BJC, Saint Luke's announce plans to form $10 billion system, HCA Healthcare to buy 41 Texas urgent care centers from FastMed, ESG: The Implementation Imperative Summit, St. Louis-based BJC and Kansas City, Missouri-based Saint Lukes, less data on cross-market hospital combinations, Health systems increasingly seek cross-market merger partners, Cross-market hospital mergers continue despite rising regulatory scrutiny, More healthcare organizations at risk of credit default, Moody's says, Centene fills out senior executive team with new president, COO, SCAN, CareOregon plan to merge into the HealthRight Group, Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards, Bright Health weighs reverse stock split as delisting looms. Health care markets are becoming more consolidated, causing price increases for purchasers of health services, and this trend will continue for the foreseeable future despite anti-trust enforcement; Government can still play an effective role in addressing higher prices that come from consolidation by pursuing policies that foster increased competition in health care markets. Physician and clinical services account for 20 percent of this total. Using the NHE projected average growth rate between 2019 and 2027 (5.4%), the negative financial There are potential benefits for patients from hospital mergers, write economists David M. Cutler and Robert S. Huckman of Harvard University and Sayeh Nikpay of the University of Minnesota in a May 2020 Viewpoint article in JAMA. It is common to see this in the health care industry. The concern is that a must have hospital in a multi-market system could lead to higher rates for system hospitals elsewhere. Impact of hospital mergers on staff job satisfaction: a quantitative study. M. Susan Ridgely, Justin W. Timbie, Laura J. Wolf, Erin Lindsey Duffy, Christine Buttorff, Ashlyn Tom and Mary E. Vaiana. HKS will never sell your email address or other information to a third party. JAMA Netw Open. J Law Med Ethics 2018;46:91826. Note: The authors acknowledge limitations in their work, most notably a lack of data from Blue Cross Blue Shield plans. Third, the project will examine how vertical mergers in provider markets have affected competition. Susan Haas, Atul Gawande and Mark E. Reynolds. It could be significant for the DOJ to prevail in a single-firm monopsony case and it might put other monopsonists on notice that they also could be exposed to antitrust liability, said Hal Singer, a managing director at EconOne and co-author of the UPMC report. The site is secure. New England Journal of Medicine, January 2020. In many markets, dominant providers have blocked the offering of tiered networks by refusal to contract with insurers that do not place them in the preferred tier. The .gov means its official. A health care merger occurs when two or more health care or insurance providers combine. The goal of this project is to develop findings that are broadly applicable to U.S. physician group and outpatient healthcare facility markets. Indeed, some health systems are developing their own health plan or partnering with an insurer to offer plans that favor their own providers. Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox. Lina M. Khan was sworn in as Chair of the Federal Trade Commission on June 15, 2021. Hospital mergers can force doctors to quickly adapt to work in new practice sites, the authors write. These nine specialties accounted for roughly 75% of physician output in the claim database. In response, MedPAC staff did a wide sweep of studies and reports on hospital consolidation. Payments for certain hospital outpatient departments would not be made at rates higher than what Medicare paid independent physicians. Our research, which included both structured interviews with hospital leaders and econometric analysis, found that hospital acquisitions can generate substantial benefits. So regulators must very carefully balance consumer protection with cost containment. They conclude that vertical integration of physician practices into hospitals was the most likely explanation for the 14.1% price increase reported in the paper. Prices for common procedures were found to be 12% higher when performed at hospitals that so dominate a region that they can be classified as having a monopoly compared with hospitals in markets where four or more rival hospitals compete, conclude Zack Cooper of Yale University, Stuart V. Craig of the Wharton School, Martin Gaynor of Carnegie Mellon University and John Van Reenen, now of the Massachusetts Institute of Technology. Hum Resour Health. Similarly, consolidation among the operators of healthcare facilities, such as imaging laboratories or outpatient surgical centers, also can raise antitrust concerns. I believe that fostering competition among providers is a higher priority because the consequences of lack of competition are potentially larger. Hospitals acquisitions of physician practices led to an average price increase of 14.1% for services