Healthcare Innovation:Legal Expert: Antitrust Regs Have Failed to Protect Us All From Consolidation Harms (3/21) – Despite the fact that the U.S. health care system is a highly regulated industry, and the fact that there are numerous legal boundaries around the consolidation of provider organizations and other health care organizations, one legal expert believes that the time has come for federal policy leaders to reconsider the tools in their toolbox and apply some new combination of the enforcement of existing antitrust regulation and what he terms “creative regulatory interventions,” given that he believes that the current set of regulations and guidelines is not working.
Harvard Business Review: Research: What Happens When Private Equity Firms Buy Hospitals? (3/20) – In this article, we provide an overview of the existing research on the effects of private equity ownership of U.S. hospitals and health systems. Specifically, we highlight the key changes in health systems after they’ve been acquired by private equity firms with respect to their financial health, staffing levels, care quality, and availability of service lines. We conclude by calling attention to the key issues that should shape future policy deliberations on private equity in health care. Our research on the net effects of private equity activity in the hospital sector paints a mixed picture of its effects. Any policy reforms should therefore be guided by the available evidence specific to a particular sector and the principle that protecting patients from harm should always be the top priority.
Medical Economics: Primary care slots outpace resident interest (3/20) – While the matchmaking process coordinated by the National Resident Matching Program (NRMP) saw 42,952 applicants and 40,375 certified positions, primary care fields still have triple-digit numbers of unfilled positions. Family medicine finished the matchmaking process with 577 unfilled positions, while internal medicine had 380. Overall, both specialties filled more slots than any others, with family medicine filling 4,511 (89 percent of open slots) and internal medicine filling 9,345 (96 percent). The number of unfilled positions, driven in part by the decreased number of U.S. MD and U.S. DO seniors who submitted ranks for the specialty, could reflect changing applicant interests or projections about workforce opportunities post residency, according to the NRMP.
Medical Economics: Hospital acquisition of practices drives up workers’ comp costs (3/16) – When hospitals acquire physicians practices, the cost of providing care for workers’ compensation claims goes up, according to Impact of Medical Provider Consolidation on Workers’ Compensation Payments, a study
from the Workers Compensation Research Institute. “Medical markets are increasingly concentrated. This means that patients are more likely to be treated by physicians at sites owned by hospitals and health systems,” said John Ruser, WCRI president and CEO, in a statement. “This raises a policy concern that the increasing concentration of medical providers may lead to higher payments for medical care without corresponding improvements in patient outcomes.”
Healthcare Dive: MedPAC recommends physician pay bump, but not enough for provider groups (3/16) – Last year, the commission didn’t recommend any payment increase for physicians under the Medicare program, irking groups like the American Medical Association that cited continued pandemic-related pressures. Provider groups and others were upset with the increase amount this year, citing record inflation and heightened expenses. “In the best of times such a nominal increase would not cover annual medical practice cost increases,” the MGMA wrote in a statement. “In the current inflationary environment, it is grossly insufficient.”
Brookings Institution: Procompetitive health care reform options for a divided Congress (3/16) – In this piece, the Brookings Institution highlights areas where the 118th Congress can make tangible progress in reducing health care costs by increasing competition. A large body of evidence finds that the merger of potential competitors within health care markets increases costs to consumers and is suggestive that it also reduces the quality of care. Despite this evidence, many acquisitions that raise significant antitrust concerns go unchallenged by antitrust authorities or are allowed to proceed by the courts. Greater transparency and strengthened antitrust statutes could help reduce the amount of anticompetitive consolidation in health care. Requiring site-neutral payments more broadly would further reduce Medicare spending, beneficiary costs, and incentives for hospitals to purchase physician practices.
STAT: The big-money Medicare policy that has hospitals worried this Congress (3/16) – As debate in the Capitol rages about the future of the Medicare program, hospitals are worried that lawmakers could finally be considering a change they hate — so-called site neutral payment policy. It’s somewhat of a unicorn on Capitol Hill — it saves the federal government tens of billions of dollars, reduces patient costs, and it’s gained bipartisan support over the years. The policy would ensure Medicare pays the same price for the same medical services, regardless of whether they are provided at a hospital or at a physician’s office. If Congress aggressively pursued the policy, it could save the federal government more than $100 billion, by one recent estimate. It could also help reduce incentives that encourage consolidation, experts say.
Americans for Prosperity: New poll shows widespread support for increased hospital competition (3/16) – Americans for Prosperity released a poll conducted showing that Americans are concerned about hospital consolidation and want lawmakers to address the problem.
- 67 percent of voters say they’re concerned about the growing consolidation of hospitals across the country.
- 72 percent say hospital consolidation creates regional monopolies that keep prices high. Just 28 percent believe that hospital consolidation creates efficiencies and economies of scale that keep costs low.
- 69 percent say that independent doctors should be reimbursed the same amount that hospital-employed doctors get.
Health Payer Intelligence: Stakeholder Groups Oppose Medicare Advantage Risk Adjustment Changes (3/16) – Organizations have urged CMS not to finalize these changes to the risk adjustment model, stressing that they could adversely impact the shift to value-based care and care access for people with chronic conditions. Dozens of health care stakeholder groups have called on the agency to delay the proposed changes until the effects on beneficiaries, providers, and payers can be fully understood. Many organizations have encouraged CMS to collaborate with stakeholders to discuss how the changes may hurt vulnerable populations. “While the proposed changes appear to make significant progress on this goal, they also appear to have some unintended consequences for beneficiaries more likely to have the conditions involved, including more serious or complex forms of these conditions that are more costly to manage, creating offsetting reductions in the accuracy of risk adjustment,” leaders from the Duke-Margolis Center for Health Policy wrote.
AJMC: Eliminating Defects in Value: Turnaround of an MSSP ACO (3/15) – Study findings estimate that defects in value—the practices or systems that worsen quality or patient experience and increase costs without benefit—account for one-third of health care expenditures (or $1.4 trillion) in the United States. Federal policy makers have implemented programs to address these defects. The Medicare Shared Savings Program (MSSP) rewards provider organizations with shared savings when they reduce the annual cost per Medicare beneficiary and improve overall quality. However, payment policies, such as MSSP, alone have had limited impact on improving value across the United States. To realize larger gains in value, health systems and providers must redesign their care models and implement strategies to achieve their value improvement goals.
Healthcare Dive: FTC says health privacy key priority in 2024 budget request (3/15) – The FTC’s proposal calls for a $160 million boost in funding for the 2024 fiscal year, which would increase its budget by 37 percent compared to 2023. The hike is necessary as substantial merger activity, signs of market concentration and related competition concerns have “dramatically increased” the pressure on the FTC’s resources in recent years, the budget request says. The FTC has been active in challenging health care mergers it views as anticompetitive. In 2022, regulators moved to block three health system mergers, resulting in all parties abandoning the proposed deals, according to the budget request. The proposed budget for 2024 “reflects continued growth in our investigative and litigation capacity to meet the increasing, broad-based anticompetitive challenges in health care and technology markets,” the budget proposal says.
Health Leaders: The Exec: CFO Kevin Murphy on the 'Fundamental Flaw' in Fee-For-Service Payments (3/15) – The argument for value-based care starts with quality of care and economics. There is an increasing push from CMS for the adoption of value-based care, and the incentives are quite clear and cannot be separated from the economic side of the equation. Care quality always comes first, ask any doctor why they chose their profession, and they’ll say that providing the best care is why they became doctors. Through value-based care, we can increase doctors’ income by 10 percent, 20 percent, and in many cases north of 30 percent. So, it is a meaningful shift in their practices’ profitability and their personal income to participate in value-based care.