The number of surgeries of more than 800,000 units a year makes sports medicine the next "darling" of capital, and the sports rehabilitation clinic that is one step ahead of the instruments, is it possible that the next "medical mao" may appear?
Text/Ling Xin
Editor/Sun Aimin
Photo/ Xu Mengtao Source/Xinhua News Agency
In February 2022, a sports medicine clinic in Shanghai confirmed a new round of financing, amounting to tens of millions of yuan, and the valuation doubled from half a year ago.
In today's medical and health racing track, this is the envy of peers. Since the fourth quarter of 2021, with the downturn in secondary market medical stocks, the primary market has less enthusiasm for the medical track than before. Many new drug developers have launched financing since the summer of 2021 and have not yet completed the transaction.
In the field of sports medicine, there is a different picture. Under the effect of the Winter Olympics, the people's enthusiasm for ice and snow sports has been activated, and the demand for diagnosis, treatment and rehabilitation of the resulting injuries is increasing. In the upstream and downstream of the industry, the story of a round of financing in half a year and a transaction within three months occurs frequently.
In January 2022, sports medicine equipment company Tianxing Bomaidi received hundreds of millions of yuan of B round financing. In 2021, at least seven similar enterprises have received multiple rounds of financing totaling not less than 500 million yuan, including well-known institutions such as Hillhouse Capital and Legend Capital. According to the founder of the sports medicine clinic, "There are more investors waiting for our next round of financing." ”
Sports medicine is gradually becoming the new darling of medical investment.
Along the slopes, there is sports medicine
"Three hundred million people are on the snow and ice, and at the end of the slopes are orthopedics." This is a popular "paragraph" on the Internet with the bid and successful holding of the Beijing Winter Olympic Games.
According to survey data from the National Bureau of Statistics Social Opinion Survey Center, since Beijing successfully bid for the Winter Olympics in 2015, the number of participants in ice and snow sports nationwide has reached 346 million by October 2021.
Ice and snow sports are hot, and an increase in injuries is inevitable. In Beijing, during the 2017-2018 snow season at Yanqing Ski Resort alone, 428 people needed emergency treatment due to injuries and illnesses, of which 61 needed to be transferred to hospitalization. In other words, for 3 months, 4 to 5 people were sent to the hospital every day for ski injuries.
There is a post called "skiing is very expensive" among ski enthusiasts: domestic tibia fibula steel plate is 3,000 yuan - 4,000 yuan each, the operation cost is 10,000 yuan - 100,000 yuan per time, the rescue through train is calculated according to the mileage, and the missed work fee, nutrition fee, rehabilitation fee and so on are not counted.
This is self-deprecation among "snow friends", but if you are really injured in skiing, the cost is far more than orthopedics. Wu Xiaohua of the Shanghai Institute of Sport combed through the sports injury data of ten ski resorts in northeast China from 2018 to 2020 and found that fractures accounted for only 12.3% of ski injuries; knees, elbows, wrists, shoulders and ankles were damaged, accounting for nearly half of all injuries.
It is not the traditional orthopedic traumatologist who diagnoses and treats these injuries, but a discipline that combines sports and medicine - sports medicine. In layman's terms, sports medicine looks at the injury of the motor system, in addition to the foot in exercise, twist the knee, the ligament fracture caused by the wrist, the meniscus tear, etc., the elderly osteoarthritis, rotator cuff injury also belong to the category of sports medicine.
Li Guoping, a core member of the IOC's Medical and Scientific Committee and head of the Beijing Winter Olympics Medical Core Expert Group, firmly disagreed with the statement that "the end of the snow road is orthopedics". In an interview with the "Finance and Economics Health" reporter, he said that along the slopes and ice rinks, whether it is the construction of the team of ski rescue doctors, or the application of minimally invasive reconstruction and sports rehabilitation technology, the core is the prevention, treatment and rehabilitation of sports medicine from beginning to end. "The end of the trail should be happy and healthy, even returning after injury."
