Fusões e aquisições na saúde: prepare-se, o próximo a ser comprado pode ser você

Primeira parte da matéria sobre a palestra “Maturidade da gestão hospitalar e transformação digital”, do consultor Roberto Gordilho 

Assista ao vídeo desta palestra no canal do AnestEdu

Desde a promulgação da Lei 13.097/2015, que liberou a participação de empresas de capital estrangeiro em atividades de assistência à saúde e em atividades de apoio, as fusões e aquisições na saúde entre hospitais e laboratórios de análises clínicas aqueceram bastante no Brasil. Nesta semana, foi anunciado que o Hospital Renascença, no Centro de Osasco (SP), está à venda, e entre os possíveis compradores estão a Amil, controlada pela UnitedHealth, e a Rede d’Or, da família Moll, do fundo soberano de Cingapura (GIC) e da gestora de private equity Carlyle. Em junho, o Grupo NotreDame Intermédica (GNDI), que deixou o Hospital Renascença, que arrendava, anunciou a assinatura da intenção de compra do Grupo Samed Saúde, tradicional empresa do Alto do Tietê, em São Paulo, pioneira em planos de saúde na região. (Fontes: Estado de S. Paulo e Valor Econômico) 

No ano passado, o país viu 50 operações de fusões e aquisições na saúde e em 2016 viu 31 operações, segundo a consultoria KPMG. Esses processos de consolidação na saúde são mais uma realidade que, gostemos ou não, está aí para que nos adaptemos, e com eles virão mudanças que irão impactar todo o sistema. “As grandes redes estão comprando tudo o que é bom”, declarou o consultor Roberto Gordilho na palestra “Maturidade da gestão hospitalar e transformação digital”, no 8° AnestEdu. Segundo ele, agora que esses grupos adquiriram as nossas “joias da coroa”, ou seja, grandes hospitais e operadoras brasileiros, irão partir para os menores. O Renascença de Osasco, por exemplo, tem 77 leitos e foi fundado pelo médico Faisal Cury. 

Gordilho disse que os grandes consolidadores Amil, Rede d’Or e NotreDame Intermédica adquiriram pelo menos dezoito operações desde janeiro de 2015. Para ele, uma nova onda de fusões e aquisições deve incluir operações de médio e pequeno porte, já que boa parte das grandes operações no Brasil foi de alguma forma consolidada em grandes grupos nos últimos dez anos. Inicialmente serão compradas as operações especializadas. Quando estas acabarem, será a vez das clínicas e dos hospitais menores. 

Segundo o consultor, esses grupos trazem eficiência, não têm compromisso com o passado e chegam fazendo uma pergunta bem simples: por que não pode ser diferente? E mais, não aceitam a resposta “porque sempre foi assim”. “Vão pensar o negócio hospital com equilíbrio entre a gestão empresarial e a gestão clínica, os dois promovendo uma boa gestão para o paciente a para a instituição”, afirmou.

Veja também: Sistema de saúde seguirá existindo, mas você estará dentro? Mudanças estão aí e o 8.º AnestEdu mostra os caminhos

Por que grandes fundos de investimento querem nossas instituições? 

Roberto Gordilho perguntou a dois grandes fundos de investimento o que eles estão vendo em nossas instituições, ou seja, por que estão “nos comprando”, já que, segundo o consultor, todos que trabalham na saúde se queixam de como essa área é o pior negócio do mundo e só faz perder dinheiro. A resposta foi: mercado abundante e fonte pagadora segura. 

Mercado: o Brasil tem aproximadamente 208 milhões de habitantes e, segundo o IBGE (Instituto Brasileiro de Geografia e Estatística), é uma população que vai viver mais e, portanto, envelhecer, ou seja, vai gerar demanda por saúde, prevenção, tratamento e cura. 

Entre 2000 e 2015, o número de pessoas com plano de saúde triplicou: de 15 para 45 milhões. Ainda assim, menos de 25% da população brasileira têm plano de saúde, mas isso significa que há um espaço enorme para crescimento. Para Gordilho, se a crise não atrapalhar e os problema da cadeia forem resolvidos, esse percentual pode dobrar. 

