Over 70% of physicians are now employed by a health care system or corporate entity, including publicly traded and private equity firms. Research to date shows that consolidation has increased health care prices with limited impact on quality or access to care. Yet the impact of consolidation is highly heterogeneous across market conditions. Research at CAHPR aims to inform policy by understanding this evolving landscape that has critical implications for competition, choice, access, and the structure of health care services.
Center for Advancing Health Policy through Research
Markets and Consolidation
While the health care industry has been consolidating for two decades, a number of trends are changing how physician markets are organized and how various stakeholders are impacted.
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Dr. Yashaswini Singh, Assistant Professor at Brown University, presented findings from a study on private equity (PE) in Maryland physician practices, mandated by Maryland’s 2024 legislation (HB 1388). The study analyzed PE trends, geographic penetration, affected communities, and PE-affiliated physicians' participation in payer networks and value-based programs. Erin Fuse Brown provided NASHP-based policy recommendations focused on enhancing oversight of healthcare transactions, protecting healthcare workers through stronger CPOM laws and limiting covenant restrictions, and increasing ownership transparency.
Recent News
The article covers a study published in JAMA Health Forum by Yashaswini Singh and colleagues on the increasing affiliation of primary care physicians with hospitals and private equity firms, leading to higher patient costs without clear improvements in care quality or physician compensation.
This article discusses a study led by Dr. Yashaswini and published in JAMA Health Forum on trends in physician practice ownership, showing a significant shift from independent practices to corporate ownership, as well as the associated price increases, with hospital and PE-affiliated practices charging higher fees, and its implications for healthcare costs and quality.
This article highlights the study led by Dr. Yashaswini Singh on the growing affiliation of primary care physicians with hospitals and private equity firms along with increasing healthcare costs that come with these affiliations.
The Oregonian/OregonLive
Doctors unions, like the one on strike at Providence, are growing more common
Physicians, traditionally less unionized, are aligning with nurses and other healthcare workers due to shared grievances over understaffing, burnout, and corporate cost-cutting practices exacerbated by the pandemic. Hayden Rooke-Ley comments on this trend highlighting his study that found that the number of physician unions formed between January 2023 and May 2024 nearly equaled those established over the previous two decades (2000–2022).
A new Harvard Medical School study found that patient satisfaction declines after PE takeovers due to cost-cutting measures, including staffing reductions. Dr. Yashaswini Singh from CAHPR comments on how patient experiences are crucial to understanding the broader effects of PE in healthcare, a frequently underrated aspect in studies on PE's impact on healthcare.
The article discusses the proposed merger of Oregon Health & Science University (OHSU) and Legacy Health, which has drawn significant criticism for potentially violating federal antitrust standards. Advocates argue the merger would lead to excessive market consolidation in Oregon, controlling a majority of hospitals in key regions and potentially driving up healthcare costs without improving access or quality.
healthleaders
Critical Access Hospitals Feel Unique Financial Strain
This article highlights a study led by Dr. Christopher Whaley that shows that while system affiliation helps improve CAHs’ financial stability, it often results in higher prices for patients.
Becker's Healthcare
Critical access hospitals face uphill battle: 6 things to know
This article explores the study by researchers from Johns Hopkins University and CAHPR at Brown University, which examines financial disparities between critical access hospitals (CAHs) and larger acute care hospitals from 2016 to 2022. The study highlights significant financial disparities, showing that system-affiliated critical access hospitals (CAHs) achieved higher operating margins than independent ones and highlights the need to balance financial sustainability with the risks of uneven care access and higher prices.
The New Yorker
The Gilded Age of Medicine Is Here
This article dives into the controversial world of private equity in healthcare, where profit-driven strategies lead to higher patient costs and declining care quality. This article examines real examples, from staffing cuts to surprise billing, and explores how these changes threaten physician autonomy and the stability of U.S. healthcare.
Health Affairs Forefront
California’s Failed Bid To Regulate Private Equity Investment In Health Care
The article examines California’s failed attempt to regulate private equity investments in healthcare through AB 3129, which proposed stricter transaction oversight and protections against corporate control of medical practices. It critiques the bill’s limited scope, exemptions, and political challenges while positioning it as a case study for future state-level reforms in addressing healthcare consolidation.
This article highlights a study by Christopher Whaley showing how hospitals have received billions in extra payments by documenting care at higher levels of complexity than expected. This practice, known as "upcoding," raises concerns about the incentives in current payment systems and their impact on rising healthcare costs.
The article written by CAHPR researchers, emphasizes the opportunity for Congress, in its final weeks of the 118th session, to advance healthcare affordability and transparency through the Lower Costs, More Transparency Act (LCMT) and the Health Care PRICE Transparency Act 2.0