Photo/pixabay
At this Winter Olympics, Xu Mengtao and Qi Guangpu won the gold medal in freestyle skiing aerial skills for the Chinese team. It was Chinese sports medicine that allowed these two "four dynasties elders" to return to the field after repeated injuries. "Freestyle skiing aerial skills, athletes not only have to do a variety of rotational movements at high altitude, but also stand firmly on the snow, this 'station' if not steadily fall, it may cause the rupture of the anterior cruciate ligament." Li Guoping, who has led the medical security work of the ten Olympic Games, including four Winter Olympic Games, pointed out.
Knee ligament injuries are common in winter snow sports. Xu Mengtao, who has one gold, two silver and three Olympic medals, has suffered such injuries more than once. Before the Vancouver Winter Olympics, the anterior cruciate ligament of the right leg was ruptured; before the Sochi Winter Olympics, the medial collateral ligament of the right leg was torn; before the Pyeongchang Winter Olympics, the anterior cruciate ligament of the left leg was ruptured.
"For such injuries, we usually use advanced minimally invasive techniques." Li Guoping made an analogy, first to build a reconstruction "tunnel", and then transplant a new "ligament", which may be the injured person's own, may be allogeneic, or even artificial ligaments. For these minimally invasive reconstruction techniques, doctors can only perform precise operations in two arthroscopic holes that are only the thickness of chopsticks.
"The purpose of sports medicine is to escort sports." Chen Yichen, chief physician of orthopedic sports medicine at Shanghai First Hospital, told the "Finance and Economics Health" reporter that this discipline does not do the "ultimate surgery" of joint replacement, but more of a "small repair" of tendons, ligaments and other surrounding tissues.
Although it is a "small repair", "Xueyou" once injured to seek help sports medicine, the cost is only a lot more than the fracture and other surgery. In public hospitals in Guangdong, a set of belt and thread nails for ligament repair costs 8,000 yuan, a titanium plate with loops to fix tendons and ligaments is 12,000 yuan, and the interface screws for fixing implants are also 3,300 yuan. Such a minimally invasive operation also requires arthroscopy and power planing system to cooperate, a piece of equipment will cost hundreds of thousands or even more than 1 million yuan, and patients will have to spend money to use supporting consumables.
Delicate surgery and expensive consumables have not led to the development of disciplines and industries before. According to the incomplete statistics of the Orthopedic Branch of the Chinese Medical Association, more than 110,000 cases of arthroscopic surgery were completed in mainland China in 2009. The same data in the United States reached 3.63 million cases in 2007. Arthroscopic surgery is regarded as an important indicator of the development of sports medicine.
Sports medicine was once regarded as "special medicine" and was designed to serve elite athletes. When the Sports Medicine Branch of the Chinese Medical Association was established in 2007, "only nearly 200 doctors were able to implement arthroscopic minimally invasive techniques," recalls Li Guoping, who was the founding chairman.
"In a more mature medical market like the United States, the quad of orthopedics is more average. But in China, trauma and spinal subdivision tracks developed earlier, and joints have also developed rapidly in the past two years, and sports medicine is dragging its feet. Zhang Ao, executive director of Qiming Venture Capital, analyzed the reporter of "Finance and Economics Health". It is precisely the difference between the development of the industry and Europe and the United States, coupled with the rise of sports demand with economic development, which is the main reason why capital is optimistic about sports medicine.
"Originally, everyone didn't understand sports medicine, and maybe the economic level at that time didn't need sports medicine to help everyone improve their ability to exercise." Ye Tingjun, a doctor at Ruijin Hospital affiliated to Shanghai Jiaotong University, analyzed. He began to focus on sports medicine in 2010, and many doctors switched from orthopedics or rehabilitation to sports medicine in those years.
Doctors who "changed careers" have come to the transformation of sports medicine disciplines and markets, and the sports medicine branch of the Chinese Medical Association and the sports medicine branches of various provinces and cities across the country have nearly 10,000 members. Li Guoping said, "You now go to all provinces in the country to see, sports medicine experts everywhere can use arthroscopy to treat sports injuries." ”
Peking University Third Hospital, known for its sports medicine department, has an average of nearly 30 cases of sports injury-related surgeries per day. From the time each patient is issued a hospitalization slip to surgery, it also goes through a "queue" that can be as short as one month and as long as three months.