Fonte pagadora: não é necessário negociar com cada paciente que entra no consultório. Negocia-se com vinte, cinquenta operadoras e está resolvido o problema. E as dez maiores operadoras representam 80% do faturamento de qualquer grande hospital. “É consolidado e é seguro”, disse.

Veja também: 8 perguntas da administração ao corpo clínico: o que os gestor hospitalar sempre quis saber e teve coragem de perguntar

Problemas internos: os players atuais 

Segundo Roberto Gordilho, os grandes grupos de investidores também enxergam os problemas quando olham para nós. Veem baixa maturidade de gestão: 

  • Ineficiência 
  • Baixa produtividade
  • Muito desperdício
  • Um setor que não coopera entre si 
  • Baixo poder de negociação com operadoras 
  • Baixo índice de profissionalização 
  • Baixo índice de informatização (apesar de todo mundo ter sistema de gestão informatizado)
  • Um setor que não se conhece 

É por isso que quem trabalha com saúde se queixa, o sofrimento e as perdas são reais. De 8% a 15% do faturamento são perdidos no conjunto de ineficiências que começa na recepção e vai até a saída do paciente. Ou melhor, passa da saída do paciente, quando a conta é fechada. “É uma guia mal preenchida, um material ou medicamento não lançado na conta, um item que se perde no prontuário e faz com que a conta fique um, dois meses no faturamento, sem poder ser enviada à operadora, gerando problema de caixa. Um caminhão de dinheiro, todos os meses, indo pelo ralo”, alertou Gordilho.

Veja também: Como levar seu hospital à excelência: a importância das habilidades não técnicas

E você? Como se preparar para esse futuro que já chegou? 

Nos últimos vinte anos, segundo Roberto Gordilho, os hospitais compraram sistemas informatizados de gestão achando que estavam comprando gestão: “Mas maturidade de gestão é muito mais do que estar informatizado, é ter pessoas qualificadas e capacitadas para utilizar a tecnologia com bons e sólidos processos para execução de estratégia definida, aliada a um sistema de governança que permita o acompanhamento e controle da organização e dos projetos definidos”. Ele listou os cinco elementos-chave da maturidade de gestão: 

  • Governança corporativa 
  • Estratégia empresarial 
  • Tecnologias 
  • Processos 
  • Pessoas 

A ideia é aumentar o nível de maturidade ciclo a ciclo, aplicando os seguintes fundamentos para desenvolver os elementos mencionados acima: 

  1. Visão sistêmica 
  2. Liderança 
  3. Orientação por processos 
  4. Desenvolvimento de pessoas 
  5. Foco no cliente 
  6. Foco na segurança 
  7. Foco na prevenção 
  8. Melhoria contínua 
  9. Orientação por resultado 

Esses precisam ser os fundamentos da operação do hospital, com os quais é possível chegar a estes quatro resultados: 

  • Segurança do paciente 
  • Qualidade no atendimento 
  • Eficiência nos processos 
  • Resultados econômico-financeiros 

Assim é possível estar preparado quando o consolidador bater à porta. O processo de consolidação, porém, não é a única mudança que os ventos nos trazem. Há as que já vimos falando, como a nova forma de remuneração e a nova forma de monetização. Nos próximos posts, continuaremos abordando da palestra de Roberto Gordilho, que também trouxe esses assuntos e ainda a falta de atualização da tabela Sistema Único de Saúde (SUS) e a verdadeira transformação digital. Siga conosco!

E se quiser saber como aplicar os fundamentos de uma gestão madura para alcançar resultados na área anestésica de sua instituição, o que irá refletir em todos os demais resultados, entre em contato conosco pelos nossos telefones: (41) 3556-0936 / 99152-3713 ou mande um e-mail: contato@wmc.med.br. Teremos o maior prazer em conversar com você. 

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