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HM Goes Public

You know your industry is on the map when a trailblazer takes his company public. That signals the capital markets that top executives in a leading company are confident in their business model’s ability to grow the company enough to satisfy Wall Street’s voracious hunger for profits.

It’s a tall order, and Adam Singer, MD, founder and CEO of IPC-The Hospitalist Company, based in North Hollywood, Calif., accomplished it in January.

During 2007, Dr. Singer set the wheels in motion for taking IPC public the following year. “Our company is built right, has a solid revenue stream, and the nirvana of a real healthcare company—a battle-tested, proven business model,” he says.

Dr. Singer and his management team had the usual reasons for going public: raising capital to pay for operations and to allow for growth by acquisition, reducing debt, and creating liquidity for shareholders. He also had other fish to fry with a public offering. “I wanted to be the first in our industry to make it out of the box,’’ he says. “I also wanted IPC to be a model for the many hospital medicine companies that would like to mature beyond having a bunch of doctors running around a hospital and calling themselves a hospitalist medicine company.”

For Dr. Singer, going public went beyond the desire to produce quarterly financial results that would warm investors’ hearts. It spoke to his core belief in what the business of hospital medicine should be and, from his vantage point, isn’t.

“By leading a publicly traded hospital medicine company I am debunking the myth that hospitalist groups need hospital subsidies to survive,” he says. “This is a powerful myth, one that is mired in a work force’s idea that its members should get full-time pay for less than full-time work. IPC has raised the bar for our industry. We think that hospitals should demand the overall level of sophistication, physician commitment and productivity that IPC has.”

With few publicly traded physician companies for templates for a public offering, Dr. Singer looked to a colleague, Roger Medel, MD, for direction. Dr. Medel took his company public in 1979 and has grown Sunrise, Fla.-based Pediatrix Medical Group, a provider of neonatal, maternal-fetal, and pediatric intensivist/hospitalist services, from a company with $100 million in market capitalization to $3.32 billion and a recent stock price of $67 per share. The company has a “buy” consensus rating from analysts and respectable price-to-earning and earnings-per-share values.

Timeline of IPC’s Initial Public Offering

Prior to its 2008 IPO, IPC’s largest institutional backers/owners were Bank of America Ventures, 30.92%; Morganthaler, 25.13%; Bessemer, 17.38%; and CB Health Ventures, 14.80%.

  • 1988-2007: $47 million in venture capital invested since 1988.
  • 2007: Credit Suisse Securities and Jeffries & Co selected as joint underwriters; Wachovia Capital Market and William Blair & Co as IPO co-managers.
  • August 2007: IPC plans a 2008 IPO to sell $105 million of common stock; 2.8 million shares in the IPO, 1.9 million by shareholders.
  • Jan. 20: IPC released financial highlights on net revenues and net income. IPO planned of 4.7 million shares at $15 to $17 per share; net proceeds of approximately $38.3 million anticipated.
  • Jan. 30: IPO of 5.905 million shares.
  • Feb. 11: IPCM makes its first acquisition as a publicly traded company by purchasing Ludlow, Mass.-based Innovat­ive Phy­sician Services, 38 hospitalists group caring for 300 patients daily, in 12 acute care facilities. —MP

MARKET ENTRY SPURS CURIOSITY AND CONCERNS

As chief of a 25-physician hospital medicine group at Philadelphia’s Temple University Hospital, which is run by Cogent Healthcare, IPC’s public offering is of great interest to William Ford, MD.

“I am thrilled that people smarter than me have decided that hospital medicine is a solid investment,” says Dr. Ford, a Cogent medical director. “Going public was a good thing for IPC and a fantastic thing for hospital medicine. It shows our specialty has a business model that can sustain growth and that IPC has a platform on which a hospitalist company can build successfully.

“The problems with going public are daily scrutiny by the market and the media and the need to satisfy investors’ primary goal, which is making money,” he continues. What remains to be seen is if IPC can balance stockholder thirst for returns and the company’s performance long term.

Dr. Ford won’t comment on Cogent’s prospects for going public but says Cogent’s business model, which includes hospitals supporting their hospital medicine programs, also is sound. He points out that Cogent partners with its hospitals to reduce variations in care, develop best practices, and remove barriers to efficiency.

Elaborating on such funding, which IPC eschews, Dr. Ford adds that while the “2005-2006 SHM Survey: State of the Hospital Medicine Movement” shows that hospital support averages $75,000 to $120,000 per physician annually, the numbers show that the efficiencies hospitalists deliver outweigh the cost of such support.

Another issue hospital medicine detractors raise is that hospitalists haven’t dramatically cut costs, so their support is unwarranted.

However, a 2007 New England Journal of Medicine article documented that hospitalists reduce costs modestly: $125 for reduced length of stay and $268 in lower costs per case.1

Dr. Ford goes so far as to say drops in payer reimbursement wouldn’t jeopardize hospitalist medicine’s existence. “Even if Medicare cut reimbursement to zero, hospitals will stay open and they’ll need hospitalists to care for patients,” he asserts.

One potential flashpoint for a publicly traded hospitalist company is patient volume. “Wall Street may want me to see 25 to 30 patients a day to drive revenues—an eat-what-you-kill mentality. On an average day a hospitalist in my group sees 14 or 15 patients. That works well in avoiding burnout and reducing the average $75,000 it costs to recruit a new physician,” he says.—MP

Reference

  1. Lindenauer PK, Rothberg MB, Pekow PS, Kenwood C, Benjamin, EM, Auerbach AD. Outcomes of care by hospitalists, general internists, and family physicians. N Engl J Med. 2007 Dec. 20;357(25):2589-2600.
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    July 1, 2008

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