, Biden’s EO Is Too Little Too Late, But We Can Increase Competition In Other, More Meaningful Ways, The Nzuchi News Forbes

Biden’s EO Is Too Little Too Late, But We Can Increase Competition In Other, More Meaningful Ways

, Biden’s EO Is Too Little Too Late, But We Can Increase Competition In Other, More Meaningful Ways, The Nzuchi News Forbes

Earlier this month, President Biden put out an “Executive Order on Promoting Competition in the American Economy,” which called on the Justice Department and FTC to review and revise merger guidelines to ensure that healthcare players are still forced to compete over patients’ best interests.

Increasing scrutiny over consolidation in healthcare is needed, but quite frankly, it’s too little too late.

Hospital consolidation isn’t new. Bringing Value to Healthcare recalls how hospitals had “embarked on massive affiliations and buying sprees” in the 1990s in order to, they claimed, increase productivity as well as profitability. Few acquisitions delivered on their expectations for the purchasing provider, and though many may have promised that the union would decrease consumers’ healthcare costs, the opposite occurred. In a 2010-2013 analysis of 25 metropolitan areas with the highest rates of horizontal consolidations – that is, consolidations between two hospitals or health systems – the cost of the average hospital stay by private insurance increased in most areas between 11%-54% in the years that followed.

To an extent, that damage has already been done. Unlike other industries where consumers can tell what they are spending money on up front, in healthcare, consumers have grown accustomed to being left in the dark when it comes to evaluating the healthcare services they consume. A fundamental disregard for transparency is the norm, as is a system that has been largely paternalistic and opaque.

Only recently – and because costs have gotten so far out of control – have consumers begun to call for change. Where before they were less inclined to speak out on the issue because “somebody else,” i.e. their insurer, was paying, today, consumers aren’t afraid to send reporters their “surprise” medical bills – bills with expensive fees or out-of-network charges from an in-network hospital. If it were from anyone outside of a healthcare provider – an auto dealer, TV repair person, internet provider, landscaping company, etc. – consumers would have never accepted these surprise bills for nearly as long as they’ve tolerated them in healthcare.

All this is to say that the last few decades of consolidation have already done their damage on consumers. And the problems consumers currently have with high costs and lagging quality won’t be fixed by scrutinizing future consolidations alone, or by long court battles to unwind consolidations that have already been approved. There are other, more meaningful ways to improve care by instead enabling market-based competition over two things: healthcare costs and healthcare quality.

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The Trump administration started to make progress on the former via the hospital price transparency rule that went into effect in early 2022. President Biden has wisely said that he would support that rule, but there’s more that can be done here. A starting point would be more robust enforcement than we have seen from this administration to date. Earlier this year, a systematic survey showed that 65 out of the country’s largest 100 hospitals were noncompliant with the transparency rule.

, Biden’s EO Is Too Little Too Late, But We Can Increase Competition In Other, More Meaningful Ways, The Nzuchi News Forbes

And once the data is posted, the next milestone would be making it comprehensible. Just a few weeks ago when Kaiser Health News’ Bernard J. Wolfson reported on his efforts to price shop for himself, he concluded:

“After three months of glazed eyes and headaches from banging my head against walls of numbers, I am throwing in the towel. It was a fool’s errand. My efforts ultimately yielded just one helpful piece of advice: Don’t try this at home.”

The Centers for Medicare and Medicaid Services (CMS) announced recently that it would be increasing the fines for those systems that aren’t complying to the hospital price transparency rule – a step in the right direction where transparency is concerned. However, to really get to consumers’ core concern, there must also be a hospital outcomes transparency rule. After consumers have an idea of what certain healthcare services will cost, then the next logical step is for them to be able to understand what level of performance they are getting for the price.

To be clear though, these outcomes aren’t solely dependent on hospital performance. Patient well-being outside of the healthcare system is equally important. If consumers in a particular area don’t have access to shelter, transportation and/or healthy foods, that will have an impact on the outcomes data of their local healthcare providers. An ounce of prevention is worth a pound of cure, and we need to better address social determinants of health and make it easier for consumers to access such upstream support.

Insufficient access to behavioral health services will also have an impact. Anxiety, depression and other behavioral health issues can snowball out of control if left unaddressed. And when that happens, interrupted sleep patterns and disrupted eating habits can quickly cause physical well-being to deteriorate.

Giving consumers access to more physical and behavioral health supports – not just to the same, fundamentally flawed healthcare system – would be a step forward for this country, assuming consumers make use of those services. As we are now seeing with Covid-19 vaccines, without a clear understanding of the scientific benefits to such interventions, consumers may neglect to act, and population health suffer as a result.

Pushing back against healthcare consolidation isn’t the only way to increase competition in healthcare, nor is it the most effective. If the goal is to improve care, competition should be over costs and quality – and all of us should play our part. If hospitals and health systems choose not to cooperate, not-in-kind competitors will continue to chip away at the business that was theirs to lose.

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