2019Q1 Healthcare Earnings Roundup

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  • Universal Health Services, Inc.: The King of Prussia, Pennsylvania-based hospital management company did not meet its earnings per share or revenue expectations.
  • CVS Health: CVS Health’s still-pending acquisition of Aetna delivered exceptional financials for the company in Q1.
  • Encompass Health: The Birmingham, Alabama-based post-acute care provider attributed its improved revenue metrics to volume and pricing growth.
  • Cigna Corp: The Bloomfield, Connecticut-based insurer rebounded with revenues totalling nearly $38 billion in Q1.

  • Community Health Systems: The for-profit rural hospital operator produced yet another dismal earnings report.
  • Tenet Hospital Corp.: The Dallas-based for-profit hospital operator showed year-over-year improvement on its net losses though revenues slipped to $3.86 billion.
  • TeladocOnce again, the telemedicine company saw its revenues rise alongside with its net loss.
  • Molina HealthcareThe Long Beach, California-based insurer’s net income rose to nearly $200 million in Q1, a $91 million bounce year-over-year, prompting the company to boost its year-end guidance.
  • Humana: The Louisville-based insurer again raised its earnings per share guidance for 2019, this time due to expected Medicare Advantage growth.
  • WellCare Health PlansThe Tampa-based insurer’s net income and total revenues experienced a significant bump compared to Q1 2018.

  • HCA Healthcare Inc.The Nashville-based for-profit hospital operator’s revenues topped $12.5 billion but net income dropped below $1.1 billion.

  • Magellan Health: The Scottsdale, Arizona-based for-profit managed care company experienced a horrid Q1 across nearly all financial metrics.


Are healthcare jobs safe from AI? More so than many might think


No occupation will be unaffected by the technology, but healthcare will be affected less than other industries, owing much to its inherent complexity

Across the country and across industries, workers are nervous that automation and artificial intelligence will eventually take over their jobs. For some, those fears may be grounded in reality.

Healthcare, however, looks like it will be largely safe from that trend, a new report from the Brookings Metropolitan Policy Program finds.

Examining a chunk of time from the 1980s to 2016, the piece tracks the historical evolution of the technology and uses those findings to project forward to 2030.

The verdict? AI will replace jobs in various industries, but not so much in healthcare.


AI is projected to be an increasingly common form of automation, and the report claims the effects should be manageable in the aggregate labor market. Uncertainty remains, of course, and the effects will vary greatly — across geography, demographics and occupations.

Overall, though, only about 25 percent of U.S. jobs are at a high risk of replacement by automation. That translates to about 36 million jobs, based on 2016 data.

A higher percentage, 36 percent, are at medium risk (52 million jobs) while the largest group is the low-risk group, at 39 percent (57 million jobs).

Most of healthcare belongs in the medium-to-low categories, largely driven by the complexity of healthcare jobs. Still, the risk varies wildly. Medical assistants have what the report calls “automation potential” of 54 percent, but home health aids have just an 8 percent automation potential. Registered nurses sit somewhere in between, at 54 percent.

For healthcare support occupations, the number is closer to 49 percent; healthcare practitioners and technical jobs have 33 percent automation potential.


The report emphasizes that while some occupations will be safer from automation than others, no industry will be unaffected totally. Mundane tasks will be the most vulnerable.

Fortunately for those in the industry, there’s little in healthcare that’s mundane. AI and machine learning algorithms tend to rely on large quantities of data to be effective, and that data needs human hands to collect it and human eyes to analyze it.

And since AI in healthcare is currently utilized mainly to aggregate and organize data — looking for trends and patterns and making recommendations — a human component is very much needed, an opinion shared by several experts, who point out that empathy are reasoning skills are required in the field.



Kamala Harris’ ‘Medicare for all’ would mean massive disruption for healthcare, and the industry is prepared to fight it


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Democratic presidential contender Sen. Kamala Harris wants to “move on” from the current healthcare system in favor of a plan that would roll everyone in the U.S. onto a government plan known as “Medicare for all,” doing away with private health insurance.

