The number of patients has surged, many hospitals and clinics have been intensively landed, has the spring of private medical care come?

In the past three months, private medical care has swept away the haze of the closure of many outpatient clinics in the second half of the year, the wave of new crown infection has brought a large number of patients, and the industry has ushered in the first peak of the epidemic in three years.

As if a tacit agreement has been reached, since November 2022, a number of well-known medical institutions in the industry have intensively landed new projects.

In November 2022, the Beijing clinic of Zhuozheng Medical and the Suzhou clinic of Jiahui Medical were opened one after another.

In December, UFH's new campus in Beijing and Shanghai Yaoying Hospital, the first hospital of Yaoying Medical, were also fully opened.

In January 2023, Guangzhou Zhuozheng Youzhi Hospital and Chengdu Tianfu New Area Gulian Hetai Rehabilitation Hospital were also opened one after another. After the holiday, Yaoying Medical's Tianshan Outpatient Department will be put into operation, and the branch acquired by Shanghai United Family in Jing'an District will be officially renamed.

Almost all of the newly landed projects have caught up with the peak of this round of new crown infections, and they have been overcrowded as soon as they opened, and the number of consultations has doubled, far exceeding the expectations of managers and investors.

The liberalization of policies and the peak of patients have undoubtedly injected a shot in the arm for private medical care. When the peak of infection in first-tier cities such as Beijing, Shanghai, Guangzhou and Shenzhen has passed, and the number of patients has returned, private medical practitioners have a more realistic picture of the new year.

"Hopefully, the following year will recover the losses of 2022";

"Looking forward to the new year, the long-delayed new hospitals and clinics can be put on the agenda and land as soon as possible;

"I hope that in 2023, we can stabilize and adjust the structure"... So says private hospital administrators.

The private medical industry is showing signs of recovery, grasping the tail of new crown recovery demand, and investment transactions will be more active in the new year.

UFH stockpiled P drugs in advance, and Jiahui's emergency room volume increased fivefold

The situation of hospitals affected by the peak of new coronavirus infection is similar, with United Family being the most prominent.

On weekdays, UFH's overall annual outpatient volume is approximately 1.4 million. However, since November 2022, nearly 40,000 fever clinics and emergency departments have been received, and the number of patients has increased by more than 10 times.

Medical staff in various departments support emergency departments at UFH, and doctors in surgery, orthopedics, and ENT departments receive fever patients.

Zeng Ying, managing director of New Frontier Group and chief operating officer of United Family Healthcare, told Eight Points Health, "United Family has triaged internally. Moderate and severe patients will be treated by emergency doctors and ICU doctors. The mild case is the physician. Doctors in other departments mainly accept patients with mild symptoms. ”

In December 2022, at the peak of new crown infections, UFH could prescribe the new crown oral drug Paxlovid (commonly known as "P drug") to attract attention.

Zeng Ying said that at the end of November, he judged that there would be an influx of patients with more multi-disease in the future, and immediately purchased a large number of ventilators and high-flow oxygen inhalation equipment for the hospital ICU, and at the same time "communicated very closely" with Pfizer and purchased a large number of new crown oral drug Paxlovid.

Initially, the earliest batch of P drugs purchased by UFH had a very short expiration date, and it will expire in January and February 2023. "This medicine is very expensive, the purchase of 1,000 boxes of medicine is millions of yuan, if there is no patient needs, the loss will be very large." Zeng Ying said.

"At that time, I took a big risk, I didn't have a bottom in my heart, and I prepared for the worst." Zeng Ying said, "It is used as a guarantee and benefit for employees, to prepare employees and patients, not to invest." If it ends up on our hands, we recognize it. ”

"At that time, there were many patients who came to United Family to prescribe drugs, cancer patients, and patients with underlying diseases. Most of the patients who prescribed the drug were over 65 years old to get the medicine, which really helped many people. Zeng Ying said, "We still have some urgent inventory on our hands, and they will arrive one after another, dynamically adjusting according to the current outpatient volume and drug prescription speed." ”

For Yaoying Medical, the first hospital experienced the impact of the peak of new crown infections when it opened. On December 9, the hospital clinic opened. On December 12, the inpatient department officially opened, and within a week it was full of patients. In its two weeks of opening, the hospital has seen more than 1,500 patients, more than 50% of whom are elderly patients.

In fact, the opening of Shadow Hospital was originally planned to open in mid-2022, but it has been postponed until now due to the impact of the epidemic. In the 6 years since its establishment, Yaoying Medical has 8 outpatient departments, and the reason for establishing the hospital is to undertake the needs of patients for surgery and hospitalization, and provide patients with a complete closed loop of medical services. And these require complete staffing, department settings, facilities and equipment, etc., all of which must be achieved through hospitals.

