More AI, + What PE Gets Wrong About IVF

Pre ASRM 2022 IVF Innovation Notes, Part 2

Of all the things I’ve written about the IVF world this year, the most commented upon was the discussion of anti-exploitative pricing models. IVF pricing will change drastically in the coming years, as better data utilization and the use of predictive analytics open the marketplace to a much greater number of patients, with more choices for care and different price points.

Of course you’ve heard this before. What are the specific things to look for?

Watch how the greater number of patients who now have employer-based coverage, often managed coverage, affects the rate of expansion in cycle supply, and whether pricing changes as marketplace reacts.

There is a collision coming between the acceleration in the number of people in the United States who have infertility coverage, and the total capacity of US IVF clinics to handle them.

The same is true for graduating reproductive endocrinology fellows versus retiring REI’s. I will argue what may be an unpopular side of the physician labor force debate at a Society for Reproductive Endocrinology and Infertility (SREI) session on Sunday afternoon, arguing that the limited number of REI’s should not be the bottleneck to patients’ ability to access care.

Now, about private equity (PE.)

First: we need to teach a course in contract negotiation to doctors thinking of selling their practices. This is a bread and butter skill for the PE firms that buy them. No one teaches us the basic principles — such as the concept that term sheets are the start of a negotiation, not take-it-or-leave-it offers.

Or that every single line in the agreement is open to negotiation, and that negotiation includes the ability to politely and cheerfully walk away, up to the moment that pen hits paper.

As more PE firms bid for IVF practices, it’s important to know which have a true knowledge of IVF, and which are applying a generic outpatient medical practice models to their assumptions.

IVF clinics are not just one more version of dermatology clinics or dental practices, businesses where procedure dollar divided by aggregate patient throughput can be calculated and maximized, and any increase in resulting increase in profits can be realized within a relatively short period of time by selling the practice to someone else. Failure to factor in how changes in operations affect pregnancy rates blows up the private equity model — something that some of the PE firms understand well and some, well, don’t.

Similarly, some firms get that, unlike other healthcare models that make attractive PE acquisition candidates, the IVF marketplace is immature — a lot more patients are outside the system than are being treated. The greatest business opportunity in IVF is expanding the greater market, not in consolidating the existing one (although if that consolidation includes propagation of best practices and survival bias for those clinics and networks that have the best outcomes there’s nothing wrong with that either, _as long as it does not prevent the emergence of alternatives for the currently unserved.)

As my freshman economics professor at Penn said: you can no more ignore the laws of supply and demand than you can ignore the laws of gravity.

See you in Anaheim!

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David Sable

bio fund manager, Columbia prof, ex-reproductive endocrinologist, roadie for @PriyaMayadas