巴克莱-美股-医疗保健行业-美国医师调查：COVID-19造成跨科室之间的流动降低-2020.3.30-38页.pdf

Equity Research 30 March 2020 CORE Barclays Capital Inc.and/or one of its affiliates does and seeks to do business with companies covered in its research reports.As a result,investors should be aware that the firm may have a conflict of interest that could affect the objectivity of this report.Investors should consider this report as only a single factor in making their investment decision.This research report has been prepared in whole or in part by equity research analysts based outside the US who are not registered/qualified as research analysts with FINRA.PLEASE SEE ANALYST CERTIFICATION(S)AND IMPORTANT DISCLOSURES BEGINNING ON PAGE 30.Restricted-Internal U.S.Healthcare Physician Survey COVID-19 Reduces Office Visits and Procedures Across Multiple Specialties The Barclays Global Healthcare Team surveyed 199 physicians from 41 U.S.states across 13 different sub-specialties including interventional cardiology,cardiology,cardiothoracic surgery,general surgery,orthopedic surgery,pain management,urology,gastroenterology,endocrinology,dermatology,neurology,hemo-oncology,and rheumatology to evaluate the impact of COVID-19 on practice trends particularly office volumes,elective procedures,and prescription patterns.We present the results herein.Survey Context:COVID-19:Gauging the early impact on healthcare utilization Within three months time,the novel coronavirus“COVID-19”has rapidly spread throughout the world.Efforts have been underway to“flatten the curve,”some of which are impacting healthcare utilization trends.Governments,states,and hospitals have cancelled elective procedures in part to avoid potential virus transmissions,as well preserve personal protective equipment(PPE)and hospital bed space.Key survey findings:physician practices feeling significant financial pressure Nearly all physicians reported a significant decline in patient office visits with the average visits being down around 50%.The primary reason behind the declines appear to be patient cancellation of visits.Telehealth appointments are up significantly,but perhaps not enough to offset the decline of in-person visits.Regarding prescriptions,patients are proactively requesting more refills and physicians are willing to write them.Physicians expressed a willingness to write new prescriptions and switch patients to a new drug,even if they did not see a patient in-person.This should bode well for prescriptionsat least in the near term.The majority(72%)of physicians indicated their facilities(hospitals,ASCs,and offices/surgi-centers)implemented policies to cancel elective procedures.This has led to a significant reduction in surgeries.We believe the investment community may underestimate what is likely to be considered elective in this COVID-19 period.In Figure 9,we list the most common elective procedures for each specialty cancelled.The“usual suspects”like knee and hip replacements,arthroscopy,radiofrequency ablation,nerve blocks,spinal fusions,some stenting,etc.,were on the lists.We think the list is greater than some might think and include procedures like valve replacements,some TAVRs,LAA,prevention ICDs,some pacemakers,CABG,peripheral intervention,endoscopies,prostatectomy,SCS,DBS,and more Physicians indicated they believed the length of postponement was(on average)likely to be 8 weeks,but we think that may be a moving target.MedTech Implications:We see MedTech earnings risks ahead These results,coupled with the consideration that the U.S.is not alone and that other countries are seeing similar COVID-19 challenges,show reduced procedures are likely to have a significant impact on MedTech outlooks.Several companies have already preannounced and/or suspended 2020 guidance.We expect more to follow.INDUSTRY UPDATE European Medical Technology&Services POSITIVE Unchanged European Mid Cap Pharmaceuticals POSITIVE Unchanged European Pharmaceuticals POSITIVE Unchanged U.S.Biopharmaceuticals POSITIVE Unchanged U.S.Health Care Services NEUTRAL Unchanged U.S.Life Science Tools&Diagnostics POSITIVE Unchanged U.S.Medical Supplies&Devices NEUTRAL Unchanged U.S.Small&Mid Cap Biotechnology POSITIVE Unchanged U.S.Specialty Pharmaceuticals NEUTRAL Unchanged U.S.Medical Supplies&Devices Kristen Stewart,CFA+1 212 526 6965 BCI,US Josiah Hannon+1 212 526 4155 BCI,US 每日免费获取报告1、每日微信群内分享7+最新重磅报告；2、每日分享当日华尔街日报、金融时报；3、每周分享经济学人4、行研报告均为公开版，权利归原作者所有，起点财经仅分发做内部学习。扫一扫二维码关注公号回复：研究报告加入“起点财经”微信群。Barclays|U.S.Healthcare Physician Survey 30 March 2020 2 BARCLAYS GLOBAL HEALTHCARE CONTACTS U.S.Medical Supplies&Devices Kristen M.Stewart,CFA +1 212-526-6965 BCI,US Josiah Hannon+1 212 526 4155 BCI,US Benjamin Weaver+1 212 526-1961 BCI,US European Medical Technology&Services Hassan Al-Wakeel,CFA+44(0)20 7773 3898 hassan.al- Barclays,UK Blanka Porkolab+44(0)20 3134 4836 Barclays,UK Rohit Rajan+91(0)22 6175 1698 Barclays,UK U.S.Health Care Services Steve Valiquette+1 212 526 5496 BCI,US Andrew Mok,CFA+1 212 526 2687 Andrew.M BCI,US Morgan McCarthy+1 212 526 1168 BCI,US Jonathan Yong+1 212 526 3647 BCI,US U.S.Biopharmaceuticals Carter Gould+1 212 526 0865 BCI,US Andrew Ang+1 212 526 5692 BCI,US Justin Burns+1 212 526 0102 BCI,US U.S.Specialty Pharmaceuticals Balaji Prasad,MD +1 212 526 4160 B BCI,US Ann-Hunter Van Kirk +1 212 526 2279 ann- BCI,US Stephen Ragard,CFA+1 212 526 5080 BCI,US U.S.Small&Mid Cap Biotechnology Gena Wang,PhD,CFA+1 212 526 4252 BCI,US Peter Kim,Ph.D.