Many stocks are at or near all-time highs despite showing slow or negative growth in recent quarters. Nowhere is this more evident than in the U.S. healthcare sector, where elective procedures that normally drive profits have slowed or stopped altogether at different points throughout 2020. Despite daily volatility, the market is still looking ahead to the future. Many of the same patients who put off procedures will be lining up after a vaccine is rolled out and they feel safe returning to doctor's offices and hospitals. Unlike skipping a dinner out or a coffee on the morning commute, most of the delayed business for these companies will be there waiting when the pandemic ends.
Three companies in healthcare that are primed to make a comeback in 2021 as people are vaccinated and life returns to normal are HCA Healthcare (NYSE:HCA), Intuitive Surgical (NASDAQ:ISRG), and AMN Healthcare Services (NYSE:AMN).
1. HCA Healthcare
HCA Healthcare's stock sits almost exactly where it did in January, before the pandemic, government stimulus, and dramatic fall in patients and procedures. Over the past two quarters, patients and procedures have dropped precipitously and then mostly recovered. Admissions were down 12.8% year over year in the second quarter, but only 3.8% in the third quarter. Similarly, inpatient surgeries were down 15.7% and 6.8% in the second and third quarters, respectively.
Despite still having negative year-over-year patient admission growth, revenue climbed about 5% to $13.3 billion in the quarter ended Sept. 30. HCA has been able to stand up on some external federal aid, including $1.4 billion in grants from the federal Coronavirus Aid, Relief, and Economic Security Act (CARES) Act and $4.4 billion in accelerated payments for Medicare services to date. Currently, management expects patient admissions to be down 2% to 3% overall in 2021, but as the third quarter shows, that doesn't mean a decline in the top line. HCA achieved this through tight expense controls on salaries, benefits, and other operating expenses. Going forward, management is looking at potential staff reductions in call centers and labs as it consolidates to reduce costs. As volume returns, expect a leaner, more profitable HCA to come back with bigger profit margins and returns for investors in the year ahead.
2. Intuitive Surgical
Like HCA, Intuitive Surgical faced a steep decline in the second quarter. The company shipped 35% fewer of its da Vinci robotic surgery systems compared to 2019, and procedures -- where the company generates 16% of its sales -- fell 19%. Just as HCA saw surgeries rebound in the third quarter, Intuitive Surgical saw procedure growth return. Procedures were actually up 7% in the third quarter compared to 2019, but system sales were still down 29% year over year. This is a good indication that patients were more eager to return to pre-pandemic activities than the hospital executives holding the purse strings.
The good news for investors is that shares of the stock are up nearly 22% this year. Perhaps investors see the elective abdomen, urological, and head and neck surgeries, among others, simply being put off until patients feel safe coming into the hospital. With a backlog of patients waiting to have procedures, hospitals may decide to purchase additional da Vinci robots to handle the increased volume of surgeries in 2021 and beyond. Outside the U.S., the company placed 79 da Vinci systems in the third quarter, down 12% from the same period in 2019. That number was actually up in Europe, where pandemic lockdown measures were avoided in the July to September timeframe. Despite the current challenges, I expect a big rebound in procedure volume and system sales as the vaccine rolls out through next year.
3. AMN Healthcare Services
Like HCA and Intuitive Surgical (and most of the stock market for that matter), shares of AMN Healthcare Services -- a healthcare staffing and solutions provider -- are back very close to where they began 2020. The company has quite the Jekyll and Hyde story for 2020. The impact of COVID-19 has had very different affects on the company's business segments. While one segment is booming, the other has been headed in the opposite direction. The travel nurse staffing business grew 41% in the second quarter and continued to set records with 12% growth in the third quarter. Months of coronavirus stress led to worker burnout and attrition, which created an increased need for AMN's services. On the other hand, the company's physician and leadership business fell 24% year over year in both the second and third quarters. This was another indication that healthcare systems were being very careful committing money to salaries while uncertainty remains about how soon business will return to normal.
As hospitals and healthcare systems tighten their belts due to admissions and procedures decreasing, they are holding off on adding expensive physicians and executives. That AMN segment specifically -- physician and executive search -- was down 32% in the third quarter. Like its customers, AMN implemented cost controls during the pandemic targeting SG&A expenses (marketing and administrative professionals, as well as other executives), dropping the line item from 23.5% of sales in 2019 to 20.2% in 2020. As lagging business units bounce back, expect a more profitable AMN Healthcare in 2021. Nurses are sure to stay in high demand, and the physician and executive roles will be filled once the profits associated with elective procedures have returned for good.