When the American Recovery Act was passed four years ago, I was covering the health IT beat for ZDNet. I fully expected companies in that space to be huge beneficiaries of the act, given that $19.2 billion in sweet, sweet stimulus cash would be doled-out under the act by fiscal 2015, all aimed at lowering costs by collecting data and automating treatment.
But I also expected those benefits to fall mostly to new companies, specifically those offering Software as a Service or SaaS. SaaS systems can be updated and upgraded all at once, rather than over time like conventional client-server systems. I also expected mainline tech companies like Microsoft (MSFT) and Google (GOOG) to increase their penetration here, as they have in every other niche that got a growth spurt over the last 30 years.
So far I've been wrong. Not only have Microsoft and Google withdrawn from the market but the biggest winner appears to be Cerner (CERN), a mainline company whose stock has more than tripled in value since the act was passed early in 2009. By contrast the best-run of the SaaS companies, AthenaHealth (ATHN), has barely doubled in value.
CERN revenues have grown by 50% during the last four years, to $2.2 billion, with steadily rising operating margins and profit margins. The company has managed to reduce debt during the period, and now creates nearly $600 million in free cash flow during each quarter. ATHN has grown faster, tripling in total sales volumes, but from a much smaller base, with revenue for all of 2012 likely to come in near $400 million, and net income near $20 million.
Growth investors have gotten what they wanted from both stocks, but the last year of the stimulus is due to begin in just 21 months. The requirements for that cash are steadily rising over time, based on plans first put in under the-ONCHIT David Blumenthal, now head of the Commonwealth Fund, a private foundation that does research and advocates policies on hospital efficiency.
Investors are paying a huge premium for this growth. CERN enjoys an earnings multiple of 38, while ATHN's is an Amazonesque 157. The news peg is from ATHN, an agreement to buy Epocrates (EPOC), a producer of medical apps, for $11.75/share, a premium of about 22% for EPOC. The deal has ATHN up another 1%, just about what it's paying for the company.
From a technology perspective this is a good deal. EPOC can help ATHN extend its reach to the point of care, even when that point of care is outside a hospital. Using smartphones or tablets and keeping the expensive hardware in a server room makes great sense.
But whether this will boost ATHN's top line enough to justify its current multiple is questionable. The stock is just now getting over a warning on earnings for the msot recent quarter. There's no new stimulus cash coming with this deal, no obvious source of new revenue other than taking share from other companies, like Allscripts (MDRX), whose customers must now be looking for a way out of their contracts after a boardroom coup.
I just don't see that sustaining much growth. ATHN stock is primed to roll over in 2013.