At the peak of the new crown infection, Shanghai Jiahui International Hospital, a subsidiary of Jiahui Medical, was also affected. Dean Xiang Naiqiang said that the number of emergency department visits and online consultations in general medicine in December was 5 times that of usual, the number of pediatric and respiratory medicine patients increased to 2~3 times, and the ICU and inpatient department beds were completely occupied.

While ensuring the basic medication of patients as much as possible, Shanghai Jiahui International Hospital also purchased the new crown treatment drug Paxlovid in the early stage of policy liberalization, which is mainly used for adult new crown patients with high-risk factors for progression to severe disease, but the purchase volume is not large. Paxlovid was purchased in large quantities from all over the world, and when the supply was at its tightest, "it also happened when there were only 3 or 4 boxes left in the entire hospital, and in this case, we will give priority to the needs of cancer patients and hospitalized patients." ”

"The new crown specific drug is not suitable for everyone, so we will be more cautious when prescribing, tumor patients, patients with chronic diseases, older people and antigen or nucleic acid test positive, we will provide drugs to these patients." Xiang Naiqiang said.

After the volume of diagnosis and treatment returns, what is the next step

Shanghai Jiahui International Hospital has been open for 5 years, and the number of patients has gradually increased before the epidemic. This peak of new crown infection suddenly brought a large number of patients, especially elderly patients and critically ill patients, although it has been under great pressure from the operational level, but it has also increased the influence of Jiahui Medical, and Xiang Naiqiang hopes to retain this group of patients in the future.

"For many patients, they may have heard of Jiahui before December, but they may not come to Jiahui. However, in April ~ May and December this year, many patients received Jiahui's experience and treatment, and most of them were still very recognized by Jiahui. Xiang Naiqiang said. If they still need it, we can provide pneumonia and myocarditis screening services, post-Yangkang exercise guidance, TCM conditioning and rehabilitation treatment, and pediatrics have also opened a follow-up clinic for children's new crown infection. ”

In November 2022, Jiahui Medical Suzhou Clinic opened. Xiang Naiqiang said that in fact, the Suzhou clinic has been on the agenda in 2021, but it has to be postponed due to the epidemic. According to the plan, Beijing Jiahui International Hospital will start construction this year, which is planned to be a "tertiary general hospital with a total investment of not less than 10 billion yuan", which is planned to be completed and put into operation in 2026.

"The operational difficulties caused by the epidemic can be imagined for medical institutions, especially private medical institutions." Pan Jing, a senior professional manager of medical operation management, said that since 2019, she has participated in the preparation and cooperative operation and management of 3 specialist medical service projects and 1 general practice clinic.

One of the 1,400-square-meter specialist outpatient clinics with day surgery officially opened in October 2021, and the planned revenue target should reach several million after 12 months of smooth operation. However, "seeing that both doctors and patients were under epidemic control in March ~ May 2022, the operation of the institution was worrying, and then adjusted the budget, discounted the target revenue, and by the end of 2022, the outpatient department tenaciously completed 60% of the original budget." ”

"According to the actual operating capacity, we have only adjusted the revenue budget, but the actual cost has not decreased, including fixed costs such as rent and employee salaries. Although the workload has been reduced in 3 months, the power consumption is a little lower, and the others are not low. Pan Jing said.

After the epidemic was released, Pan Jing faced some decision-making difficulties.

In terms of operation, the first thing is whether to buy specialized equipment, such as ventilators and other rescue equipment. "Basic rescue equipment in clinics or outpatient clinics is standard with permission to set, and the utilization rate is extremely low, and there is no planned output. Only inspection equipment and surgical treatment equipment can estimate the input and output. Therefore, the procurement of rescue equipment must be cautious, and there is no need to blindly prepare for the unknowable accidents in the future. For management, this is a matter of mastering a degree, because equipment input is a fixed asset, and even if it is not used, there are depreciation and maintenance costs. ”

Pan Jing said that including the tight P drug this time, the clinic finally entered 20+ boxes, or charged a reasonable fee according to the pricing principle of the drug.

Like Pan Jing, many private hospital managers want to introduce P drugs, but they are worried about smashing them in their hands. An industry insider said, "Even if we have medicine in our hands for others to take, the seriously ill (patient) does not dare to accept it." Therefore, even if the temporary surge in patients can turn us over or flatten, medical institutions should still operate normally in the future. ”

From the perspective of hospital operations, the sudden increase in patient volume is hardly a good thing. The hospital needs to operate for a long time, and the time to recoup the investment is ten years, and the sudden increase in patients is actually disrupting the original operation order of the hospital. After the number of patients returns to normal, what is the next step for private medical care is a problem.