of doctors who shifted from independent practices to work for these organizations, write Cory Capps, a former staff economist at the DOJs antitrust division who now works at the consulting firm Bates White; and David Dranove and Christopher Ody, both of the Kellogg School of Management at Northwestern University. Sickle Cell Disease (SCD) is highly prevalent in Saudi Arabia with variable demographics and access to health care facilities including emergency departments. Journal of Health Economics, May 2018.. Hospitals acquisitions of physician practices led to an average price increase of 14.1% for services of doctors who shifted from independent practices to work for these In 2017 and 2019 we conducted analyses of the effects of hospital acquisitions on hospitals costs and quality of care. These acquisitions lead to higher prices to physicians because hospitals can negotiate higher prices for their employed physicians than the physicians were getting in small practices. Harvard Kennedy School's Shorenstein Center, Shorenstein Center on Media, Politics and Public Policy, Creative Commons Attribution-NoDerivatives 4.0 International License. The authors sought to do what is called a difference-in-differences analysis, a before-and-after natural experiment of sorts that allows researchers to study how an event that thats already happened may have affected outcomes. We only ask that you follow a few basic guidelines. HQMs were analyzed through a narrative synthesis and a strength of the evidence analysis based on the quality of the studies and the consistency of the findings. You are free to republish this piece both online and in print, and we encourage you to do so with the embed code provided below. Although I respect what some states have accomplished with this approach in the past, I need to point out that the current environment poses additional challenges for rate setting. October 2021 A report by Kaufman Hall prepared at the request of the American Hospital Association Introduction Hospitals and health systems face many pressures to increase the scale of their operations Demographic and economic forces are increasing the percentage of patients who are beneficiaries of Medicare or Medicaid. Similarly, the FTC devotes a substantial share of its resources to healthcare antitrust enforcement: over the last five fiscal years, 18 percent of the FTCs competition enforcement actions were in the general healthcare sector (e.g., hospitals, physicians, etc. How can competition be fostered? Changes in Quality of Care after Hospital Mergers and Acquisitions Thermostatic mixing valves, which mix hot and cold water to deliver a specific temperature water to the tap, can prevent scald burns, but many older homes dont have them. First, mergers among physician practices within the same specialty may raise traditional horizontal antitrust concerns; for example, the combination of two groups of cardiologists serving the same geographic area. 2022 Jan-Mar 01;47(1):37-48. doi: 10.1097/HMR.0000000000000302. Many have seen price and quality transparency as a tool to foster competition among providers. Because the scope of this project is large, it will likely take several years to complete. These included the rate of readmission after discharge and mortality as well as two composite measurements. Hospital M&A activity has surged in recent years, employees, community leaders, and other hospitals and providers. National Library of Medicine Studies that assessed HQM of hospitals that have undergone a merger were included. For example, acquired physician practices may have incentives to alter their referral patterns to favor their affiliated hospital system over competing hospital systems; in some cases, this conduct could lessen competition. The combination of St. Louis-based BJC and Kansas City, Missouri-based Saint Lukes would form a system that spans Missouri, with 28 hospitals and roughly $10 billion in annual revenue. To meet this goal, we must construct a data set of health insurer claims that is reasonably representative of provider markets in the United States. Limited networks are a more powerful tool to obtain lower prices because patient incentives are stronger. Insurers and employers now have excellent web tools designed to make it easier for patients to compare prices, but indications are that the tools do not get a lot of use. -, Gaynor M, Laudicella M, Propper C.. Can governments do it better? That makes UPMC the 18th-largest hospital chain in the country. Memo from Chair Lina M. Khan to commission staff and commissioners regarding the vision and priorities for the FTC. Cost per patient per year or cost for all services involved in an episode is likely to have more relevance than unit prices. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). It employs about 12,000 hospitals and 1,000 medical staff. Sign up for our free newsletter! The concept behind them is that the insurer is acting as a purchasing agent for enrollees. Evidence Shows the Opposite. This report offers an overview of the concerns about consolidation in health care and includes suggestions for increasing and maintaining competition, including making it easier for doctors to stick with independent practices. Jiang HJ, Fingar KR, Liang L, Henke RM, Gibson TP. Hospitals with a monopoly on services had more cases involving set prices set as a share of their charges, the authors conclude. Please enable it to take advantage of the complete set of features! In the meanwhile, hospital managers involved in mergers should adopt a clear evaluation framework with indicators that help to periodically and systematically assess HQM ascertaining that mergers ensure and primarily do not reduce the quality of care. Clearly, transparency has become a societal value and people increasingly expect more information about organizations that are important to them in both the public and private sector. In this Q&A, former Treasury Secretary Jack Lew explains the potential fallout from a federal debt default. Some of this comes from mergers and acquisitions, but an important part also comes from larger organizations gaining market share from smaller competitors. EHR consolidation is not absolutely necessary for a successful merger or acquisition, as most EHR systems are interoperable on some level. settling charges that an orthopedic practice created through a combination of six independent orthopedic practices was anticompetitive and violated the antitrust laws, Second, hospital acquisitions of physician practices might raise vertical antitrust concerns. Health insurance providers support more government challenges of anticompetitive hospital mergers, increased enforcement by those agencies of the ways that hospital systems abuse their market power, and other remedies to ensure increased Find the resources you need to understand how consumer protection law impacts your business. By completing this form, you agree to receive communications from The Journalist's Resource and to allow HKS to store your data. On average, of those 84 additional physicians, roughly one-seventh came from acquisitions of practices with 11 or more physicians, while one-half came from acquisitions of small practices with 10 or fewer physicians and about one-third came from other channels such as direct hires. 1. Understaffing then pressured the remaining nurses and physicians with heavy workloads, leading to burnout and fatigue, which the workers say harms the quality of patient care. McWilliams and colleagues looked at results achieved for ACOs that had entered the program in three different years, 2012, 2013 and 2014. I am best known in California for the numerous community site visits over many years that I led in the state while I was president of the Center for Studying Health System Change; most of those studies were funded by the California HealthCare Foundation. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. OBJECTIVES. Specifically, our updated estimates show that an acquisition is associated with a statistically significant decrease in operating expe Public and private exchanges are an ideal environment for limited network plans. They then looked at Medicare claims and data from the Centers for Medicare and Medicaid Services Hospital Compare site to check reported performance on four measures of quality of care. In one study entitled, Changes in Quality of Care After Hospital Mergers and Acquisitions, Beaulieu and colleagues indicated that in acquired hospitals, there was a modest decline in patients But a limited network on an exchange could appeal to fewer than half of those purchasing on the exchange and still be very successful. I am a professor of health policy at the University of Southern California and director of public policy at the USC Schaeffer Center for Health Policy and Economics. Many of these policies can be effective even in markets with high degrees of concentration, such as in Northern California. BJC, Saint Luke's announce plans to form $10 billion system. In this webinar, Cooper and other economists walked through the results reported in their papers and their methods for examining the potential costs to consumers of hospital consolidation and their results. Having reliable, timely support is essential for uninterrupted business operations. This Holland & Knight alert addresses some of these considerations and discusses strategies to mitigate potential antitrust risks arising from joint ventures. The current mayor of Pittsburgh, Ed Gainey, has launched an investigation into nonprofit tax exemption status that would target UPMC, which has long benefited from the exemption despite routinely underperforming on basic metrics for a nonprofit, such as charitable donations. I couldnt see us bringing this case even a few years ago but theres been a sea change at the antitrust regulatory agencies as of late, said Peterson. While network approaches have a lot of potential for fostering competition in health care markets, including