行业焦点：诊断成像设备维修和零件更换

Private Equity Interest Intensifies for Businesses that Service MedicalEquipment and Replace Parts The diagnostic imaging and biomedical equipment ecosystem is a rapidly growing market with constant innovationcreating the need for businesses that service (maintain, repair, refurbish) that equipment and replace parts. Historically, Original Equipment Manufacturers (“OEM”) have dominated the resources and expertise to serviceequipment and replace parts, but for several reasons outlined here, Independent Services Organizations (“ISO”) havegained a foothold among cost-conscious users who like ISO’s more customer-centric servicing options. As businesses in the ISO space have proliferated, strategic and private equity capital has flocked to this fragmented,recession-resistant space. The Cascadia Healthcare team has recent and relevant experience transacting ISO businesses, and understands themarket, value drivers, and industry participants as well as, or better, than any other bank. By virtue of ourexperiences, our team has developed a clear vision on where the market is heading. The industry is changing rapidly,and we’re at the forefront of the activity with this new wave of consolidation and value creation. Tailwinds for Imaging Utilization Growth of Diagnostic Imaging Procedures Demographic Trends:Aging population increases utilization ofimagingper year providing utilization visibility for imaging;simultaneously,increased life expectancy increases lifetimeutilization per patient supporting long-term growth of the sector Payor Pressures/Focus:Healthcare payors (both governmentaland commercial) are increasingly focusing on preventive care(including diagnostic testing) as they seek to bend the cost curveand promote value-based care Evolution of the Equipment User Hospitals have traditionally dominated the utilization of imagingtesting; however, several factors have caused imaging to migratefrom the hospital to freestanding imaging centers: Diagnostic Imaging Centers Quick Facts 10,000+US Diagnostic Imaging Centers(~6,000 freestanding & ~4,000 aligned) •Hospital margin compression generally and governmental(and commercial) payor pressure particularly have pushedlow- and medium-acuity imaging work out of the hospitaland into freestanding diagnostic imaging centers (alignedor not aligned with a hospital/physician group)•COVID-19 negatively impacted imaging utilization initially,but COVID-19 accelerated the migration of imaging to anoutpatient setting due to patient concerns and facilitycapacity•Increasing technological complexity of equipment hasgiven imaging centers (which often specialize in certaintypes of testing) a comparative advantage over traditionalhospital-based settings ~$23bnDiagnostic Center Industry 11%Cumul. 2020-22 IP vs OPReimbursement Cut for Radiology Source: Organisation for Economic Co-operation andDevelopment, Centers for Medicare and MedicaidServices, Grand View Research Hospitals will continue to be important users of diagnostic equipment, but the trend toward procedures performedin imaging centers is here to stay. The Legacy Model of Servicing Equipment & Replacing Parts •Hospitals (the historical user of equipment) traditionally have large contracts with Original EquipmentManufacturers (“OEM”) who manufacture the equipment, as well as other medical devices, supplies, andequipment that hospitals use•For contract, legal, liability, and other reasons, hospitals would default to the repair work and replacementparts offered by the OEM’s – these arrangements are often high cost, high minimum time commitments, andbureaucratic with respect to customer service•With the migration of imaging from hospitals to imaging centers, significant governmental action supporting“right to repair” (i.e., the user’s right to have repair work performed outside the OEM’s repair network), andthe increasing sophistication of independent services organizations (“ISO”), businesses that offer equipmentservicing or parts repair have proliferated across the US The New Model: Independent Services Organizations •ISO’s consist of highly trained engineering teams, typically with long-term customer contracts that offer high-touch, high-value customer service•An increasingly popular offering by ISO’s is Healthcare Technology Management (“HTM”), a managementservices arrangement that serves as a one-stop shop for many imaging centers•The geographic coverage of many ISO’s is not tightly confined, but the primary service areas of many ISO’s isfairly limited, leading to a fragmented market Capital Markets Overview Despite a spate of recent deals, the space for equipment servicing and parts replacement is still highly fragmentedwith rollup or consolidation opportunities. This fragmentation, combined with recession-resistant margins and high technical expertise required to run thesebusinesses, has attracted significant amounts of strategic and private equity capital. Buyers of servicing and parts replacement fal