Hangzhou Gulian Xiqiao Rehabilitation Hospital is a secondary rehabilitation hospital. During the peak of this round of new crown infections, the number of ICU beds in the hospital has increased from 42 to more than 60, and the patients are almost all elderly people, all of whom need to be on ventilators. Now that the situation has been greatly alleviated, Executive Director He Zhicheng told Eight Points that although the ICU is still full, patients can be removed from the ventilator one after another.

For this year's business expectations, He Zhicheng believes that pulmonary rehabilitation is a development direction, and he is recruiting a director of the respiratory department, hoping to drive the development of the pulmonary rehabilitation department.

"After the surge in the number of new crown cases this year, a large number of household oxygen concentrators are out of stock, indicating that the demand for patients is increasing. After the oxygen generator was out of stock, everyone took oxygen at home. If these patients can be attracted to the hospital, through a series of standards, norms, professional clinical and rehabilitation treatment, seriously and solidly, (patients) should definitely have. ”

What supports Ho's judgment is not only the new crown virus infection, but also the large number of patients with chronic lung diseases such as COPD, emphysema, and asthma. These patients are easy to aggravate their original condition after being infected with the new crown, but the usual cognition of patients is "really not good, go to the hospital to take oxygen, infusion and control it". He believes that if acute symptoms and complications can be alleviated and controlled through standardized rehabilitation treatment, such as breathing and exercise training, "the quality of life will be improved." ”

The special departments of Xiqiao Rehabilitation Hospital are intensive rehabilitation and neurorehabilitation, and patients are mainly referred from higher level hospitals, and some are from community hospitals. For Ho Zhicheng, the decision to do pulmonary rehabilitation was a natural choice, and the hospital has established a referral channel with local community hospitals, "Before we dealt with the community mainly with patients with elderly people, high blood pressure, and stroke sequelae, it was normal to expand to respiratory diseases such as COPD. ”

Xiqiao Rehabilitation Hospital was acquired by Gulian Medical in 2021, and He Zhicheng was transferred as the president from June last year. He said that the main work of this year is standardization and specialization. The hospital was originally mainly elderly patients who were bedridden for a long time, which was essentially equivalent to a nursing home. This year, through transfer and other means, the hospital has freed up half of the beds, and gradually strengthened the admission of rehabilitation patients such as neurology, brain surgery, and orthopedics.

In addition to pulmonary rehabilitation, Ho Zhicheng also hopes to do sports rehabilitation. Another Hangzhou rehabilitation hospital under Gulian Medical will be transformed into a general hospital this year and will open an orthopedic ward. He Zhicheng planned to connect with them, "They open the operation, we do rehabilitation." After the surgery, the doctor came to me for consultation and instructed the rehabilitation physician and rehabilitation therapist to carry out musculoskeletal and joint rehabilitation, which is a combination of the three. ”

This is equivalent to a closed loop of service, and there is no need to recruit a large number of people, "mainly to do professional and standardized." ”

In 2023, cautious and optimistic

After this round of new crown infection peak, Shadow Medical is very confident in 2023, and plans to launch more new projects this year, such as orthopedic surgery, ERAS rapid recovery, sleep center, cardiac ablation treatment, and VIP physical examination center.

Zhuo Guangsong, CEO of Shanghai Dunfu Medical Group, expects that this year's operation can return to the level of 2021 if new business is not considered. He told Eight Points that "as far as the stock business is concerned, higher expectations are not." Patients' medical habits, especially the local medical habits of non-local patients, have been cultivated after three years of the epidemic, just like it takes a while to recover after the change of supply chain. ”

Dunfu Medical has one hospital in Shanghai and one in Tianjin, and one outpatient department in Guangzhou. Zhuo Guangsong said that Dunfu Medical is differentiated and dislocated in competition, "We mainly do accurate screening and accurate triage of cancer patients before diagnosis, new special drug services and surgical support during diagnosis, and tumor rehabilitation after diagnosis, all of which complement public hospitals." ”

Zhuo Guangsong advocates looking at private healthcare from the perspective of more driving factors, such as potential patient needs, payment methods, digital transformation and pharmaceutical policies. "Because talent, capital, itself is dynamic and fluid, but also passive and lagging. Private medical care itself has a good development trend, and talents and funds will follow. ”

Zhuozheng Medical and Yaoying Medical are opened hospitals by chain outpatient clinics, hoping to pursue business upgrading and economies of scale.

As Zhu Yan, vice president of Zhuozheng Medical, said, "Many departments are inseparable from the support of the hospital platform, especially those like partial surgery, such as surgery, otolaryngology, obstetrics and gynecology, and gastroenterology." We have a place to undertake the surgical needs of these outpatient businesses. Our hospital is mainly about supporting the surgical business. ”

Industry insiders believe that the construction of hospitals in chain outpatient clinics may be the future trend, "outpatient services are limited, fever patients can not be accepted, what should I do?" For some institutions, the pandemic is, in a sense, an accelerator for building hospitals. ”

Regarding the post-pandemic development strategy, UFH Chief Operating Officer Zeng Ying said that the overall strategy was set several years ago to promote the construction of specialties and develop women's health, children's health, interventional and minimally invasive surgery and oncology businesses based on comprehensive medical capabilities.

