Healthcare Staffing

With millions Americans unemployed and left without healthcare, demand for medical services has declined. To prepare for an expected 2% drop in revenue for the third quarter of 2009, hospitals and other healthcare providers are cutting back medical staff and are covering shifts with part time nurses internally. As a result, the healthcare staffing industry is experiencing falling demand for services. However, negative revenue growth should be short-lived with potential healthcare reforms in the making. Assuming the Obama Administration’s healthcare reform bill provides more reasonable healthcare to a significant portion of the 46 million uninsured and 26 million under insured, hospital rooms and other providers will initially be flooded with patients who had been holding off on medical treatment. To meet staffing requirements quickly, healthcare providers will outsource to staffing firms to ensure all shifts are covered, yet still avoid paying the benefits of a full-time employee. We expect 4.5% revenue growth in the fourth quarter of 2009 followed by 3.2% growth for all of 2010.

Despite revenue growth starting in the fourth quarter of 2009, the bill-pay spread margins will not increase until the medical staff shortage begins to intensify again. The return of the medical staffing shortage and increased patient flow signal good news for healthcare staffing companies, as they will be in high demand once unemployment falls back around 8% in the first quarter of 2011.

With higher valuations expected once patient flow increases, M&A activity should pick up in the near future. Buyers will be looking to expand coverage and capacity in preparation for an expected rise in demand for healthcare staffing. In particular, middle market buyers should be looking at boutique specialty medical staffing firms, while valuations are low in order to expand their scope and geographic coverage. Once cash flows start to pick up, middle market buyers should be well positioned to finance acquisitions, as the current industry leverage ratios are a modest 1.9 on depressed earnings.