.1

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-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Recession Y/Y change in healthcare quits 3-month moving average

Y/Y % Change in Healthcare Quits - Healthcare & Social Assistance

Good News: Healthcare “Quits” Rising Again

Source: U.S. Bureau of Labor Statistics


Agenda



Historical Growth of Healthcare Staffing

Source: SIA U.S. Staffing Industry Forecast (September 2013)

% indicates annual growth rate vs. prior

year


Pulse Survey Suggests Deceleration in Healthcare Revenue Growth

Source: SIA Staffing Industry Pulse Survey (September 2013)



2013 a Low Growth Year in Healthcare Staffing


Healthcare Staffing Market Share Leaders

Top 5 Market Share 2005 = 25% 2012 = 30%

Source: SIA 2013 Staffing Firm Market Share Landscape and Book of Lists

Largest healthcare staffing firms in the U.S.Ranked by estimated 2012 U.S. temporary staffing revenue

Rank Company

2012 U.S. Staffing Revenue ($million)

Market Share

1 AMN Healthcare Services $912 10%2 CHG Healthcare Services $721 8%3 Jackson Healthcare $467 5%4 Cross Country Healthcare $400 4%5 Maxim Healthcare Services $279 3%6 Medical Staffing Network $244 3%7 On Assignment $208 2%8 Supplemental Healthcare $199 2%9 Team Health $190 2%

10 Aureus Medical Group (C&A Industries) $178 2%11 Parallon Workforce Management Solutions (HCA Holding) $173 2%12 Soliant Health (Adecco) $157 2%13 Reliant Healthcare $100 1%

Total $4,228 46%


Public Company Revenue Growth Slowing

Source: Company Reports and Staffing Industry Analysts

*Includes nurse/allied/physician business only

6%

12% 11%

7%

-2%

3%2% 2%

13%

28%

11%

6%

3Q12 4Q12 1Q13 2Q13

Healthcare Staffing* Revenue (Y/Y Growth)

AMN Cross Country On Assignment


Public Company Gross Margins Relatively Stable Since 2012

Source: Company Reports and Staffing Industry Analysts

*Includes nurse/ allied/physician business only, except Cross

Country margin is company-wide

27.1% 27.0% 27.0% 27.6% 27.7%24.9% 24.6% 25.0%

26.2%25.1%

29.7% 29.6% 29.2% 29.8% 30.0%

2Q12 3Q12 4Q12 1Q13 2Q13

Healthcare Staffing* Public Company Gross Margin %

AMN Cross Country On Assignment


Allied and Locum Tenens About Half of the US Healthcare Staffing Market


2012 US Healthcare Staffing by Segment


Travel Nurse Growth Forecast Slower in 2013



Pulse Deceleration in Travel Nurse Growth


-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

50%

J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A

2010 2011 2012 2013

Y/Y

Reve

nue

Grow

th


SIA NATHO Benchmark Survey Shows Travel Nursing Gross Margins Tightly Clustered

Source: SIA 2013 NATHO Benchmarking Analysis


SIA NATHO Benchmark Survey: A Profitable Travel Nurse IndustryAggregated across travel nurse survey respondents

Source: SIA 2013 NATHO Benchmarking Analysis


Per Diem Nurse Growth Forecast Improving in 2013

0%

5%

0%

5%

10%

15%

20%

2012 2013P

Grow

th in

Per

Die

m T

emp.

Sta

ffing

Mar

ket



Allied Health Growth Forecast Down in 2013



Allied Health Pulse Shows Recent Deceleration in Growth



SIA Allied Benchmark Survey Revenue Mix

Source: SIA 2013 Allied Health and Advanced Practice Benchmarking Survey

$416M in Annualized Revenue (15% of the market)


Allied Benchmark Survey Highlights Weakness in Key Allied Segments

Source: SIA 2013 Allied Health and Advanced Practice Benchmarking Survey

10%

-30%

-19%

-9%

-7%

9%

9%

12%

20%

-3%

Other allied health

PT assistants

OT assistants/COTA

Occupational therapists (OT)

Physical therapists (PT)

Pharmacists

Medical technologists/MLT

Speech therapists/speech pathologists

Respiratory therapists

Total Allied health

Allied Health Revenue Growth 1H13/1H12


Locum Tenens Growth Estimate & Projection



Locum Tenens Revenue from SIA NALTO Survey (2012)

Source: SIA NALTO Benchmarking Survey

$1.2B in Revenue (58% of the market)

