美国企业研究所-医院整合的政策解决方案

November2022heightofthepandemicwitInthiscontextpolicymakatelybeguntoquestionthemarketpowerdrugpriceshealthcareicantportionofthenationshealthcareexptureswithhospitalcareNinetypercentofmetropolitanstatisticalMSAsrepresenthighlycosionFTCandDepartmentofJustiTheexerciseofhospitalmarketpowerisnotjustinthelocalpaperWiththousanmarginofnearlylopercentorfourallyresolvedalbeitwiththetermsotheharmsofhospitalconsolidationgoveTheharmsofhospitalconsolimergersofgeographicallyclosehospitalpricesultimatelydrivehighermarketplacesUnfortunatelyrisingofrisingcosts.AspartofanaturalmarketresponsehealengineeringareoftenusedtojustWhiletraditionalmeasurconsolidationwithmanyhealthpincludingphysiciansnursesanfreemovementoflaborthroughtheuseofnon-practiceenvironmentdrivephwithovertwothirdsofphysiciansFinallyinnovationlosmeasureareanotherharmofhospitalconsationsandadministrativelightonthemagnitudeofthisprproductshasdrivenmuchofthepast3oyearsofinfarctionheartattackordemakersimplantablecardioverterdblockersangiotensinreceptorneprlengeofanticompetitivemergpolicingofanticompetitivecorporatebehavringannuallyprovidingtheFTCadeHSRAntitrustImprovementransactionorriskcivimergernotificationtonotingeneratingunnecessarytransactiontoreview.transactionsenforcementintheabsthegrowthofmanysmallbusinofAmericaninnovationandproductivity.AlternativepolicyinterventirentlyatopicoflegislatmentofHealthandHumanServistudycharacterizingpuserviceshospitalsambulatoulatoryreportingburdensforsmallbusicateofneed(CON)⁴0andcertificateofpublicreviewshospitalandphysicianincludingnonprofithospitalswhapproximatelyhalfofalldomestichospitals).42nonpreferredandoutofnetworkandtyevenoutofnetwork.withunclearmarketpenetrationThpayermarketswouldprovidenforcement.tendedconsequencePolicCliniciansandbeneficiariesjointvisitthephysiciancanbmentserviceIfahospitalpuambulatorypaymentclahighertotalreimbursementbutharmfultopatientswhoexneutralpaymentdrovehospitalacquisitionowasincludedaspartoftheBiparBBAofTheBBAprohibitednewofacilitiestriggeringamerrygoroundofhorulemakingandappealsoteralBudgetprojectedthatimtheproblem.Considerthecaseofthe“inpatientonlylistalistofproceduresffourelectivetotalhipandkneetorsshouldnotpreferentibanningtheuseofaninpatientPhysicianownedhospitalsPOpragmaticleverthroughwHouseofRepresentativestargetingthiscsmallnumberofphysicianstalsHospitalindustrycrapidlyemergedincludingacpensatedcare.pitalsservedunsurprisinglyhistoryofcardiacdiseasemoreMedicarepleofcardiacandorthopehospitalsprovidedlessunbenefitwasanorderofmaofthreeprimarysubmarketscarprematurelyterminatebenefitsofphysicianowners:Physician-ownedqualitywithphysicianownFinallyphysicianownedcommuqualityassociatedwithinchealthierpatientsisaproblejustthatinresponsetohospitalindhospitalsInCMSupdatedtheinprightthiswrongandprouseofphysicianownedservicespromptedovebitionofmanyclinicaloperationalpraclossofphysicianagencyandconcernsregardingbudgetarysustainaLawregulationstopromcostsremainwelloutsidetheopTodaypercentoftheMedicareprogracapitatedpublicprivateprohalfofMedicaidspendingischanneledthroughinduceddemand.todayisdifferentaspayincludingutilizationreviewprdemandthroughbundlingandhealthfinance.worldPatientsmanyofwhomexperienicaltherapisteventhoughthatsnotprofitcorporationsarelessself-interestedpartiesthanphysiciansare.Inmanycases,corporationsmandateorotherwiseenforcecorporateself-referralonphysicians,scoringprovidersbasedon“withinsystem”versusexternalreferrals.Yetthisveryactivitycanbepartofthekeytoofferinginte-gratedcaredeliveryasorganizationscancnateandsystematizecareforcomplexpatients.WhenphysicianownedantoryoversightRegulatbeneficiariesenrollediutilizationreviewpracticespreptheharmsofself-referral.centofnationalhealthcopercentofMSAsconsidhasdocumentedthemanyharmsofcaredeliveryconsolidatsharinghigherinsurancepremigainsanddecrementsinmBrianJMillerisanonresideJesseMEhrenfeldisaprofessorconsinHeisthedirectoroftheAdvancingaHealthiMedicalAssociationBoardofTrustees.MarissaPlesciaClevclhttps://finance/cleveland-clinic-s-operating-income-more-than-triples-in-2021.html.ErnstYoungConsolidatedFinancialClevelandClinicHealthSystemYearsEndedDecemhttps;//-/scassets/files/org/about/financial-statements/cchs-2021-w-ob-nonob.pdf?la-en.RobertKingClevclandClinicPostHealthcare,NovemberhttpswwwfiercehealthcarecomhospitalsclevelandclinicpostsprofitforfirstnineRobertKingClevelandClinicMakesDealwithSistersofCDecemberhttpswwwfiercchealthcarecomhospitalsclevelandclinicmakesdealsisterscharimedical-center.HeatherLandiClevelandClinicExpandsintoEuropewithOpeningofPrivateLondonHospitalncarBuckinghaFierceHealthcareMarchhttpswwwfiercehealthcarecomprovidersiclevelandclinicopensprivatelondonhospinear-buckingham-palace.CommitteeontheJudiciarySubcommittHospitalConsolidationConcernsandSolutionsMayhhospital-consolidation-concerns-and-solutions.BrentDFultonHealthCareMaAffairs36,no.9(2017):1530-38httpswwwhealthaffairsorgdoihlthaffTheHerfindahlHirschmanIndexHHIforAnHHIofzerorepresentsperfectcompetitionwhilconsideramarketabovetAnalysisofU.SHospitalMarketConcentrationJunehttpshealthcostinstituteorghccioriginalshmiinteractiveHMIConcentrationIndexandUSDepartmentofJusticeHerfindahlHirschmanIndexJulyhttpswwwjusticherfindahl-hirschman-index.MaineHealthMaineHealthGivesNoticetoBeginningin2023,”April7httpswwwmainehealthorgNewsMaincHealthgivesnoticetoremoveMaineMedical-Center-from-Anthem-health-insurance-network.Herald,June23,2022,https://20commentarytimeisrunningoutfordealbetweenanthemmainehealth-ceo-says.SceMaineHealthDataOrganizationHospitalFinancialInformationReportReport%2022020.pdf.Dive,March26,2021,httpswwwhealthcaredivecomnewshospitalmarginshithardbypandemicbutcaresactprovided/News/2022/08/MaineHealth-and-Anthem-Blue-Cross-and-Blue-Shield-in-Maine-Reach-Agreement.ofEconomics1nohttpsacademicoupcomqjcarticleabstractredirectedFromfulltextAffectHealthInsurancePremiumsJournalofHealthEconomicshttpswwwncbinlmnihgovpMarketplaces,"HealthAffairs4(20httpswwwhealthaffairsorgdoipdfhlthaffyearsandoverthelasttenyearsSeeKaihttps://report-scctionchbs-2020-summary-of-findings.KatherineBaickerandAmitabhChandraTheLaborMarketEffectsofRisiEconomicsnohttpswwwjournalsuchicagocdudoiabsmobileUiandDanieComplaintAdvocateHealthCareNetworkAdvocateHealHealthsystemFTCDocketNoDecemberhttpswwwftcgovsystemFederalTradeCommissionNonCompetesintheWorkplaceExaminingAntitrustandConsumerProtJanuary9,2020,https://newsevents/events/202noncompetesworkplaceexaminingantitrustconsumeroftheCOVIDPandemicMayoClinicProceedingshttpswwUSBurcauofLaborStatisticsPrivateCommunityHospitalsLaborProductivityhttpswwHealthCareMarketstestimonybeforetheCompetitioninStateHealthMarketsActthCongndJamesCCooperPaulAPautlerandToddJZywickiTheoryandPracticeofCompetitionAdvCommissionhttpswwwftcgoysitesdefaultfilesdocumentspubliceventsFTCthCAnniversarySyozywickipdfandFederalTradeCommissionStatsDatahttpswwwftcgovsystatsdataannualhighlightsstatsanddataiFederalTradeCommissionLegalLibraryAdvocacyFilingshttpswwwftcgovlegallibraUSDepartmentofJusticeCompetitionPolicyandAdvocacySectionAugusthttpswwwjusticdivision/cpa-section.MatthewDMitchellCertificateofNeedLawsHowTheyAffectUniversityMercatusCenterMayhttpswwwmercatusorgCertificateofNeedLawsHowTheyAffectHealthcaAccess-Quality-and-Cost.LinaMKhanetalFTCPolicyPerspecthttps://system/files/ftc-gov/pdf/COPAPolicyPaper.pdf.AmericanHospitalAssociationFastFactsonUHospitalshttpswwwahaorgstatisticsfastfactsushosp45.OversightofAnti-CompetitiveBchaviorofNon-ProfitHospitalsAct,H.R.8129,117thCong,,2ndsess.(2022),https://wwwAnnaDSinaikoVariationsinPatientResponsetoTieredPhysicianNetworksAmericanJournalo(2016):420-25,https://view/variations-in-patient-responsc-to-tiered-physician-networksUSDepartmentofJusticcAtriumHealthAgreestoScttleAntitRestrictionspressreleaseNovemberhttpswwwjusticegovopapratriumhealthagreessettleanticliminateanticompetitivesteeringandUnitedStatesofAmeriNationalAcademyforStateHealthPolicyNContractsAprilhttpswwwnashporgnashpmodelacttoaddressanticompetitivetcontracts.AddressingAntiCompetitiveContractingClausesActthCongndsesshttpswwwcongreCentersforMedicareMedicaidSServicesAugusthttpswwwcmsgovRescarchStatisticsDataandSystemsRescarchActuariaphysicianrcsponse:pdfMedicarePaymentAdvisoryCommissionOutpatientHPaymentandAmbulatoryS(November21,2018):58818,https://documents/2018/11/2medicarcprogramchangestohospitaloutpatientprospectivepaymentMedicarePaymentAdvisor/document/http-www-medpac-gov-docs-default-sourcereportsmaroentirereportsecpdf55.DepartmentofHealthandHumanServices,OfficeofInspectorGeneral,“HospitalOwnershipofPhysicianPractices,”SeptemberhttpsoighhsgovocireportsocipdfandDepartmentofHealthandHhttpsoighhsgovocireport56.BipartisanBudgetActof2015,PubL.No.117-74§603,https://bill/114th-congress/house-bill/1314.CentersforMedicareMedicaidServicesCMSFinalizesRuleThatEncourpressrelease,November2,2018,https://newsroom/press-releases/cms-finalizcsruleencouragesmorechoiccsandlowercostsseniorsandCenterProspectivePaymentandAmbulatoryS//2018-24243-pdf.httpswwwfiercehealthcarecomhospitalshealthsystemsjudgestrikesdowntrumpadministrationsitpayments-rule.CentersforMedicareMedicaidServicesCYMedicareHospitalOutpatientProspectivePaymentSyCommunitybenefitrepresentedpercentofrevenueforcardiacphysicianownedhospitalsPOHspercentrevenuefororthopedicPOHsandDrug,Improvement,andModernizationActof200TablehttpswwwcmsgovMedicareFraudandPatientProtectionandAffordableCareAcHealthcareforAmericaImpactofImplementationofSectionoolFebruaryhttpsphysiciansledcScrviceCharacteristics,”JAMA268,no.15(1992httpspubmedncbinlmnihgovandBHillmanctalFrequencyandCostsofDiagnosticImagin77HaaviMorreimConflictsofInterestProfitsandProblemsinPhysicianReferralsJAMAhttpsjournalsjama/article-abstract/378029.OmnibusBudgetReconciliationActofPubNoandOmnibusBudgetReconL.No.103-66(1993).HealthCareFinancingAdministrationMedicareProgra