"As of 2020, the market size of implant consumables for sports trauma in China's sports medicine has reached more than 5 billion yuan, and the sports rehabilitation market will reach tens of billions of yuan." Chen Shiyi, chairman of the Sports Medicine Branch of the Chinese Medical Association and director of the Institute of Sports Medicine of Fudan University, once said that the total scale of China's sports medicine market is expected to reach 200 billion yuan in the future.
Scramble for a sports healer
In Chen Shiyi's expectation, in the 200 billion yuan sports medicine market, non-device revenue will account for half of the country, which mainly includes sports rehabilitation, training and certification of sports prescribers and other services. Compared with implant consumables, the current domestic sports rehabilitation medical service market is one step ahead.
Unlike other disciplines, the success of surgery in the diagnosis and treatment of sports medicine can only be regarded as 51% complete, and if the rehabilitation is not done well, the efficacy is difficult to be recognized by patients. Taking arthroscopic surgery in the knee area as an example, some people can bend their knees to 90 degrees a month after surgery; some people still walk with a limp after ten months, many daily movements cannot be done, and they dare not do any more exercise, and even "lame" from then on.
For "skilled" doctors, minimally invasive surgery in sports medicine is not complicated in itself. Wu Peng, deputy chief physician of the Department of Orthopedics of Shanghai Tenth People's Hospital, performs more than 600 cases of knee surgery alone every year. The suture surgery after the meniscus tear only took him 10 minutes to complete, and the unilateral ligament surgery took only 20 minutes. "The difference in postoperative effects is whether there is any emphasis on the patient's rehabilitation."
Ten years ago, doctors' concept of exercise instruction and post-operative rehabilitation was still stuck in the 1980s. At that time, when doctors asked some patients from Hong Kong and Taiwan how to recover, they did not know how to answer.
Nowadays, at least in the sports medicine clinics of the top three hospitals in first-tier cities, doctors will instruct patients to do a good job of rehabilitation training, and even draw pictures and directly demonstrate in the clinic. "Through rehabilitation training, the injury should grow in accordance with the normal trajectory of the joint, so that its activity function can be restored as soon as possible." Ma Xin, secretary general of the foot and ankle surgery group of the Orthopedic Branch of the Chinese Medical Association and vice president of Huashan Hospital affiliated to Fudan University, told the reporter of Finance and Economics Great Health.
Photo / In order to recover better, some sports medicine doctors will personally give patients simple rehabilitation guidance Photo / Ling Xin
This concept began in 2005, Li Guoping sports medicine experts to promote this discipline from traditional rehabilitation to sports rehabilitation integrated with sports and medicine, "one-on-one guidance for patients to take the initiative to exercise, including joint activity, cardiopulmonary function, muscle exercise, balance ability, four aspects must be taken into account." ”
Very few patients are able to complete rehabilitation on their own. "Self-directed practice is painful, and some people can't complete the standard practice moves as required, or simply do the exercise is wrong." Dong Yue, a rehabilitation therapist who works for an institution in Beijing, told the reporter of Finance and Economics Great Health.
There are 36,000 rehabilitation therapists in China, but very few of them focus on sports rehabilitation. A rehabilitation therapist who works for a public hospital told the "Finance and Economics Health" reporter that under the medical insurance control system, the rehabilitation project charges 50 to 60 yuan at a time, and the rehabilitation department is almost hovering on the edge of loss.
Private medical institutions have targeted this gap, while joining hands with sports medicine doctors, while recruiting sports rehabilitation therapists, trying to "grab" patients with sports rehabilitation needs. The product director of a rehabilitation clinic in Shanghai revealed to the "Finance and Economics" reporter that of the institution's revenue in 2021, 20%-30% of the patients who have undergone surgery in public hospitals are recovered patients, "mainly relying on the recommendation of doctors practicing in our multi-point practice here." ”
Doctors who understand sports rehabilitation are not opposed to this, and they also hope that patients who have undergone surgery can resume exercise and thus build a reputation among patients. Moreover, "most sports injuries do not require surgery and can be slowly recovered or relieved through rehabilitation." Xu Caiqi, an orthopedic physician at Shanghai Sixth People's Hospital, told the "Finance and Economics Health" reporter.