+1 212 526 2298 BCI,US David Dai+1 212 526 6608 BCI,US U.S.Small&Mid Cap Biotechnology Peter Lawson,DPhil(Oxon)+1 212 526 9445 BCI,US Mitchell Kapoor+1 212 526 5149 BCI,US European Large and Mid-Cap Pharmaceuticals Emmanuel Papadakis,PhD CFA+44(0)20 3134 1246 Barclays,UK Emily Field,CFA+44(0)20 7773 6263 Barclays,UK Jameel Bakhsh,CFA+44(0)20 7116 7038 Barclays,UK Brian Balchin,ACA+44(0)20 3134 0137 Barclays,UK Sidhartha Modi+91(0)22 6175 1326 Barclays,UK U.S.Life Science Tools&Diagnostics Jack Meehan,CFA+1 212 526 3909 BCI,US Andrew Wald+1 212 526 9436 BCI,US Nisarg Shah+1 212 526-3367 BCI,US Barclays|U.S.Healthcare Physician Survey 30 March 2020 3 CONTENTS BARCLAYS GLOBAL HEALTHCARE CONTACTS.2 COVID-19:WITHIN THREE MONTHS,A PANDEMIC.4 Why we conducted this survey.4 KEY FINDINGS OF THE SURVEY.5 Physician Demographics.6 Office Patient Visits Volume Trends.7 Elective Procedures.9 Physicians and Prescription Drug Trends.13 Thoughts Specific to HemOnc.14 Physician Comments on the Impact of COVID-19.15 A FOCUS ON MEDTECH.17 Our View on Each Companys Elective Procedure Exposure.17 MedTech Comments on COVID-19:Conference Takeaways.23 Post Surgeon General Recommendation,Some MedTech“Warnings”;Expect More.25 We see earnings risk for most companies in our universe.28 Our thoughts on the MedTech stocks.28 Barclays|U.S.Healthcare Physician Survey 30 March 2020 4 COVID-19:Within Three Months,a Pandemic Coronaviruses are the second leading cause for the common coldsecond to rhinoviruses.Coronaviruses are“zoonotic,”which means that they can be transmitted between animals and people.The novel coronavirus“COVID-19”is a betacoronavirus,which is a coronavirus that originated in a bat.The gene sequencing determined that it is related to the Middle Eastern Respiratory Syndrome virus(MERS-CoV)and the Severe Acute Respiratory Syndrome virus(SARS-CoV).On December 31,2019,Chinese Health officials informed the World Health Organization that a cluster of 41 patients had pneumonia-like illness.Most of these patients were connected to the a“wet market”called Huanan Seafood Wholesale Market within the city of Wuhan.Chinas first death linked to the novel coronavirus occurred on January 11,2020.The first case outside of China was reported on January 13 in Thailand,but it was a tourist who spent time in Wuhan.The first case in the United States was reported on January 20 in the State of Washington,but was also linked to Wuhan.By January 30,the World Health Organization(WHO)declared the coronavirus 2019-nCoV a“public health emergency of international concern.”On February 14,Europes first death occurred in France,but was a Chinese tourist.By March 9,Italy placed its residents on lockdown.On March 11,the World Health Organization declared COVID-19 outbreak a pandemic and it is rapidly spreading.As of March 29,there are over 700,000 confirmed cases with the most cases(over 140,000)being in the United States.There are over 2,400 deaths in the United States.Efforts are well-underway to“flatten the curve”globally.On March 29,President Trump extended social distancing guidelines to April 30.In the United States,a total of 27 states have issued stay-at-home orders which represent over 225 million Americans.Governments,states,and hospitals have mandated or strongly recommended cancelling elective procedures in part to avoid potential virus transmissions,free up space,and also save on personal protective equipment(PPE).We estimate over 70%of the population is covered by these state wide mandates(see Figure 11 for a full listing).Why we conducted this survey We conducted a survey of physicians across the United States with the goal of assessing the following COVID-19 impacts:Whether patients were cancelling in-person office visits and/or utilizing telehealth services.The potential impact on any prescription drug refills or new prescriptions.To what extent facilities where these physicians work have implemented policies to cancel or postpone elective procedures.Determine what were the most common cancelled/postponed elective procedures amongst the different physician specialties.Coronavirus(COV-19)Source:CDC website Barclays|U.S.Healthcare Physician Survey 30 March 2020 5 Key Findings of the Survey FIGURE 1 Key Survey Findings Survey Topic/Question Key Findings Implications Page start Physician Demographics 199 physicians from 41 states 13 different subspecialties with a weighting(143/199)on those that typically perform medical device interventions Physicians spend 42%of their time in an office-based setting,33%of the time in an academic/teaching