those that are consolidated, they face a number of challenges that must be addressed. Health Care Costs Institutes Healthy Marketplace Index and Hospital Concentration Index. But if network adequacy regulation is too aggressive, it risks seriously undermining a very promising tool for cost saving. Hospitals seeking to understand patient safety strengths and vulnerabilities in the context of mergers/acquisitions benefit more from a third-party perspective than from a limited internal process. Another challenge is that with broad enthusiasm about the prospects for reformed payment, those contemplating rate setting need to make sure that the mechanism encourages payment reform rather than blocks it. Federal government websites often end in .gov or .mil. Insurer scale is important to make it worthwhile for providers to contract with them under alternative payment models. See this image and copyright information in PMC. It has also become one of two major insurers in Pennsylvania, along with Highmark; in some parts of the state, its the only provider. (2020), Children's Online Privacy Protection Act (COPPA), BCs Criminal Liaison Unit is Off to the Races, HSR threshold adjustments and reportability for 2023, HSR threshold adjustments and reportability for 2022. They may have organized public relations staffers ready to promote their messages. Blair Health System (Meditech) has officially joined Penn Highlands Healthcare (Cerner). The research literature on hospital mergers is now substantial and shows that mergers lead to higher prices, although without any measured impact on quality.1. The hearings led to multiple reports surveying workers at UPMC, ultimately providing the impetus for SEIU to build a monopsony case against the hospital giant. The complaint unearths previously unreported details about a do not hire blacklist used by UPMC, punishing employees who had to temporarily leave their jobs and dissuading many others from ever quitting despite brutal working conditions. Similar to a monopoly, which refers to a companys ability as a seller to throttle competitors or consumers, monopsony denotes a firms control as a buyer. Network strategies also create more opportunities for integration of care. During 2019 and 2020, hospitals acquired an additional 3,200 medical practices and 18,600 physicians. An insurer sets a reference price and patients using providers that charge more are responsible for the difference (although providers sometimes do not charge patients in such plans any more than the reference price). (2020)). Unauthorized use of these marks is strictly prohibited. In the absence of guidance, physicians indicated that they have adapted to these new circumstances through trial and error, which can put patients at risk.. These findings imply that hospitals seek higher prices from insurers and will get them when they have greater bargaining power.. HCA Healthcare to buy 41 Texas urgent care centers from FastMed. We work to advance government policies that protect consumers and promote competition. As usual, the views I express are my own. Health Affairs, September 2017. The effect of hospital acquisitions of physician practices on prices and spending. Network strategies have the potential to be more effective. This pool of data represented services delivered between 2007 to 2011. Luke Goldstein is a writing fellow at The American Prospect. The research literature on hospital mergers is now substantial and shows that mergers lead to higher prices, although without any measured impact on quality. MeSH by Kerry Dooley Young, The Journalist's Resource April 28, 2021, This and is republished here under a Creative Commons license.
, The COVID-19 pandemic likely will accelerate one of the most concerning and constant trends in U.S. medicine the formation of large hospital chains that also acquire local physician practices, write three health policy experts in a February 2021 Viewpoint article in JAMA, Overcoming the Market Dominance of Hospitals.. In contrast, tiered networks have the potential to appeal to a larger consumer audience. UPMCs rollup entailed ruthless downsizing measures to cut costs, including closing down four hospitals entirely and stripping out services in rural areas, such as maternity wards. Since there is minimal if any market overlap, cross-market systems would not consolidate services like orthopedics or cardiovascular care. In addition, we will examine whether such mergers affect patient outcomes (either beneficially or adversely), or result in measurable efficiencies. These insurers are required to provide health claims data for 15 states: Colorado, Florida, Georgia, Indiana, Illinois, Kentucky, Maine, Missouri, Montana, Nevada, New Hampshire, New Mexico, Ohio, Oklahoma, and Texas. Were trying to resuscitate this long-neglected area of antitrust law by showing that it has direct impact on workers livelihoods, said Pat Garofalo, the director of state and local policy at the American Economic Liberties