【出版时间及名称】：2010年4月美国医疗行业研究报告
        【作者】：BB&T证券
        【文件格式】：pdf
        【页数】：52
        【目录或简介】：


With the passage of healthcare reform via the Patient Protection and Affordable Care Act, we
thought it would be a good time to provide investors with an overview and an update of the
home health industry. Now that we have some clarity around reimbursement rates for the
next few years, we felt investors could use a primer that clarifies some of the more
complicated industry dynamics. We also provide a view of the competitive landscape, M&A,
breakdowns of beneficiaries, market size, reimbursement, and the Medicare Payment
Advisory Commission’s (MedPAC) proposal for home health reform. Our key points follow.
• 2010 forecasts another year of solid results, but 2011 could be a struggle on the
pricing front. With 2010 pricing set at +1.8%, we expect the home health industry to
continue posting impressive results, particularly with the partial year benefit from the 3%
rural add-on, which went into effect on April 1, 2010. However, the 4.2% pricing cut
currently projected for 2011 implies a considerably more difficult year for these operators.
We note that a full year of impact from the rural add-on should help, but that 2011 should be
seen as a rebasing year for the industry. Baked into our calculation is a +2.0% market
basket update (MBU) for 2011, which some may see as aggressive. However, with the 4.2%
pricing cut already projected, we expect some offset through a full MBU. Beyond 2011,
pricing cuts should be lessened due to the ending of the previously approved case mix
adjustment, which has been negatively impacting pricing by 2.75% since 2008.
• Volume trends remain intact for the growth of home health. While healthcare
reform is a first step, larger problems lie ahead for the country as Baby Boomers reach
Medicare-eligible status. Costs are expected to continue to rise with the expanded need to
service a larger population. We view the home health industry as a beneficiary of these
dynamics due to its positioning as the lowest cost environment to care for aging patients.
Continued investments in technology for remote monitoring systems could further expand
this industry’s importance within the healthcare continuum. With all the cost pressures, we
view home health as an excellent way to play the aging demographics of the United States.
As the need for home-based services intensifies with a growing Medicare-eligible population,
we expect demand for home health to only increase.
• Visibility is the key to unlocking M&A. We have witnessed consistent investor focus
on the pricing environment for home health and we don’t expect that to change. However,
with the recent passage of healthcare reform, home health has gained better visibility into
future pricing patterns. For more than a year, the lack of pricing clarity had been delaying
much of the anticipated M&A activity, but we expect that environment to change and it
could be an impetus for larger home health operators to redouble consolidation efforts. The
current outlook from healthcare reform is for a sizeable reimbursement cut in 20011 and,
while that cut has near-term consequences for home health operators, it could also open the
doors for more motivated sellers and robust M&A activity.
• A penny for Medicare’s thoughts. We note that one of the major difficulties for
Medicare is balancing the desire to reduce provider rates with maintaining access to care. It
is a delicate balance that we believe has often superseded other priorities and caused the
entity to disregard MedPAC’s recommendations of market basket freezes. One popular
theory that we have heard was that Medicare was looking for a sizeable pricing cut—
speculated to be anywhere from the high single digits up to 10% in a given year. We
continue to believe that such a pricing cut is unlikely and would be detrimental to access to
care and unlikely to garner enough support, even in a recessionary environment like we have
seen in recent times. Rather, we expect a series of smaller cuts and note that larger, wellcapitalized
home health operators have a greater likelihood of preserving EBITDA in such a
scenario by growing market share both organically and through M&A.

CONTENTS
Home Health Industry Overview....................................................................... 3
What is Home Healthcare? ........................................................................................................3
Who is Eligible to Receive Home Nursing Services? ................................................................3
Who Provides Home Nursing Services? ....................................................................................4
How Long Does a Typical Patient Receive Home Nursing Services?.......................................5
How Much Do Home Health Services Cost and Is It Cost Efficient? .......................................6
How are Home Health Providers Evaluated for their Services?...............................................6
Who Pays for Home Health Services? .......................................................................................7
How Large is the Home Nursing Market in the United States? ...............................................9
Market size by Expenditures ..................................................................................................9
Market Size by Providers .......................................................................................................11
Market Size by Beneficiaries ................................................................................................ 14
Competitive Landscape ....................................................................................18
M&A Environment ...........................................................................................24
Home Health Reimbursement..........................................................................29
Home Health Prospective Payment System (HH-PPS) ..........................................................29
CMS’ Proposed Rule for 2010 ..................................................................................................33
CMS’ Final Rule for 2010 .........................................................................................................33
MedPAC’s Proposal for Home Health Reimbursement in 2010 ............................................35
MedPAC’s Proposal for Home Health Reimbursement in 2011 .............................................36
Increased Regulatory Oversight...............................................................................................37
Legislative Environment and Healthcare Reform...................................................................37
President Obama’s Proposed Budget for Federal Fiscal Year 2010....................................38
H.R. 3200—America’s Affordable Health Choices Act of 2009......................................... 40
America’s Health Future Act of 2009 ................................................................................. 40
H.R. 3962—Affordable Health Care for America Act .......................................................... 41
H.R. 3590—Patient Protection and Affordable Care Act ....................................................42
H.R. 4872—Health Care and Education Affordability Reconciliation Act .........................44
Estimated 2011 National Standardized 60-Day Home Health Episode Rate ....................45
Conclusion...................................................................................................... 46
Appendix: Glossary of terms and acronyms......................................................47