Bigger Health Care Providers Mean Bigger Profits, But Not Always Better Care

Nov 24, 2014Emily Cerciello

Hospitals are buying private physician practices left and right, and state attorneys general should consider whether such mega-providers violate anti-trust laws.

Hospitals are buying private physician practices left and right, and state attorneys general should consider whether such mega-providers violate anti-trust laws.

In 2002, only 22 percent of private physician practices were owned by hospitals. Today, this number has climbed to more than 50 percent, and 75 percent of newly hired physicians are entering the workforce as hospital employees. As the physician population ages, the behaviors of young physicians will have long-term impact on the organization and norms of care delivery.

Amid declining reimbursements and a shift toward value-based payment models in which physicians are reimbursed for quality rather than quantity of services, health care providers are facing pressure to reduce costs and improve outcomes. An increasing number of physicians are selling their practices to hospitals, and hospitals are aggressively buying to remain competitive.

Two chief catalysts that are driving hospitals to purchase physician practices include the recent economic downturn and passage of the Patient Protection and Affordable Care Act (ACA).

In this economic environment, hospital survival is a matter of cost cutting and care organization. The ACA requires compliance with new quality regulations, including curbed readmission rates and a reduction in hospital-acquired infections, and facilities are compelled to spend money in efforts to meet those requirements. Hospitals are acquiring physician practices to increase scale for better negotiating positions with insurers, further penetration of local markets, the ability to integrate IT systems, and the improvement of purchasing power with suppliers.

Physicians are selling their practices to hospitals for greater access to capital and fewer administrative responsibilities amid reform, an improved work-life balance, and recruiting incentives by hospitals.

But when hospitals purchase physician practices instead of contracting with physicians, the results can be costly. A recent Health Affairs study gives authority to the issue: hospital ownership of physician practices increases hospitals’ pricing power, and prices rise for privately insured patients. A one-standard-deviation increase in market share can increase prices by 3 percent, and a one-standard deviation increase in hospital Herfindahl-Hirschman Index (a statistical measure of market concentration), can increase prices by 6 percent.

In central North Carolina, Duke University Health System has been aggressively converting nearby clinics into Duke-affiliated outpatient centers. State Attorney General Roy Cooper is examining whether antitrust laws or new legislation can be used to reduce growing hospital prices.

In January, a federal judge blocked a major purchase of Idaho’s largest physician practice by the state’s largest hospital system. In light of that case, the FTC has suggested it will show greater scrutiny of healthcare provider consolidations.

In theory, true integration of physician practices into hospital systems can provide substantial gains for both parties. By reducing barriers to patient information and care coordination, facilities can improve quality and generate cost-savings in the long-term. Truly integrated practices employ a well-managed infrastructure, aligned incentives, coordinated IT tools, and a culture of partnership and collaboration. But there is a great possibility that hospitals are primarily motivated by the prospect of greater bargaining power with insurers, and are not truly integrating.

State Attorneys General should renew a focus on anti-trust legislation to protect the strained wallets of healthcare consumers in states where transactions are occurring. In a time of seismic shifts in care delivery and payment mechanisms, we need to keep the patient at the center of health activity and ensure that transactions do not further burden consumers in an already expensive system.

Emily Cerciello is the Roosevelt Institute | Campus Network Senior Fellow for Health Care, and a senior at the University of North Carolina at Chapel Hill.

 

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Daily Digest - November 24: How to Win Minimum Wage Fights

Nov 23, 2014Rachel Goldfarb

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The Fight for $15.37 an Hour (NYT)

Steven Greenhouse explains how the Los Angeles Alliance for a New Economy won its campaign to get hotel workers in L.A. a significantly higher minimum wage.

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The Fight for $15.37 an Hour (NYT)

Steven Greenhouse explains how the Los Angeles Alliance for a New Economy won its campaign to get hotel workers in L.A. a significantly higher minimum wage.

Elizabeth Warren Tells NY Fed President: Fix Your Problems, Or We’ll Find Someone Who Will (Buzzfeed)

At the Senate Banking Committee on Friday, the four senators in attendance – all Democrats – pushed back hard on William Dudley's framing of his work as a "fire warden," reports Matthew Zeitlin.

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Paul Vigna writes about a new report examining how executive compensation lines up with company performance. It turns out that most companies don't measure success very accurately.

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The GOP Controls Congress So Now It Can Change How Math Works (MoJo)

The Republicans' preferred method of calculating budget projections uses impossible predictions about economic growth, writes Erika Eichelberger, making tax cuts appear less costly.

