Surge in hospital-owned physician practices poised to increase healthcare costs

http://www.healthcaredive.com/news/surge-in-hospital-owned-physician-practices-poised-to-increase-healthcare-c/425881/

  • Independent physicians and physician-owned practices could soon become a rare breed, suggests a new analysis by Avalere Health and the Physicians Advocacy Institute (PAI) released Wednesday.
  • The study found the percentage of physicians employed by hospitals or health systems rose 86% from 2012 to 2015, from 95,000 to more than 140,000.
  • As of mid-2015, 38% of all U.S. physicians were employed by hospitals and health systems, findings show.
  • Also from 2012 through 2015, hospitals acquired 31,000 physician practices, resulting in one in four medical practices being hospital-owned.

Mylan’s CEO A Villain? Depends On Your Preferred Brand Of Capitalism

http://healthaffairs.org/blog/2016/09/06/mylans-ceo-a-villain-depends-on-your-preferred-brand-of-capitalism/

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Different Flavors Of Capitalism

As usual, the answer is a clear “No” and “Yes,” and resolving the question raises much deeper issues than one executive’s personal culpability. The answer depends on what definition of capitalism one deems appropriate. As the European economist André Sapir has noted, there are actually four distinct brands of capitalism in the Western economy, of which the version practiced in the United States and some other Anglo-Saxon countries—sometimes also referred to as “savage capitalism”—is but one.

The clearest version of raw Anglo Saxon capitalism, and one quoted widely to this day, was offered by the late Nobel Laureate economist Milton Friedman in his classic book “Capitalism and Freedom.” There he proposed that the one and only social obligation to society that the CEO of an investor-owned, for-profit company is “to maximize its profits while engaging in ‘open and free competition without deception and fraud.’” (Quoted in Thomas Carson’s “Friedman’s Theory of Corporate Social Responsibility.”) On that view, any corporate action that is legal is ipso facto ethical.

Ms. Bresch can argue that with her aggressive pricing policy on EpiPen she was merely owning up to this doctrine of Anglo-Saxon capitalism. Her board of directors may or may not have known about that policy with regard to this particular product, one of many the company sells. Here Ms. Bresch also can point out that she is in good company in the drug industry. Many drug companies beyond the poster-boys for what is now decried as “price gouging”—Valeant Pharmaceuticals International and Turing Pharmaceuticals—have adopted raw Anglo-Saxon capitalism as the intellectual foundation for their pricing policies by steadily raising prices on long existing drugs, year after year, or even quarter after quarter.

What 4 health system CEOs think of hospital consolidation

http://www.beckershospitalreview.com/hospital-transactions-and-valuation/good-bad-or-too-tough-to-say-what-4-health-system-ceos-think-of-hospital-consolidation.html

Market Power

There is a great deal of consolidation occurring in the healthcare industry today, and whether that is good or bad news to health system CEOs depends on their organization’s market and M&A track record.

During a panel discussion at the Becker’s Hospital Review 4th Annual CEO Roundtable + CFO/CIO Roundtable in Chicago, Chuck Lauer, former publisher of Modern Healthcare, asked the speakers to offer their thoughts on provider consolidation.

Here’s how CEOs responded.

The rise of ‘super regional systems’ and what it means for healthcare

http://www.beckershospitalreview.com/hospital-transactions-and-valuation/the-rise-of-super-regional-systems-and-what-it-means-for-healthcare.html

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Consolidation has touched all facets of healthcare, including hospitals of all sizes, medical groups and insurers, and this trend will significantly affect the industry as a whole.

Mergers, acquisitions and other types of partnerships are critical as hospitals focus on providing coordinated, cost-effective care. There has been an increase in hospital M&A in recent years, with transactions rising 18 percent in 2015 compared to the year prior, according to an analysis by Kaufman, Hall & Associates.

Through consolidation, hospitals become more efficient and, many times, improve care quality. However, consolidation also increases leverage and causes revenue to rise. This has led to the creation of “super regional systems,” says Gregory F. Hagood, senior managing director and president of SOLIC Capital. This trend is noted in almost every major market, but it is most visible in metro areas like Chicago.

Rise Of The Megamergers: Inside The Record Year For Healthcare M&A

http://www.forbes.com/sites/baininsights/2016/08/22/rise-of-the-megamergers-inside-the-record-year-for-healthcare-ma-infographic/#660b429b5a8b

Healthcare M&A Is Growing Fast [Infographic]

http://www.bain.com/publications/articles/global-healthcare-private-equity-and-corporate-ma-report-2016.aspx

 

42 hospital transactions and partnerships in August 2016

http://www.beckershospitalreview.com/hospital-transactions-and-valuation/42-hospital-transactions-and-partnerships-in-august.html

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The following hospital mergers, acquisitions and general transactions took place or were announced in August.

