47% of active physicians in the United States were age 55 or older.
Market
US health care spending reached $4.3t in 2021 or $13k per person.
Spending for hospital care services reached $1.3t. Spending on physician and clinical services reached $865b. Retail prescription drug spending reached $378b.
Provider Margins, Costs, Challenges
Hospital margins are razor thin and volatile.
Outpatient settings drive revenue.
Effectively estimating, communicating, and collecting balances from patients who are underinsured or likely to have large out-of-pocket liabilities is a top priority for providers.
47% of physicians reported they are burned out.
53% of hospitals were projected to have negative margins through 2022.
41% of providers relied on external funding to remain open.
The average deductible for single coverage is $1,763, up 61% since 2012.
38% of consumers put off treatment due to costs.
71% of payers reported calls due to member confusion and payment questions as a top challenge.
72% of providers receive paper checks from payers.
Health care payers and providers in the United States spend about $496 billion on billing and insurance-related (BIR) costs annually.
The US spends about twice as much as needed on the administration of health care.
As costs rise, providers are doubling down on software that boosts revenue while reducing costs, leveraging digital front door solutions/patient scheduling applications to increase volume while reducing back-office costs.
Labor, Automation
Labor expenses per patient are up more than one-third from pre-pandemic levels.
31% of providers spent more than budgeted or typical on training and hiring new staff.
18% of providers reduced the hours for patient visits due to staffing shortages.
78% of providers primarily collect from patients with paper and manual processes.
74% of providers say it takes 2+ statements to collect a patient balance in full.
$187 billion has been saved annually due to previous automation efforts in healthcare administrative transactions.
Payers could save between $80 billion and $110 billion in the next five years with AI.
Nearly $25 billion can be saved annually by further automating administrative transactions.
Half of a primary care physician’s day is spent on EHR interaction, including billing, coding, ordering, and communication.
Some 45% of providers accelerated software investment over the past year, with only 10% decelerating their spending.
Software is now a top five strategic priority for nearly 80% of provider organizations and a top three priority for almost 40%.
Providers cite revenue cycle management (RCM), security and privacy, patient intake/flow, clinical systems, and telehealth as the most strategically important categories for software investment.
Interoperability and electronic medical record integration are top pain points for providers with their existing third-party tech stacks.
Patient experience
Patients now bear a higher share of the overall financial burden than ever before.
68% of consumers received a statement more than a month after service.
71% of consumers are confused by their medical bills.
76% of consumers received an unexpected medical bill.
92% of consumers say convenience is an important factor when choosing a primary care provider.
77% of consumers now expect virtual and self-service options to be offered.
85% of consumers want to pay all of their medical bills in one place.
Surgical centers, Outpatient shift
ASC (Ambulatory surgical centers) market is projected to grow from $37b in 2021 to $59b by 2028.
Over 6k Medicare-certified ASCs and growing.
Patients continue to seek care away from inpatient settings. Average length of stays at hospitals are down. Patients are shifting to ambulatory settings, with ambulatory surgery centers and outpatient operating room volumes increasing.