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Bigger Health Care Providers Mean Bigger Profits, But Not Always Better Care

Roosevelt Institute | Campus Network Senior Fellow for Health Care Emily Cerciello calls on state attorneys general to consider whether hospitals that buy up physicians' practices are violating anti-trust laws.

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Daily Digest - October 24: Redefining Corporate Goals Could Rein in CEO Pay

Oct 24, 2014Rachel Goldfarb

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Understanding the CEO Pay Debate: A Primer on America's Ongoing C-Suite Conversation (Roosevelt Institute)

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Understanding the CEO Pay Debate: A Primer on America's Ongoing C-Suite Conversation (Roosevelt Institute)

In their primer, Roosevelt Institute Fellow Susan Holmberg and Campus Network member Michael Umbrecht suggest a shift away from shareholder primacy to reduce incentives for high CEO pay. 

One-Third of Top Websites Restrict Customers’ Right to Sue (NYT)

Jeremy B. Merrill reports on major consumer websites that restrict customers' ability to take legal action, even when the companies engage in harmful activity like conspiring to fix hotel room prices.

Majority of Bank Risk Managers Are Worried About the Wealth Gap (WSJ)

Nick Timiraos looks at a new study on bank risk managers' concerns regarding the health of our financial system. Only 14 percent think inequality doesn't pose any threat at all.

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Kara Dansky profiles Salt Lake City's shift to a Housing First model, which recognizes that long-term housing for the homeless is cheaper than standard interventions like shelters and emergency services.

The Terrifying Idea That the Economy Might Stay Stuck Forever Just Got More Terrifying (WaPo)

Matt O'Brien lays out a new study's model for secular stagnation -- i.e., a potentially never-ending economic slump -- in the U.S., and explains what will be needed to break the cycle.

Fed’s Loan Scrutiny Leaves Banks Passing on Buyout Deals (Bloomberg News)

Christine Idzelis and Alex Sherman report that the big banks' decision to pass on high-scrutiny deals is opening up opportunities for their smaller competitors.

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The Phenomenology of Google's Self-Driving Cars

Roosevelt Institute Fellow Mike Konczal says that driving requires some unconscious and reflexive learning that artificial intelligence just can't duplicate, and that will create an obstacle for driverless cars.

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Obama Administration Defends Amazon’s Low Pay – Again

Oct 9, 2014Richard Kirsch

It's hard for workers to trust the President's support for policies that help them when the administration sides with Amazon at the Supreme Court.

Amazon’s business model is based on quick easy buying and low prices. One way it does that is to force its warehouse workers to wait a long time to leave work, without getting paid. And that’s just fine with the Obama administration, which continues to have a blind spot when it comes to decent pay and working conditions at Amazon.

It's hard for workers to trust the President's support for policies that help them when the administration sides with Amazon at the Supreme Court.

Amazon’s business model is based on quick easy buying and low prices. One way it does that is to force its warehouse workers to wait a long time to leave work, without getting paid. And that’s just fine with the Obama administration, which continues to have a blind spot when it comes to decent pay and working conditions at Amazon.

Yesterday the Supreme Court heard a case (Integrity Staffing Solutions v. Busk) in which workers are suing the temp firm that staff’s Amazon warehouses. The workers are in court because they don’t get paid for the time they are forced to stand on line for a security check when they leave work to be sure they haven’t stolen anything. The security screening itself reveals the poor working conditions and lack of respect that Amazon has for its workers. Workers who are well paid and have job security will not take the risk of stealing. The lack of pay adds costly insult to their injury.

The legal issues revolve around whether the security screenings, which can take 20 minutes or more, are “integral and indispensable” to the job, which would trigger pay under the Fair Labor Standards Act. Amazon certainly thinks so; the screenings aren’t optional. Still the firm, which pays warehouse workers around $11 or $12 an hour, cheaps out by denying the workers pay when they are waiting on line to leave.

As Jesse Busk, the lead plaintiff in the case, told The Huffington Post, "You're just standing there, and everyone wants to get home. It was not comfortable. There could be hundreds of people waiting at the end of the shift."

While President Obama has made numerous passionate speeches about giving Americans a raise, his administration is taking Amazon’s side at the Supreme Court, filing an amicus brief, alongside the U.S. Chamber of Commerce and other business lobbies.

Unfortunately, there’s nothing new about this from the administration. Last August, as I wrote at the time, “President Obama gave a great speech on why good jobs are the foundation for his middle-out economic strategy... from a huge Amazon warehouse where the workers do not have good jobs.”