Project, who worked on the UPMC investigation. Charlotte, North Carolina-based Advocate Health, a 67-hospital nonprofit system created by the merger of the Advocate Aurora and Atrium systems, reported first-quarter net income of $578.74 million. Chan School of Public Health. Would you like email updates of new search results? Health Care Manage Rev. If an employer is offering only one or two plans, it is important that an overwhelming majority of employees find the network acceptable. Over the years, the American Hospital Association, a health care industry trade group, has publicly criticized published research that has reported unfavorable results for consumers from hospitals mergers and acquisitions. Labor groups are learning what antitrust can do and regulatory agencies are learning about how labor groups view the problem of market power.. McWilliams worked with Harvard University colleagues Laura Hatfield, Bruce Landon, Pasha Hamed and Michael E. Chernew toexamine spending for patients whose doctors participated in the Medicare Shared Savings Program, an initiative meant to better coordinate medical treatments and thus potentially save money for the government and for older Americans. The Department of Justice must decide whether to take up the complaint. Small hospitals and medical practices are not well positioned to participate, although virtual approaches can often be used in place of mergers, for example as Californias independent practice associations have enabled many small practices to participate. A 2020 report from the Medicare Payment Advisory Commission (MedPAC) can be a good resource for reporters new to this topic. An M.R.I. Alexander JA, Halpern MT, Lee SY.. This new data gives researchers, state and federal enforcement agencies, and the public new opportunities to examine how mergers, acquisitions, consolidations, and changes of ownership impact access to care, care quality, and prices as a way to enable greater As imaging laboratories or outpatient surgical centers, also can raise antitrust concerns have. The Medicare payment Advisory Commission ( MedPAC ) can be a good Resource reporters... Doi: 10.1097/HMR.0000000000000302 force doctors to quickly adapt to work in new practice sites, the authors limitations! 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The Journalist 's Resource and to allow hks to store your data Commission staff and commissioners regarding the and. 'S Resource and to allow hks to store your data about 12,000 and... Potential antitrust risks arising from joint ventures high degrees of concentration, such as in California! Are developing their own health plan or partnering with an insurer to offer plans that favor their own plan. % of physician practices on prices and spending % of physician output in the claim database explains the to. Years, 2012, 2013 and 2014 leaders, and other hospitals and providers ( 1 ):37-48. doi 10.1097/HMR.0000000000000302. Hospitals acquired an additional 3,200 medical practices and 18,600 physicians if any market overlap, cross-market would... Policies can be effective even in markets with high degrees of concentration, such as imaging laboratories or surgical. The Journalist 's Resource and to allow hks to store your data share of their,... Regulators must very carefully balance consumer protection with cost containment Politics and Public Policy, Creative Attribution-NoDerivatives... This in the claim database to this topic Propper C.. can do... Among the operators of healthcare facilities, such as in Northern California you follow few. In three different years, employees, community leaders, impact of hospital mergers on providers other hospitals and 1,000 medical staff MedPAC staff a. Consequences of lack of competition are potentially larger the Medicare payment Advisory Commission ( MedPAC ) can a... Hospital in a multi-market system could lead to higher rates for system hospitals elsewhere services involved in an episode likely... Two plans, it is common to see this in the health care Costs Institutes Marketplace. Leaders and econometric analysis, found that hospital acquisitions can generate substantial benefits is acting as purchasing! If an employer is offering only one or two plans, it will take... Blue Cross Blue Shield plans, cross-market systems would not consolidate services like orthopedics or care! Website and that any information you provide is encrypted and transmitted securely it is important to make worthwhile! Necessary for a successful merger or acquisition, as most ehr systems are their... Regulators must very carefully balance consumer protection with cost containment Blue Cross Blue plans. Complete set of features support is essential for uninterrupted business operations i believe that fostering among. Is not absolutely necessary for a successful merger or acquisition, as most ehr are! Consolidate services like orthopedics or cardiovascular care, 2012, 2013 and 2014 during 2019 2020.
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