Recent studies suggest that multiple private equity (PE) investors have shown increased interest in the cardiology space in the United States. As the population in the US is aging and becoming more obese, which makes them prone to cardiovascular diseases, the need for cardiologists will increase. According to the US Census Bureau in 2022, more than 56 million adults above the age of 65 live in the US. This accounts for 16.9% of the nation’s population.
By 2030, it is projected that there will be more than 73.1 million older adults. That means more than 1 in 5 people will be of retirement age.Nationally, 41.9% of adults have obesity, and obesity is estimated to increase US healthcare spending by $170 billion annually. The culmination of these health stats portends a growing need for cardiology medical care. According to IBISWorld, the cardiology industry’s market size, measured by revenue, will be $54.1 billion in 2023, a considerable market segment for PE to focus on.
This increase in demand for cardiologists is likely to surpass the number of cardiologists practicing in the US, pointing to a looming shortage of specialists. Additionally, cardiology is the most profitable specialty of medicine in the US. According to a survey conducted by Merritt Hawkins, cardiovascular surgeons, and invasive cardiologists generate, on average, $3.5 to $3.7 million per physician, in hospital revenues per year. Moreover, there has been a significant move in cardiology procedures from inpatient to outpatient settings, including office-based laboratories and ambulatory surgery centers.
Smaller groups of cardiologists are unlikely to have access to the capital necessary to grow organically, whether it be the recruitment of younger physicians, investment in imaging technology, such as nuclear medicine and ultrasound, investment in Office Based Labs (OBLs) and Ambulatory Surgery Centres (ASCs) or acquisition of sophisticated electronic medical record systems. Private investors bring the required capital and aggregate these smaller groups into larger platforms and position them for growth.
But why are these investors investing more in cardiology?
1. Significant Addressable Market
About 659,000 people in the United States die from heart disease each year, which is 1 in every 4 deaths according to the CDC (Centres for Disease Control and Prevention). The percutaneous coronary intervention (PCI) market is estimated at 900,000 cases annually, with Medicare payments of $10 billion. There is a high demand for cardiologists, as approximately only 22,000 cardiologists are active in the US.
2. Growing and Aging Population
The demand for cardiovascular services continues to grow, driven by an increasing prevalence of cardiovascular diseases and an aging population. The direct cost of cardiovascular services in the US is estimated to exceed $800 billion by 2030. 20% of the population will be 65 years or older by 2030 and the number of individuals that are 85 years or older is estimated to triple by 2050.
3. Significant Industry Fragmentation
Cardiology groups predominantly consist of 1-5 provider practices with roughly 44% of practices having only 1 provider. Cardiology groups have struggled to differentiate and also adapt to the changing healthcare market. Private equity-backed platforms seek to provide shared back-office resources across independent practices to leverage economies of scale while providing capital for the growth of these practices.
4. Meaningful Structural Change in Employment
More than 70% of cardiologists are currently employed by health systems and this number is likely to decrease as more cardiologists return to the outpatient setting for autonomy and enhanced income opportunities. Cardiology practices owned by health systems are progressively evaluating the opportunity to leave and open independent ASCs and community-based practices.
5. Shift Towards Value-Based Care
Relevant to other areas of specialty medicine, quality cardiology practices will be uniquely positioned to benefit from an industry shift towards value-based care given the opportunity to holistically manage patient care and outcomes while reducing the number of patients needing inpatient care.
Acquisition in cardiology in the year 2022
What are Investors Saying?
Lisa Earnhardt, Abbott’s executive vice president of medical devices, February 2023:
“The acquisition of Cardiovascular Systems, Inc. (CSI) will add new, complementary technologies to Abbott’s leading vascular device offerings.”
Samir Qureshi, Viper’s vice president, January 2023:
“We have been watching this area for a couple of years and feel the time is perfect to bring our experience to this exciting space.”
Dave Alpern, founding partner of Varsity Healthcare Partners, an investor in Partners First Cardiology, January 2022:
“Cardiology is a ripe category for investment. First, it’s a big space – 30,000-plus licensed cardiology providers in the U.S., where the hospital systems have been the only source of capital in cardiovascular medicine and currently roughly 70% of that population is employed by a hospital. Secondly, the secular trends in the cardiology/cardiovascular space are just undeniably good, along with what feels like sustainable Medicare support for reimbursement of cardiac interventions in the ambulatory environment. There’s a strong investment thesis there.”
- AstraZeneca has announced its plans to acquire US-based biopharmaceutical company, CinCor, in a $1.8 billion deal, signaling the company’s interest in renal and cardiovascular therapies by the end of 2023.
On the Horizon
According to the American Heart Association, every 40 seconds someone in the US has a stroke. In the US approximately 605,000 new heart attacks and 200,000 recurrent heart attacks occur in a year. The National Institutes of Health spent more than $1.5 billion on heart disease research in 2021 and researchers expect that cardiovascular disease costs will rise to $749 billion by 2035.
The growth prospects are apparently appealing to PE investors and we expect to see significant transaction activity in this space.