The President told the Amazon warehouse workers who were in the audience, “we should be doing everything we can as a country to create more good jobs that pay good wages.”

Everything, it turns out, except being sure they get paid for all the time they are required to be at work.

The Obama administration may wonder why the President does not get more credit for the economic progress the nation has made coming out of the Great Recession or more recognition for his calls for raising the minimum wage. The core reason is that for too many Americans too low wages, too few hours at work, and job insecurity or no job at all remain their reality.

The President’s defense of Amazon reveals another reason. Americans see that he is unwilling to take on the powerful forces that are driving down the living standards and hopes of American workers. They see his embrace of Amazon and Wal-Mart, where he gave a speech on energy earlier this year. And too many come to the conclusion that it is only campaign contributors that matter, despairing of finding leaders who understand what really is going on in their lives – and who are willing to take their side against the powerful.

Richard Kirsch is a Senior Fellow at the Roosevelt Institute, a Senior Adviser to USAction, and the author of Fighting for Our Health. He was National Campaign Manager of Health Care for America Now during the legislative battle to pass reform.

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Daily Digest - October 2: Democracy Has Become a Luxury Purchase

Oct 2, 2014Rachel Goldfarb

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This Edition: K. Sabeel Rahman, Four Freedoms Center (Eldridge & Co.)

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This Edition: K. Sabeel Rahman, Four Freedoms Center (Eldridge & Co.)

Ronnie Eldridge speaks with Roosevelt Institute Fellow Sabeel Rahman about why democracy isn't working right now. He says public policy is mostly responding to the needs of the wealthy.

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  • Roosevelt Take: On Next City, Roosevelt Institute | Campus Network National Director Joelle Gamble argued for a stakeholder model of corporate governance to force companies to pay more attention to local communities.

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The death of Maria Fernandes, a part-time employee at three different Dunkin' Donuts stores, highlights the crisis created by low-paying employers, writes Jana Kasperkevic.

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Wendy R. Weiser highlights the variety of new voting laws which will serve to suppress the vote in 2014, pointing at North Carolina, Texas, and Wisconsin as the most important states to watch.

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Daily Digest - September 16: It's Time to Rethink the Purpose of Corporations

Sep 16, 2014Rachel Goldfarb

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The Overpaid CEO (Democracy)

Roosevelt Institute Fellow Susan Holmberg and Mark Schmitt argue that exorbitant executive pay cannot be addressed without reconceptualizing a corporation as more than just an agent of its shareholders.

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The Overpaid CEO (Democracy)

Roosevelt Institute Fellow Susan Holmberg and Mark Schmitt argue that exorbitant executive pay cannot be addressed without reconceptualizing a corporation as more than just an agent of its shareholders.

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Roosevelt Institute Chief Economist Joseph Stiglitz argues that Scotland should base its decision about independence on values rather than short-run economic gains or losses.

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Lauren Weber looks at a new study on pensions, which suggests that the increase in influential investors who buy large blocks of stocks is tied to dropped pension plans.

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A new study from Standard & Poors shows the impact of inequality on state budgets, writes Josh Boak. S&P says that changing state tax codes won't be enough to solve this problem.

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Paul Kiel looks at the rise of wage garnishment for consumer debts, a system that has few protections for debtors and causes great financial hardship, since up to 25 percent of a paycheck can be taken.

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Daily Digest - September 4: On Corporate Boards, Local Stakeholders Protect Local Interests

Sep 4, 2014Rachel Goldfarb

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Fighting Corporate Inversion at the City Level (Next City)

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Fighting Corporate Inversion at the City Level (Next City)

Roosevelt Institute | Campus Network National Director Joelle Gamble argues for linking tax exemptions to local stakeholder governance on corporate boards to increase corporations' ties to their communities.

Guards Need Job Security of Their Own, Say Apple Store Protesters (In These Times)

Julia Carrie Wong reports on a union protest last week that aimed to garner public attention around Apple's use of subcontracted security guards who receive low wages and few, if any, benefits.

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The structure of the Education Department's contracts with debt collectors encourages abuse by paying less for services like income-based repayment plans, writes Molly Hensley-Clancy.

The Huge, Regressive Tax Break Right Under Your Roof (TNR)

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Nick Carnes, using examples from his book White Collar Government, explains how the wealthiest Americans' control of the political system impacts policy outcomes.

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When higher-skilled workers take low-skill jobs, the trickle-down effects exasperate inequality, reports Pedro da Costa, according to new research from economists in Barcelona.

