The great thing in this world is not so much where we stand, as in what direction we are moving.
—Oliver Wendell Holmes
This year marks my thirtieth as a healthcare appraiser and the twentieth anniversary of Health Capital Consultants (HCC), the consulting firm I started in 1993. During that period, I've witnessed and experienced unprecedented change in both the healthcare industry and the valuation profession, as described in the following sections.
THE CHANGING HEALTHCARE INDUSTRY PARADIGM: THE CORPORATIZATION OF MEDICINE
The corporatization of medicine and the rise of for-profit healthcare have replaced the cottage industry of Marcus Welby–physician practices and the small community hospitals that were prevalent at the start of my career. The last three decades have seen the accelerated transformation of the medical professions into U.S. healthcare service industry enterprises, whereby healthcare services have been unitized, protocolized, and homogenized, in order to facilitate their sale in the market, just as if they were any other fungible market commodity, little differentiated from soybeans and pork bellies. This new healthcare delivery paradigm has accelerated alongside the corporatization of medicine, as demonstrated by the increase in large hospital systems; the retreat from private practice of medicine to employed physicians; and the consolidation of payors by large, for-profit health insurance firms.