Hospitalists, 19%

Emergency Medicine, 16%

Surgery, 11%Family/Internal Medicine

9%

Psychiatry, 7%

OBGYN, 5%

Anesthesiology, 5%

Pediatrics4%

Radiology, 3%

Other Locum Tenens

21%


Locums Results by Segment in 2012

Source: SIA NALTO Benchmarking Survey

17%

-33%

-9%

1%

4%

4%

15%

18%

19%

19%

28%

10%

Other Locum Tenens

Radiology

Anesthesiology

Family/Internal Medicine

Psychiatry

OBGYN

Hospitalists

Emergency Medicine

Surgery

Pediatrics

Urgent Care

Total Locum Tenens

Locum Tenens Revenue Growth 2012/2011

Total Locums=10%

© 2013 Crain Communications IncSource: SIA NALTO Benchmarking Survey

-10%

-22%

-20%

-19%

-5%

3%

4%

5%

16%

19%

33%

5%

Other Locum Tenens

Anesthesiology

Surgery

Radiology

OBGYN

Pediatrics

Psychiatry

Family/Internal Medicine

Hospitalists

Emergency Medicine

Urgent Care

Total Locum Tenens

Locum Tenens Revenue Growth 1H13/1H12

2013 1st Half Shows More Mixed Results

Total Locums=5%


Healthcare Staffing Firms on SIA’s Fastest Growing Staffing Firm List

Rank Company Top Staffing Segment(s) Served

2012 U.S. Staffing Revenue

($mil)

Compound Annual Growth Rate

(Organic, 2008-2012)2 InGenesis Allied healthcare, Clinical/scientific $83.3 116.1%

14 A-Line Staffing Solutions Allied healthcare $16.2 49.7%44 AB Staffing Solutions Travel nursing $27.8 29.3%51 Clinical Resources LLC Travel nursing $8.0 25.7%60 Therapy Source Inc. Allied healthcare, Industrial $15.9 22.6%70 CEO Inc. Office/clerical, Allied healthcare $5.5 20.3%78 Mitchell Martin Inc. IT staffing, Allied healthcare $145.8 18.3%

Source: SIA 2013 Staffing Firm Market Share Landscape and Book of Lists


Agenda



ACA Projected to Deliver Significant Growth in Healthcare Spending in 2014



Buyers and staffing firms disagree on which side will bear the cost of ACA compliance

Source: SIA 2012 Contingent Buyers Survey, 2013 Staffing Company Survey

Staffing companies’ median expected cost increase for ACA compliance is $1.50 per temp hour


Cost/Benefit Analysis of ACA Compliance Options Suggest Fully Compliant Insurance the Answer for Most Healthcare Staffing Firms

Pay the $2,000 penalty

Buy “Skinny Med” Insurance

Buy Fully-Compliant Insurance

$585 x FT -and/or-$3,000 x ??

Risk None Some NoneBenefits to Employees None Partial Insurance Full Insurance

Cost-Example 1

55 FT Employees

Cost-Example 2

300 FT Employees

Annual Cost $2,000 x (FT-30) $2,600 x FT x 60%

$2,000 x (55-30) = $50,000

$585 x 55 = $32,175 $3,000 x ?? = up to $50,000

$2,000 x (300-30) = $540,000

$585 x 300 = $175,500 $3,000 x ?? = up to $540K

$2,600 x 300 x 60% = $468,000

$2,600 x 55 x 60% = $85,800

Source: Affordable Care Act – The “Play-or-Pay” Employer Penalties and How to Avoid Them

Rarely Sometimes Most Likely


The Growth of VMS, MSP and RPO


Significant Growth in Healthcare VMS and MSP Spend Under Management

+24%

+27%

Source: SIA 2013 VMS/MSP Supplier Competitive Landscape Report


High Interest in MSP, VMS, Master Supplier and RPO as Offerings of Healthcare Staffing Firms

Source: SIA 2013 Staffing Company Survey


Health IT Deadlines Driving Growth OpportunitiesEHR Implementation: To avoid a penalty in 2015:

- Hospital must begin 90 day EHR reporting period no later than April 1, 2014 (if hospital has not yet demonstrated meaningful use)

- Eligible Professional must begin 90 day EHR reporting period no later than July 1, 2014 (if EP has not yet demonstrated meaningful use)

- Hardship exceptions

U.S. ICD-10 Conversion- October 1, 2014 deadline- Late compared to other developed nations (Canada is laughing at us)

AHIMA is in the house at HCSS!!


Younger and Older Nurses Growing as Part of the Mix of the Nurse Workforce

Source: U.S. Census Bureau


Nurse Shortages: The Gift That Keeps on Giving

Source: United States Registered Nurse Workforce Report Card and Shortage Forecast, American Journal of Medical Quality, 2012


Agenda



US Health Spending to Rise Significantlyin 2014 and Beyond



US Health Spending in 2014 and 2015



Our 2014 Forecast Shows Improvement



The Future of Healthcare?

The Walmart WayBig volumesLowest pricesEfficient operationsHeavy IT focus


Questions?


The Long Term Outlook

international keynote uncovering the outlook for … · 2020-05-29 · 14 a-line staffing solutions...

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