As the California Democrat and others in her party make their case, however, they will face considerable opposition not only in the insurance industry, but across the healthcare sector, which would see massive upheaval from the plan. And polling suggests that the public, roughly half of which relies on private insurance, isn’t quite on board.

Drug companies, insurers, doctors, and hospitals have united in recent months to fight national government healthcare. One healthcare industry group, called the Partnership for America’s Health Care Future, has launched a five-figure digital ad campaign arguing that “Medicare for all” would cause massive disruption, higher taxes, lower quality care, and less choice for patients. It plans to spend six figures bashing “Medicare for all” over the course of 2019.

“Whether it’s called Medicare for all, single payer, or a public option, one-size-fits-all healthcare will mean all Americans have less choice and control over the doctors, treatments, and coverage,” said Lauren Crawford Shaver, the group’s executive director.

Other candidates for the Democratic nomination, such as Sens. Elizabeth Warren of Massachusetts and Kirsten Gillibrand of New York, are, like Harris, co-sponsors of the Medicare for All Act, legislation led by Sen. Bernie Sanders, I-Vt. Although it has “Medicare” in the name, the bill would go much further than current Medicare, which covers adults 65 and older and people with disabilities. It would pay for emergency surgery, prescription drugs, mental healthcare, and eye care without a copay.

Children would be enrolled in the government plan soon after the the bill’s passage, and the rest would be gradually phased in after four years. This would mean that roughly half of the U.S. population, the 177 million people in the U.S. covered by private health insurance mostly through work, would be moved onto a government plan. Employers would pay higher taxes rather than pay for private plans.

In defending the need for a government system, Sanders has blasted insurance companies, saying upon unveiling the bill that they “make billions of dollars in profits and make industry CEOs extremely wealthy.”

But healthcare providers, not just insurers, benefit from the current fragmented system, in which insurance is purchased by employers, the government, and individuals. They charge private insurers more to make up for the gap left by patients who are uninsured or are on government programs, which pay less for their services.

If all privately insured individuals were to have Medicare instead, and if it were to pay the same rates it does now, then doctors and hospitals would see big losses caring for patients who moved from private coverage to the government plan. Healthcare providers have said that if taxes don’t go up to pay for the difference, then doctors and hospitals will face pay cuts and layoffs, leading to facility closures and long lines for care.

Hospitals serve as the main employer in many communities. For patients, that would mean losing not only a healthcare plan they might be satisfied with, but also doctors they worked with for years or hospitals they relied on in their communities.

The Medicare for All Act has not been scored by the Congressional Budget Office, but analyses from the Mercatus Center at George Mason University and the left-leaning Urban Institute found it would raise government spending over a decade by $32.6 trillion.

Overall healthcare spending, though, would actually fall by $2 trillion, as private spending on healthcare would collapse. The cut would be achieved, however, through paying 40 percent less to providers than what they were getting from private insurance.

Another obstacle to “Medicare for all” is the fact that the public isn’t fully convinced by the idea of nixing private insurance, a recent poll from the Kaiser Family Foundation shows. Initially, 56 percent of those polled favored the Medicare for All Act, but then when they learned it would do away with private health insurance, the support fell to 37 percent.

Candidates are going to face pushback within their party. House Speaker Nancy Pelosi and other Democratic leaders have not embraced government healthcare, instead pushing for adding funding to Obamacare.

But proponents of allowing the government to have a more extensive role in healthcare point out that waste is prevalent in the current system. Patients receive unnecessary medical care, such as repeated tests or surgeries that either don’t make them healthier or even make them worse.