Among them, sprains and contusions of joints and muscles, as well as synovitis caused by sprains, may develop into chronic diseases if they are not paid attention to, and they and long-term strain patients are the main customer groups of private rehabilitation institutions. These patients, after receiving a doctor's rehabilitation prescription for the first consultation, will be led by rehabilitation therapists for several months.
Ruijin Hospital once treated a wrist injury for diving Olympic gold medalist Chen Yaoxi, which was a strain caused by a long-term handstand, but the handstand was an inevitable action of diving. At this time, the human body should be treated as a motor system, and the wrist burden should be reduced by strengthening the training of the back muscles and core muscle groups. In this way, it can both relieve pain and prolong her athletic life.
Such sports rehabilitation must be jointly decided by professional physicians and rehabilitation practitioners. The reason is that one symptom may correspond to ten diseases, "such as bench press exercise of pectoralis major muscle, most of the pain in the eyes of sports medicine doctors, because the chest push action is not in place caused by the shoulder lockicle joint hypertension, inflammation pain, through the correct guidance to change the posture can be alleviated." But gym instructors or 'rehabilitators' often mistake it for a rotator cuff problem. In his work, Xu Caiqi often hears patients complain about the misjudgment of the so-called "rehabilitator" in the gym, "There are many small muscles in the shoulder joint that are important for stability, and the gym instructor may not know." ”
In fact, sports rehabilitation engineers who have undergone systematic medical education and can make such professional medical judgments are currently scarce in China. Sports rehabilitation engineers need to have both medical and sports backgrounds, there are not many colleges and universities that offer such majors, and if you want to recruit such an undergraduate or master's degree graduate, you must be the first to "book" among junior or second-year students.
Expert rehabilitation therapists who can lead the team can often get an annual salary of more than 600,000 yuan, and some can also get shares in the company, "The problem is that there are not so many people to 'grab'." Zhao Qingyi, the founder of a rehabilitation clinic, told the "Finance and Economics Health" reporter that this level of rehabilitation division has a maximum of more than 100 people in the market.
Zhao's clinic has two such "star rehabilitation engineers", one of whom is a special rehabilitation expert of the snow sports national team, and she holds a doctorate in physical therapy from the University of Southern California.
Newly graduated Doctorates may take about half a year of training to become an executive, and it will take two years for independent treatment. But even so, "it also needs to be grabbed, basically locked before returning to China," Zhao Said. The monthly salary of fresh graduates is between 20,000 and 30,000, which is comparable to that of internet manufacturers.
Become the next "healer"?
The price tag of 300,000 annual salary can be prescribed to fresh graduates, and the "gold-absorbing" ability of rehabilitation clinics can be seen. The clinic opened by Zhao Qingyi in October 2020 has reached a revenue of 6 million yuan in one year, achieving profitability.
The operation director of a private rehabilitation clinic told the "Finance and Economics Health" reporter that in this line, the main customer group is executives of foreign companies with high-end consumer medical insurance, as well as out-of-pocket customers who have studied abroad and have an understanding of sports rehabilitation. The unit price of the first-time patient is about 1,000 yuan, and the single charge for long-term and stable rehabilitation training is about 600 yuan, about two to three times per person per week.
Based on this calculation, a private rehabilitation clinic with a price in the middle of the industry can obtain more than 10,000 yuan in each stable customer.
Athletes charge more, and almost every well-known clinic signs long-term cooperation agreements with sports organizations, such as football, basketball, tennis clubs, as well as marathons, cross-country and other events. "Athletes have higher requirements for rehabilitation and physical fitness, and in addition to the therapists, they also have to match the physical fitness coaches. Practice once a day in the morning and afternoon for a month, with a total charge of about 100,000 yuan. Some are paid for by the club, and there are also many at their own expense. The aforementioned director of operations believes that for high-income people, spending this money can allow them to return to the field and the workplace as soon as possible.
Out-of-pocket payment, high unit price, bypassing public hospital medical insurance control fees and centralized procurement of medical devices to reduce prices, sounds very much in line with the investment logic of consumer medical care. In the secondary market, Aier Ophthalmology and Tongce Medical are known as "Eye Mao" and "Tooth Mao" respectively, and they are chain private consumer medical institutions. Compared with ophthalmology and dental clinics, sports rehabilitation is a blue ocean, is it expected that the next "medical mao" will appear in this field?
