AMA to Amp Up Hospital Consolidation Scrutiny

CHICAGO -- Physicians pressing for the American Medical Association (AMA) to do more on healthcare consolidation pushed through a resolution to produce in-depth annual reports on the topic that could be used to advocate for legislative change.

At the association's annual House of Delegates meeting this week, its Private Practice Physicians Section made the case for the AMA to move beyond its prior resolution for a one-time study on the consolidation of hospitals and health systems.

The independent physicians argued that healthcare consolidation strips physicians of their autonomy and places limits on how and where physicians practice medicine, driving increased burnout.

"Hospitals push us around," said Michael Brisman, MD, a delegate from New York, speaking on his own behalf. Hospitals arbitrarily take away physicians' operating room time and prohibit them from buying needed equipment, he said.

When he first started working as a physician in Long Island, New York, there were 20 different hospitals that competed with each other, Brisman said. Physicians who felt mistreated at one hospital could move to another.

Now that all of the area hospitals are part of two or three health systems, that option has been taken away.

"Good quality care ... comes from competition. It comes from choices. And when there's only one or two choices, it's not good for the patients or the doctors," Brisman said.

Authors of the now-finalized resolution highlighted other consequences of hospital consolidation, from reduced quality benefits to increased hospital prices.

Douglas Myers, MD, a delegate from the American Academy of Otolaryngology-Head and Neck Surgery speaking on his own behalf, argued that while hospitals say consolidation brings down prices, he's found the opposite to be true.

When Myers' 18-year-old son had a nosebleed, rather than cauterize the boy's nose himself, Myers took him to the clinic where he used to work. The clinic was sold to a hospital shortly after Myers retired.

Afterwards, Myers received a $900 bill.

"If an individual private practice had charged that, they would never see the patient again. But we don't have choice," Myers said.

In proposing the policy change, the Private Practice Physicians Section had called for the AMA to use its current annual report on health insurer consolidation as a model for those on healthcare consolidation. That report was used in 2016 to assist the Department of Justice in challenging the Anthem-Cigna and Aetna-Humana mergers.

As for the types of data the report could include, the Private Practice Physicians Section suggested the following:

• A review of the current level of hospital and/or health system consolidation at the level of all metropolitan statistical areas, state, and national markets
• A list of all mergers and acquisition transactions valued above a set threshold amount resulting in hospital and/or health system consolidation
• Analyses of how each transaction has changed or is expected to change the level of competition in the affected service and geographic markets
• Analyses of [how] healthcare costs and prices have changed in affected markets after a large consolidation transaction has taken place

A representative for the AMA Council on Medical Services stated during the discussion on Sunday that some of the data requested isn't publicly available, as it falls below the reporting thresholds required by the Federal Trade Commission and the Department of Justice. Members of the Council also suggested the resolution was too prescriptive.

But M. Zuhdi Jasser, MD, a delegate from Arizona and immediate past chair of the Private Practice Physicians Section argued that if there are too many obstacles to access the necessary data, then that is information the AMA should put in its report.

"The entire healthcare industry is consolidating into one big clotted mass that is of no use," he said, which is why it's important to make the data available and produce annual reports that can be used in advocacy with legislatures.

On Tuesday, the House voted in agreement with the Private Practice Physicians Section, adopting the resolution for an annual, comprehensive report that uses the current health insurer consolidation report as a model that tracks healthcare consolidation, despite the reservations of the Council on Medical Services.

The estimated cost of beginning the analysis, which includes "staff time, data purchase, and potential external expertise," is $200,000.

"Policymakers on Capitol Hill who want to advocate on our behalf are asking for this data, we just need to produce it," said Dan Choi, MD, an alternate delegate for the Private Practice Physician Section.

Comment