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Daily Digest - August 29: A Rising Minimum Wage Lifts All Boats

Aug 29, 2014Rachel Goldfarb

There will not be a new Daily Digest on Monday, September 1, in observance of Labor Day. The Daily Digest will return on Tuesday, September 2.

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Who Stands to Benefit from San Diego’s Minimum Wage Hike (Voice of San Diego)

There will not be a new Daily Digest on Monday, September 1, in observance of Labor Day. The Daily Digest will return on Tuesday, September 2.

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Who Stands to Benefit from San Diego’s Minimum Wage Hike (Voice of San Diego)

Lisa Halverstadt speaks to Roosevelt Institute Fellow Annette Bernhardt about her research team's estimate that 172,000 workers could get a raise from San Diego's minimum wage hike.

The Biggest Tax Scam Ever (Rolling Stone)

Tim Dickinson looks at the range of multinational tax avoidance strategies in use today, from inversions to offshoring. It's all legal, he says, but the law itself is broken.

De Blasio Zeroes in on Expanding Living Wage (Capital New York)

New York City's mayor looks to require more businesses, including retail tenants of subsidized developments, to pay a living wage, report Dana Rubinstein and Sally Goldenberg.

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After months of employee protests on his behalf, Market Basket's former CEO has bought out his cousins to regain control. Jana Kasperkevic says he'll face new challenges from shareholders.

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The labor union president wants 2016 candidates to avoid economics advisors who have participated in the revolving door of government and Wall Street, reports Eric Morath.

Americans Foresee Unending Economic Doom (Vox)

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The new law establishes civil rights protections for pregnant workers, which will help them to stay in the workplace if they want to, writes Michelle Chen.

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Daily Digest - August 28: Read This Before Your Internet Goes Out

Aug 28, 2014Rachel Goldfarb

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Time Warner Cable Internet Outage Affects Millions (Vanity Fair)

Kia Makarechi speaks to Roosevelt Institute Fellow Susan Crawford, who says that lack of competition and oversight leads to problems like yesterday's Internet outage on the East Coast.

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Time Warner Cable Internet Outage Affects Millions (Vanity Fair)

Kia Makarechi speaks to Roosevelt Institute Fellow Susan Crawford, who says that lack of competition and oversight leads to problems like yesterday's Internet outage on the East Coast.

How Obamacare Can End Bloated CEO Pay (Fortune)

A little-known provision in the Affordable Care Act closes the executive performance pay loophole, but just for insurance companies, writes Sarah Anderson.

The Sorry State of Bank Apologies (ProPublica)

Non-specific corporate apologies are becoming de rigueur in settlements with banks, but Jesse Eisinger says these apologies aren't enough to resolve the banks' bad behavior.

The Expanding World of Poverty Capitalism (NYT)

Thomas Edsall defines poverty capitalism as the shifting of the costs of essential government onto the poor, as in offender-funded law enforcement systems in places like Ferguson, MO.

Court Finds FedEx Drivers are Employees, not Independent Contractors (Sacramento Business Journal)

A federal appeals court's ruling on this class-action suit may require FedEx to pay 2,300 drivers millions of dollars in back pay, uniform and truck costs, and more, writes Kathy Robertson.

40 Percent of Restaurant Workers Live in Near-Poverty (MoJo)

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Daily Digest - August 27: The Known Unknowns of Unemployment

Aug 27, 2014Rachel Goldfarb

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A New Reason to Question the Official Unemployment Rate (NYT)

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A New Reason to Question the Official Unemployment Rate (NYT)

A new report says that unemployment data has become less accurate over the past 20 years, in part because of declining survey response rates, writes David Leonhardt.

Objecting to Austerity, French Style (New Yorker)

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Recently analyzed data from a 1970s Canadian experiment in guaranteed basic income shows far-reaching benefits in health and education, writes Benjamin Shingler.

Companies Say ‘No Way’ to ‘Say on Pay’ (WSJ)

Emily Chasan examines the companies that have repeatedly failed Say-on-Pay shareholder votes on their executives' pay packages, and what they have in common.

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SEIU Wins Election To Represent Minnesota Home Care Workers (HuffPo)

Dave Jamieson says that yesterday's vote, which created Minnesota's largest public-sector bargaining unit in history, shows that unions are not letting Harris v. Quinn slow organizing.

Burger King’s Supremely American Habit (MSNBC)

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Catherine Saillant reports on business opposition to the Los Angeles mayor's plan, which would raise the city's minimum wage to $13.50 over three years and then tie it to local inflation.

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