Brillant analysis of how site-of-service arbitrage drives consolidation. The 2x-3x facility fee markup hospitals pocket when buying independent practices is basically an economic cheat code that policy created. Saw this firsthnad when my doctor's practice got absorbed and the same visit suddenly had a mysterious facility charge added. The data on 340B spending less on charity care than revenue received really undercuts the vulnerable populations argument.
It’s also the chiros, the dentists, the physical therapists, just about everyone….
Everyone assumes, especially the politicians, that insurance companies are the problem. But really, insurance companies are almost as much a victim as the consumer.
They are getting bilked left and right. To survive, they have to pass those costs onto you. This is a problem with no easy answer, but the government has clearly mucked this up by restricting the supply of physicians, hospitals, and the like.
I don't have health insurance, and the last time I called to make an appointment, I was asked who my health insurance was with, and I said zero insurance to which she said: "Your right, it's a scam"
Good analysis. The 16 hours per doc per week number for quality metric reporting may be a bit out-dated now with many systems using AI or other IT methods to automate/simplify. Although, to your point, that will likely come to large systems before independent practices.
Thank you for the analysis. The consolidation of financial power really is one of the most concerning and damaging trends in our economy, and it's obviously a massive problem in the healthcare industry. Like most of the rest of the ACA, Section 6001 seems like it must've been written to primarily benefit anyone but the actual patients.
Hospital consolidation, one of the biggest issues of our time - dont think it can be fixed without fixing litigation though. If docs can be sued for millions of dollars only massive companies are going to be able to front that
Really interesting - if I could ask a follow-up question, I was wondering if you had any thoughts on how the government incentives became set to favour consolidation so? Is it just a matter of lobbying power, or was there some sort of belief that this is actually a better option for the system (along the lines of that greater standardization and investment point you note in the piece, for instance)?
Brillant analysis of how site-of-service arbitrage drives consolidation. The 2x-3x facility fee markup hospitals pocket when buying independent practices is basically an economic cheat code that policy created. Saw this firsthnad when my doctor's practice got absorbed and the same visit suddenly had a mysterious facility charge added. The data on 340B spending less on charity care than revenue received really undercuts the vulnerable populations argument.
Its interesting that you caught that, I just assumed that these were standard fees, but I will be on the lookout for this next time.
It’s also the chiros, the dentists, the physical therapists, just about everyone….
Everyone assumes, especially the politicians, that insurance companies are the problem. But really, insurance companies are almost as much a victim as the consumer.
They are getting bilked left and right. To survive, they have to pass those costs onto you. This is a problem with no easy answer, but the government has clearly mucked this up by restricting the supply of physicians, hospitals, and the like.
I don't have health insurance, and the last time I called to make an appointment, I was asked who my health insurance was with, and I said zero insurance to which she said: "Your right, it's a scam"
Good analysis. The 16 hours per doc per week number for quality metric reporting may be a bit out-dated now with many systems using AI or other IT methods to automate/simplify. Although, to your point, that will likely come to large systems before independent practices.
The more expensive things get the more they will punish insurance companies. The weaker insurance companies get, the more hospitals will charge.
Thank you for the analysis. The consolidation of financial power really is one of the most concerning and damaging trends in our economy, and it's obviously a massive problem in the healthcare industry. Like most of the rest of the ACA, Section 6001 seems like it must've been written to primarily benefit anyone but the actual patients.
Hospital consolidation, one of the biggest issues of our time - dont think it can be fixed without fixing litigation though. If docs can be sued for millions of dollars only massive companies are going to be able to front that
You're exactly right. The "litigation tax" compounds at every layer of the system, over and over again, ensuring that it will never be affordable.
Really interesting - if I could ask a follow-up question, I was wondering if you had any thoughts on how the government incentives became set to favour consolidation so? Is it just a matter of lobbying power, or was there some sort of belief that this is actually a better option for the system (along the lines of that greater standardization and investment point you note in the piece, for instance)?
Both depending on maliciousness or ignorance of policymakers.