Secret Healthcare Deals

This Wall Street Journal article will turn your stomach nicely.  If you can’t read it then here are some lowlights:

  • Dominant hospital systems use an array of secret contract terms to protect their turf and block efforts to curb health-care costs. As part of these deals, hospitals can demand insurers include them in every plan and discourage use of less-expensive rivals. Other terms allow hospitals to mask prices from consumers, limit audits of claims, add extra fees and block efforts to exclude health-care providers based on quality or cost.
  • The Wall Street Journal has identified dozens of contracts with terms that limit how insurers design plans, involving operators such as Johns Hopkins Medicine in Maryland, the 10-hospital OhioHealth system and Aurora Health Care, a major system in the Milwaukee market. National hospital operator HCA Healthcare Inc. also has restrictions in insurer contracts in certain markets.
  • Certain hospital systems are able to command advantageous terms because they have grown through years of deal-making, shifting the balance of power between hospitals and insurers. In 2010, the year the Affordable Care Act passed, the annual number of hospital mergers shot up 40% to 59, and the number of deals has remained above 60 every year since, according to Irving Levin Associates, a research firm that tracks health-care transactions.
  • “If you’re the single hospital system in an area, you essentially can set your price, because you’re a monopoly.”
  • Among the secret restrictions are so-called anti-steering clauses that prevent insurers from steering patients to less-expensive or higher-quality health-care providers. In some cases, they block the insurer from creating plans that cut out the system, or ones that include only some of the system’s hospitals or doctors. They also hinder plans that offer incentives such as lower copays for patients to use less-expensive or higher-quality health-care providers. The restrictive contracts sometimes require that every facility and doctor in the contracting hospital system be placed in the most favorable category, with the lowest out-of-pocket charges for patients—regardless of whether they meet the qualifications.

I love that we, as physicians, are watched liked hawks for conflicts of interest.  We are at the whim of the state medical board if there is ONE complaint.  We can be audited and fined for any coding issues.  We are blamed for the opioid crisis and are being penalized for it.  We can’t refer to facilities we own and we can’t open surgical centers without massive legal action.  But these hospitals and insurers are making back room deals that continually increase the cost of healthcare and nothing will ever happen to them.

It makes me sick.  Your thoughts?

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