hospital,19%in a community-based hospital,5%in an ambulatory surgery center and the remainder in other settings.We believe our survey is well represented across the United States.We included a greater weighting toward specialties that were more focused on medical devices products as we were more interested in the angle of elective procedure trends Page 6 Patient visit volumes Physicians reported a decrease in their in-patient patient visits,but reported an increase in their telehealth appointments.Using the mid-points of the ranges provided,patients visits were down around 52%with some practices down even more.Telehealth appointments were up on average 43%,though we did not establish the baseline level and believe it to be low.Patient cancellations appear to be the primary reason behind the reduced visits.While telehealth appointments were higher,we believe that the increases are not likely enough to offset the number of in-person patient visits.With COVID-19 fears being the driver behind the lower visits,we also believe that it will prevent patients from also seeking treatments in the hospitals as well and patients likely would have cancelled elective procedures irrespective of State and hospital actions.Page 7 Elective procedures A total of 143/199(72%)of physicians indicated that they regularly perform medical procedures in a hospital or ambulatory center which typically includes the use of medical devices.The majority of physicians indicated that their facilities had implemented a policy to cancel/postpone elective procedures.Physicians indicated policies were mostly implemented at hospitals(91%),but also ASCs(84%)and office and small surgi-center(80%).In Figure 9,we list the most common elective procedures that physicians indicated were being cancelled/postponed across all of the specialties.Physicians indicated on average they believed the length of postponement was likely to be 8 weeks.In our view,the survey indicated that the American College of Surgeons and U.S.Surgeon General recommendation on elective procedures as well as individual State Executive Orders to prohibit elective procedures are having an impact.As we noted above,we believe patients would have likely cancelled treatments to avoid going to the hospitals anyway to avoid potential exposure given patient fears.The results give us increased concerns around the revenue risks for our MedTech coverage universe.Page 9 The specific list of procedures identified being cancelled by specialty appears on page 10 Prescription drugs Patients are proactively requests more refills.Physicians expressed they were still willing to write new prescriptions and switch patients to a new drug for existing conditions.Physicians largely would write a prescription even if they did not physically see a patient.Physicians seemed to have a slight concern about patient prescription adherence as it related to COVID-19.There could be some risks to prescription drugs if individuals continue to avoid in-person office visits.That said,the telehealth usage and physician comfort prescribing after a telehealth appointment may mitigate such an impact.At this time,we do not anticipate seeing a significant impact on near-term script trends.We will continue to monitor trends.Page 13 Physician Commentary on COVID-19 Impacting Practice Most physicians noted the significant adverse financial impact that COVID-19 is having on their practice.Some expressed significant impacts and described as devastating.Many noted the increase in telehealth.Many noted the a significant reduction in elective but the expectation of a rebound once COVID-19 passes We will be monitoring the longer term impact of COVID-19 on physician practices and whether COVID-19 pushes more physicians to become hospital employees.Page 15 Source:Barclays Physician COVID-19 Survey Barclays|U.S.Healthcare Physician Survey 30 March 2020 6 Physician Demographics We surveyed a total of 199 physicians across 41 states as shown in Figure 2 and across a number of physician specialties as identified in Figure 3.These physicians have been in practice actively treating patients for an average of 16 years.FIGURE 2 Physician Responses Geographic Distribution Source:Barclays Physician COVID-19 Survey FIGURE 3 Physician Responses by Specialty We had a higher weighting of physician specialties that were more likely to perform medical device interventions as the initial focus of the survey was to evaluate the impact of state executive orders and hospital policies mandating or recommending the cancellation of elective procedures.Source:Barclays Physician COVID-19 Survey n=5n=7n=10n=10n=11n=15n=16n=16n=17n=20n=20n=26n=26051015202530RheumatologyCardiothoracic SurgeryE ndocrinologyGastroenterologyDermatologyCardiologyPain MedicineUrologyNeurologyInterventional CardiologyHaematology-OncologyOrthopaedic SurgeryGeneral SurgeryNumber of PhysiciansBarclays|U.S.Healthcare Physician Survey 30 March 2020 7 FIGURE 4 How much time do you spend in the following set