These proponents agree with Harris that health insurance companies are unnecessary. Wendell Potter, an advocate of a government-financed healthcare system and president of the Business Initiative for Health Policy, said in a statement that polling results show the healthcare industry’s misinformation campaign to spread “fear, uncertainty, and doubt” was effective. He said that commercial health insurance companies don’t have an incentive to lower healthcare costs and make sure patients can access care.

Potter, a former health insurance executive, described how the information campaign worked, saying the goal was to “make people believe that private health insurance companies were a necessary part of the healthcare system, and to scare them into thinking that a ‘Medicare for all’ system was expensive and impractical, and that it would cause a significant drop off in the quality of care.”





Healthcare job growth slows; hospitals add 10.6K jobs in June


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Healthcare added 25,200 jobs in June, with hospitals contributing 10,600 to that total, according to the latest jobs report from the U.S. Bureau of Labor Statistics.

This is down from the 28,900 jobs the industry added in May.

Within healthcare, ambulatory healthcare services continued to show employment growth, adding 13,500 jobs last month. Hospitals added 10,600 jobs in June compared to the 6,200 they added in May. Nursing and residential care facilities gained 1,100 jobs last month.

Overall, healthcare has added 309,000 jobs over the year, according to the BLS.

In total, the U.S. added 213,000 jobs in June.



House GOP tax cut bill has pluses and pitfalls for healthcare stakeholders


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Healthcare companies, executives and professionals could enjoy lower business and personal taxes while facing reduced revenue due to Medicare and Medicaid cuts that may be used to pay for the tax reductions, under the House Republican tax reform bill released Thursday.

The 429-page Tax Cuts and Jobs Act—which congressional Republicans hope to pass quickly through the expedited budget reconciliation process with little or no Democratic support—would slash the corporate tax rate from 35% to 20%. That would benefit profitable companies like UnitedHealth Group, HCA and Universal Health Services, according to an analysis by Mizuho Securities.

The tax plan also would sharply raise the income threshold for individuals and families paying the top personal tax rate of 39.6%, to $500,000 for individuals and $1 million for married couples. In addition, it would abolish the alternative minimum tax. Those provisions would reduce personal income taxes for many healthcare executives and professionals.

But at the same time, the bill would cap corporate interest deductions at 30% of earnings before interest, taxes, depreciation and amortization. That could hurt companies carrying large debt loads such as Tenet Healthcare Corp. and Community Health Systems, which declined to comment on the bill.

“For companies that are profitable, the lower corporate tax rate is a powerful generator of cash flow,” said Sheryl Skolnick, managing director at Mizuho. “But for highly levered companies, the interest deduction is quite powerful for them in reducing their tax bill. If that deduction is no longer available, that would be a negative for money-losing companies with little cash flow to begin with.”

Healthcare industry groups will have to consider how the long-term budget impact of the tax cuts will affect broader health policies.

“This is clearly a package that will increase the deficit significantly,” said Matt Fiedler, an economist at the Brookings Institution’s Center on Health Policy. “Ultimately the lower revenues need to be financed by reduced federal spending. Since healthcare programs are a large portion of the budget, this will create pressure for cuts in those programs.”

The release of the House GOP bill Thursday was the first step in what’s likely to be a politically difficult process of passing a bill in the House and reconciling it with a separate Senate GOP tax bill scheduled for release as early as next week. The legislation is likely to come under heavy fire from various industry and consumer groups as well as Democrats as the winners and losers are identified.

But congressional GOP leaders and President Donald Trump believe they can’t afford another legislative failure following the collapse of their efforts to repeal and replace the Affordable Care Act. “We made a promise to deliver tax reform that creates more jobs, fairer taxes, and bigger paychecks,” House Ways and Means Committee Chairman Kevin Brady (R-Texas) said in a written statementaccompany the bill’s release.

Paul Keckley, a veteran industry analyst, said healthcare companies will hold off on making any financial adjustments based on this bill because it’s certain to undergo substantial changes before anything is passed. “With all the darts that will be thrown at this thing, it’s a long way from the finish line,” he said.