According to Zhang Ao's analysis, high-quality, high-profit margins, and compliant offline medical services, whether in A-shares or Hong Kong stocks, are long-term high premiums, and they are heavily positioned by large foundations. After ophthalmology and stomatology, as the income level of Chinese people has further improved, the demand for sports and the ability to pay have also risen. "In the context of the Beijing Winter Olympics, everyone began to participate more in sports, and the market demand is definitely there."
After severe injury to the motor system, surgical treatment in a public hospital is still the first choice for patients. The systematic rehabilitation after surgery gives private medical institutions the opportunity to do a large out-of-hospital market. According to Li Guoping, "There were only a dozen social rehabilitation clinics in the past, but now there are hundreds, an increase of about 30% per year." ”
The market is expanding rapidly, and everyone has the opportunity to become a leader. A private chain of rehabilitation institutions that had been funded by Matrix Partners China and Zhen Fund appeared to have ambitions, and the institution had four outpatient clinics in Shanghai. Institutional partners have revealed that they are planning to prepare for the construction of surgical centers and replicate and expand to first- and second-tier cities such as Beijing, Guangzhou-Shenzhen and Chengdu.
Figure/The main customers are high-income groups, and the environment of private rehabilitation institutions is also better. Images courtesy of respondents
However, the existing sports rehabilitation clinics are mostly located in the urban center area of Beijing, Shanghai, Guangzhou, and Shenzhen, so that they can connect to the groups with the strongest ability to pay. But can such a development model be replicated outside of first-tier cities?
Zhao Qingyi admitted that it would be difficult. "Patients' attitudes towards sports rehabilitation mainly depend on the education of the surgeon. In first-tier cities, the industry now recognizes the importance of sports rehabilitation. But the third-tier cities we contact, such as Jiaxing and Jinhua, their consciousness will suddenly come down. ”
Relying heavily on the revenue of first-tier cities is a common pain point for consumer medical treatment. Tongce Medical has three regional general hospitals, 15 branches or clinics, half of the net profit comes from the first-tier city of Hangzhou, some people jokingly call it "a listed company supported by a hospital".
Compared with the oral field where Tongce Medical is located, it is difficult for the revenue of sports rehabilitation to be supported by a clinic. The type of service determines that the already injured client cannot be too busy, and the benefits that a single rehabilitator can bring are difficult to match with that of a dentist. "A tooth in the dental department is 10 minutes, but a single rehabilitation may take an hour, and the offline rehabilitation therapist delivers ten people a day." Behind Zhao Qingyi's calculation of this account is the difference in human efficacy between sports rehabilitation and oral medicine.
A mature dentist can contribute an average of 2 million yuan to the clinic every year, and the contribution of the "star rehabilitation" to the rehabilitation clinic may also reach this order of magnitude, but it needs to be equipped with at least two rehabilitationists who can independently perform follow-up training, and their remuneration is also a big expense.
Therefore, despite the increasing demand and increasing capital preference, rehabilitation clinics are also growing at an average annual rate of 30%, and the industry still needs to solve the problems of scarcity of talents and difficulty in replication in second- and third-tier cities.
The Gold Diggers are trying to figure out how to solve it. Many sports rehabilitation clinics train their own rehabilitation engineers, but to achieve orders of magnitude growth, it is necessary to break through the delivery ceiling of individual rehabilitation practitioners.
Online remote rehabilitation is the choice of some institutions. By connecting with public hospitals, it becomes part of the sports medicine single-disease treatment package, allowing patients to train themselves at home. However, unattended corrective training is difficult to show results, and it is difficult to bring further charges or customer growth.
In other rehabilitation institutions, when trying to use wearable device sensors to monitor movements, this data can be used as an interactive basis for intelligent systems, and the rehabilitator jointly gives patient guidance. Zhao Qingyi hopes that such a treatment plan can increase the "production capacity" of a single rehabilitation division by 50 times or even higher. But even in the United States, there are no large-scale success stories to learn from whether digital therapies can impress patients to pay.
The same choice, different development paths, who may become the next "medical mao" who is half a step ahead, who will take a wrong step and miss the opportunity, but also need to be revealed after the "blue ocean" of sports medicine.