It is understood that orthopedics, gastroenterology, cardiology and other specialties have accounted for more than 50% of UFH's business volume, while obstetrics and pediatrics, the strong departments of UFH, "actually account for the proportion of business volume, obstetrics does not exceed 15%, pediatrics does not exceed 10%."

UFH has 4 campuses in Beijing and 3 in Shanghai. Taking Beijing as an example, during the epidemic, severe patients can be admitted to the main hospital, mild and pediatric patients can be referred to Jingbei Women's and Children's Hospital, the Dongcheng campus is mainly for tumor patients, and the rehabilitation hospital provides inpatient services for elderly patients. The multi-hospital area has played the function of graded diagnosis and treatment.

Zeng Ying said, "In recent years, we have proposed the '1+X' strategy internally, with a general hospital in each city and multiple specialized hospitals built at the same time. This year, UFH is considering replicating the model in Shenzhen and Guangzhou and expanding its branches. ”

In 2022, UFH also opened its Beijing United Family Dongcheng Campus, Shenzhen United Family Hospital, and Shanghai United Family Jing'an Campus, with a total investment of about 5 billion yuan. It was also the largest investment year since UFH's founding.

The biggest problem faced by the vast majority of private hospital leaders is the brain drain. Li Dong (pseudonym), a director of a private hospital in a county-level city in central province, told Eight Points Jianwen that since the epidemic, the city hospital has interviewed all the business directors in private hospitals except the president and secretary.

The hospital ranks second in terms of business volume among local medical institutions, second only to the local municipal hospital. For more than a decade after its establishment, the hospital maintained an annual business growth rate of about 20%, until the epidemic began and the growth stagnated. In previous years, pediatrics could accommodate more than 100 beds, but in 2022, pediatrics will basically have less than 20 beds.

"Revenue has fallen significantly, but labor costs have not fallen." The new crown epidemic has led to a sharp decline in hospital revenue, and it is impossible to compete with county-level public hospitals in terms of salary and treatment.

In comparison, it is not difficult for medical staff in private hospitals to make a choice. The reason is that medical insurance funds and anti-epidemic funds are distributed and allocated by the local medical community, while all local private hospitals are excluded from the county close-knit medical community. The basis and indicators of the distribution are not clear, nor are they open and transparent, and the gap is large. After Li Dong asked the person in charge of the Municipal Health Commission, the medical staff of the private hospitals to support the frontline epidemic prevention received anti-epidemic subsidies. At present, only that group of health workers receive subsidies.

Since December, the hospital has been busy receiving patients infected with the new crown. Lacking funds to temporarily purchase equipment, Li Dong borrowed ventilators and other equipment from well-connected specialized private hospitals to survive the peak of infection.

"At present, the core staff is still stable for the time being, but some young doctors and nurses, they still prefer to go to public hospitals." Li Dong said that during this time, medical staff were busy receiving patients and had no time to take care of other things, "This is definitely not the case after the beginning of spring." ”

Li Dong believes that the strategy of "differentiated competition" for private hospitals is actually not valid. Especially in private general hospitals at the prefecture-level city and even county level, the vast majority of patients are locals, mainly the elderly, followed by children. It is difficult to develop specialties and differentiate competition.

"If a private hospital says that it wants to occupy this piece through differentiated competition, it is only temporary. It's just that this market is not big enough, public hospitals have not yet seen it, or a certain director of public hospitals has not kept up. In a large public hospital, the head of the department or the director, if he has this idea, he will soon be able to mobilize resources to suppress you. ”

"Based on a certain region, based on the business traditions of some hospitals themselves, or the development concept of leading in certain specialties, it is not ruled out that some private hospitals will do well." However, for the private medical care as a whole, Li Dong is pessimistic, he believes that on the one hand, it is difficult for a large number of high-quality doctors to leave the system.

On the other hand, the state is promoting medical insurance DRG/DIP payment, making hospitals and other business indicators transparent, there is no high profit to support the rise in medical labor costs, the treatment of medical staff is basically solidified, and it is impossible to attract a large number of high-level medical talents with high salaries.

"The development of the hospital is not a single person, there must be the cooperation of the team, and there must be the support of other disciplines." If the leaders of various disciplines are hired with high salaries, it will definitely cause problems in the cost management of your hospital. Li Dong said.

Xi Xiangyu丨Written by

Shi Chenjin 丨Responsible editor

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