Top 10 Medicaid insurers represent over half of U.S. managed care market

http://www.beckershospitalreview.com/payer-issues/top-10-medicaid-insurers-represent-over-half-of-u-s-managed-care-market.html

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Fifty-seven percent of the U.S.’s managed Medicaid market is held by the top 10 Medicaid insurers, an analysis from a Washington, D.C., publishing and information company Atlantic Information Services found.

AIS’ Medicare and Medicaid market data found four of the top 10 payers are involved in mergers and acquisitions that may allow them to gain more market share. Specifically, Hartford, Conn.-based Aenta’s proposed acquisition of Louisville, Ky.-based Humana would allocate more than 400,000 Medicaid beneficiaries to Aetna, if the deal is not blocked by the U.S. Department of Justice. In addition, the third ranked insurer, St. Louis-based Centene, acquired Woodland Hills, Calif.-based Health Net in July, leaving the resulting entity with the highest market share.

Here are the top 10 insurers with the most Medicaid beneficiaries and market share.

A timeline of eye-popping drug prices

http://www.usatoday.com/story/news/2016/08/25/timeline-eye-popping-drug-prices/89335852/

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The firestorm over steep price increases for the EpiPen — which can rescue people having life-threatening allergic reactions  — is just the latest in a long line of controversies over high prescription drug prices. A decade ago, much of the concern over prescription drug prices involved new high-tech cancer drugs, used by only a few thousand patients a year. In recent years, the prices for decades-old generic drugs have soared, as well, as pharmaceutical companies purchase the rights for drugs with no competition.

Here’s a recap of some of the most eye-popping prices.

Pfizer’s Involvement in EpiPens Could Complicate Drug Price Debate

https://morningconsult.com/2016/08/26/pfizers-involvement-in-epipens-could-complicate-drug-price-debate/

cnythzl/iStock.com

Mylan Pharmaceuticals has come under intense fire for massive price hikes of EpiPens over the last week, facing scrutiny from lawmakers and industry groups. It is less well known, however, that while Mylan markets and prices the drug, Pfizer Inc. actually manufactures the drug and has seen increased revenues from EpiPens over the last few years.

The financial relationship between the two drug companies is unclear, and Pfizer declined to elaborate. Mylan did not respond to a request for further comment about EpiPens or how the two companies divide revenues.

“Meridian Medical Technologies is the contract manufacturer of EpiPen and takes great pride being able to supply a high quality and life-saving product. The terms of our supply agreement are confidential,” said Rachel Hooper, a Pfizer spokeswoman. Meridian Medical Technologies is a Pfizer subsidiary.

The EpiPen outrage centers around a 400 percent hike for the dispenser, used for emergency allergic reactions, since 2009, even though the product remains unchanged. It now costs as much as $600 for a pack of two EpiPens, which must be replaced every 12 to 18 months.

Why A Single-Payer Healthcare System Is Inevitable

http://www.huffingtonpost.com/entry/why-a-single-payer-healthcare-system-is-inevitable_us_57bb38d0e4b0b51733a4e665?&utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=33278487&_hsenc=p2ANqtz–pFhM1yVmgKE5kBJSkJqgzGm6EX86cVbU_jxP8glbnNrQH2CY9ktk8qbzIisOdLEgV0JX5fgsxqoDwrFym5ZxmTnCJOw&_hsmi=33278487

The best argument for a single-payer health plan is the recent decision by giant health insurer Aetna to bail out next year from 11 of the 15 states where it sells Obamacare plans.Aetna’s decision follows similar moves by UnitedHealth Group, the nation’s largest health insurer, and by Humana, another one of the giants.

All claim they’re not making enough money because too many people with serious health problems are using the Obamacare exchanges, and not enough healthy people are signing up.

The problem isn’t Obamacare per se. It lies in the structure of private markets for health insurance – which creates powerful incentives to avoid sick people and attract healthy ones. Obamacare is just making this structural problem more obvious.

In a nutshell, the more sick people and the fewer healthy people a private for-profit insurer attracts, the less competitive that insurer becomes relative to other insurers that don’t attract as high a percentage of the sick but a higher percentage of the healthy.

Eventually, insurers that take in too many sick and too few healthy people are driven out of business.

If insurers had no idea who’d be sick and who’d be healthy when they sign up for insurance (and keep them insured at the same price even after they become sick), this wouldn’t be a problem. But they do know – and they’re developing more and more sophisticated ways of finding out.