margot sanger-katz: "supersized: the rise of the hospital giants," 5.19.15
TRANSCRIPT
Margot Sanger-KatzHealth Care Correspondent
The UpshotThe New York Times
[email protected]@sangerkatz
Supersized: The Rise of the Hospital GiantsReporting on Health Webinar
USC Annenberg School for Communication and JournalismMay 19, 2015
Here’s the trend
Did Obamacare make them do it?
• The legislation is officially agnostic about hospital size.
• But features of the Affordable Care Act and other recent legislation are often cited by hospitals are reasons for their desire to merge. They are:
Policy changes
• HITECH Act and the shift to electronic health records• Increased quality measurement and pay incentives
in Affordable Care Act• Accountable Care Organizations and other payment
methods that reward coordination of care• Tighter payments from Medicare and declining
Medicaid DSH payments (especially in non-expansion states)
• The new Doc Fix bill
Other common explanations:
• “Musical chairs” anxieties• Cultural and generational changes in medical
practice• For doctors: “site of service” pay differentials,
particularly in oncology and cardiology• Narrow networks• Desire for negotiating leverage and better
prices
Some good stories to read:
• Boston Globe series on the “Partners Effect” in Massachusetts
• Charlotte Observer series on consumer effects of consolidation in North Carolina
• New York Times story on emergency room prices, focused on Sutter Health, which has expanded across California
• National Journal (my) story, summarizing some of the research you are about to hear about.
Stories to cover• Local hospital mergers: Who is merging and why? What arguments
are they making and are they supported by the evidence?• Special cases: rural hospitals; mergers of hospitals across a state or
region• Hospital-physician mergers: What specialties are getting bought?
How quickly? (And after-the-fact: Are practices a good investment?)• What’s the financial status of the remaining independent hospitals
and practices? • ACOs: Are they living up to the hype?• Consumer impacts: Out-of-pocket costs, access.• Effects on charity care• Are the mega hospitals trying to become insurance companies?
Sources (besides Marty and Paul):• The American Hospital Association, Irving Levin Associates, the Advisory
Board Company, and the Medical Group Management Association all track mergers and acquisitions.
• Insurers are the natural opponents of consolidation, and can be helpful, if you keep their bias in mind.
• Patients can tell you about their experiences and out-of-pocket costs. (But ask for bills to verify.)
• Independent physicians can describe the pressures they face. National and local specialty societies also understand the environment for docs.
• Hospital form 990s and bond applications (great Karl Stark tip sheet here) can give you good data on financial performance of nonprofit institutions. For-profits file quarterly and annual reports with the SEC.
• Claims databases and crowd-sourced price data in some states.