Beyond the immediate tax impact, however, analysts cautioned that healthcare companies should beware of big cuts in Medicare, Medicaid and Affordable Care Act funding that Congress may consider to offset the revenue losses from the bill’s tax cuts. The House and Senate budget resolutions capped the 10-year cost of the tax cut package at $1.5 trillion.

A Democratic analysis of the Senate budget blueprint passed by Republicans last month found that it would cut Medicaid by $1 trillion and Medicare by $473 billion over 10 years.

“This massive tax cut for the rich would add trillions of dollars to the national debt, allowing Republicans to then come after Medicare, Medicaid, Social Security, and other middle-class priorities,” Sen. Patty Murray (D-Wash.) said in a written statement.

“There’s no way you can offset $1.5 trillion in tax cuts without looking at entitlements,” said Anders Gilberg, senior vice president for government affairs at the Medical Group Management Association.

He worried that if congressional Republicans seek to cut Medicare to recoup those revenue losses, that could destabilize the current transition of physicians from fee-for-service to value-based payment. “We’ll be looking at what the offsets are,” he said. “This sounds easy until you have tension between cutting taxes and being accountable for the deficit.”

Skolnick agreed that hospital leaders need to watch out for possible cuts in federal healthcare programs as a way to pay for the tax cuts. “Unless you pay a whole lot of whopping taxes, tax reform will be a net negative for the hospital sector, both for-profit and not-for-profit,” she predicted. “Careful what you wish for, you may get it.”

The American Hospital Association raised objections to two provisions of the bill affecting hospitals. One would stop treating tax-exempt bonds as investment property. The AHA warned that if hospitals’ access to tax-exempt financing is limited or eliminated, they would have a harder time investing in new technologies and renovations.

The other measure would impose a 20% excise tax on executive compensation above $1 million. The AHA said the law already requires a rigorous process for hospital boards to set compensation based on competitive market rates for top talent.

Physician groups were left behind on the bill’s provision reducing tax rates for pass-through entities. Passive owners of S corporations and limited liability corporations — the structures used by many medical groups — would be able to pay just a 25% tax rate rather than the 39.6% top rate for personal income. But medical groups and other professional service firms would not receive that reduced rate unless they were able to show the income was not labor-related.

“I’m disappointed we wouldn’t see a benefit for our members,” said Tina Hogeman, the MGMA’s chief financial officer.

She also worried about the bill’s $500,000 cap on home mortgage interest deductions, down from the current $1 million. “That’s a real problem for our members,” she said. “The average physician has a home that cost more than $500,000.”

A controversial provision of the House GOP bill that affects consumers is the proposed elimination of itemized deductions for high medical expenses, including long-term care costs. That deduction costs the Treasury about $10 billion a year. The AHA opposes ending that deduction.

The Brookings Institution’s Fiedler said that while the deduction isn’t well-targeted to help people with high medical costs, it’s a bad idea to repeal it to help pay for tax cuts for corporations and wealthier Americans.

“It could be sensible policy to repeal the deduction, but here it’s just financing regressive tax cuts,” Fiedler said.

Healthcare industry groups and supporters of the Affordable Care Act were relieved that the House GOP tax bill did not include provisions Republicans were considering to repeal the ACA’s individual mandate or erase the ACA’s taxes on wealthier people’s investment earnings. Those provisions could have undermined the individual insurance market and the financing for the law’s coverage subsidies.

“The bill is most notable for what’s not in there,” Fiedler said.

CHS Chief Leads Discussion on Wall Street’s Healthcare Outlook


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After a tough 2016, market analysts say that this year they expect a better investment climate in many healthcare sectors.


9 latest healthcare industry lawsuits, settlements


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From a Florida hospital settling a whistle-blower lawsuit for $12 million to six pharmaceutical executives being charged in an alleged fentanyl racketeering scheme, here are the latest healthcare industry lawsuits and settlements making headlines.