Large health systems have widely acquired providers of other types, mostly physician practices, but also home health care and skilled nursing companies. The primary justification for these acquisitions, no matter what the hospital system says, is to force referrals into the hospital and to enhance market power to allow for higher prices. And that is exactly what happens following such acquisitions according to the research, including this new study in JAMA. The study was conducted in Massachusetts and compared acquired practices to those that remained independent. The study examined referrals and prices after a health system acquired a primary care physician practice. The consequences of the acquisition included more specialist referrals, ER visits and hospitalizations within the health system; and higher total patient spending, about $350 a person a year or around 6%. By one measure of quality, hospital readmissions, there was no change. So while the acquisition didn’t negatively affecte quality, it didn’t improve it either, and such quality improvement is one justification hospitals use for these acquisitions. (JAMA Article)
My belief is that the health system is better off with a truly competitive situation in which there are multiple hospitals in an area and those hospitals are not allowed to purchase other provider types. This likely lowers prices and spending and improves quality by giving patients and payers more choice. While there are limits to consumers ability to make informed health care choices, most people if given the right data can understand and use it. And payers certainly can help their members with those choices. To me an obvious remedy to control health spending is to force the breakup of these massive horizontal and vertical health systems.