What We Know About Provider Consolidation – Issue Brief – 9510-2
  1. Cynthia Cox, Rabah Kamal, and Daniel McDermott, “How have healthcare utilization and spending changed so far during the coronavirus pandemic?” Peterson-KFF Health System Tracker. May 29, 2020. https://www.healthsystemtracker.org/chart-collection/how-have-healthcare-utilization-and-spending-changed-so-far-during-the-coronavirus-pandemic/.

     

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  2. Karyn Schwartz and Damico, Anthony. “Distribution of CARES Act Funding Among Hospitals.” KFF (blog), May 13, 2020. https://www.kff.org/coronavirus-covid-19/issue-brief/distribution-of-cares-act-funding-among-hospitals/.

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  3. “HHS Announces Over $4 Billion in Additional Relief Payments to Healthcare Providers Impacted by the Coronavirus Pandemic” Press Release, July 10, 2020. https://www.hhs.gov/about/news/2020/07/10/hhs-announces-over-4-billion-in-additional-relief-payments-to-providers-impacted-by-coronavirus-pandemic.html.

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  4. Health plans merging with health care providers is another form of vertical integration, but that type of merger does not impact prices in the same way and so is not the focus of this brief.

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  5. MedPAC, “March 2020 Report to the Congress: Medicare Payment Policy,” March 13, 2020.

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  6. Reed Abelson. “When Hospitals Merge to Save Money, Patients Often Pay More” New York Times, November 18, 2018, Sec. B. https://www.nytimes.com/2018/11/14/health/hospital-mergers-health-care-spending.html

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  7. Zack Cooper, Stuart V Craig, Martin Gaynor, and John Van Reenen. “The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured.” Working Paper. National Bureau of Economic Research, December 2015. https://doi.org/10.3386/w21815

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  8. Martin Gaynor. “Examining the Impact of Health Care Consolidation,” Committee on Energy and Commerce Oversight and Investigations Subcommittee (2018). https://docs.house.gov/meetings/IF/IF02/20180214/106855/HHRG-115-IF02-Wstate-GaynorM-20180214.pdf

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  9. Leemore Dafny, Kate Ho, and Robin Lee. “The Price Effects of Cross-Market Hospital Mergers.” Cambridge, MA: National Bureau of Economic Research, March 2016. https://doi.org/10.3386/w22106

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  10. John Simpson, and Richard Shin. “Do Nonprofit Hospitals Exercise Market Power?” Federal Trade Commission, November 1, 1996. https://www.ftc.gov/reports/do-nonprofit-hospitals-exercise-market-power; Michael G. Vita and Seth Sacher. “The Competitive Effects of Not-for-Profit Hospital Mergers: A Case Study.” The Journal of Industrial Economics 49, no. 1 (2001): 63–84. https://doi.org/10.1111/1467-6451.00138; Steven Tenn. “The Price Effects of Hospital Mergers: A Case Study of the Sutter–Summit Transaction.” International Journal of the Economics of Business 18, no. 1 (February 1, 2011): 65–82. https://doi.org/10.1080/13571516.2011.542956

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  11. Glenn Melnick, Yu-Chu Shen and Vivian Wu. “The Increased Concentration Of Health Plan Markets Can Benefit Consumers Through Lower Hospital Prices.” Health Affairs 30, no. 9 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2010.0406

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  12. Lewis, Matthew S., and Kevin E. Pflum. “Hospital Systems and Bargaining Power: Evidence from out-of-Market Acquisitions.” The RAND Journal of Economics 48, no. 3 (2017): 579–610. https://doi.org/10.1111/1756-2171.12186

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  13. Lewis and Pflum, 2017.

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  14. Gaynor, 2018

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  15. Gold, Jenny. “Surprise Settlement In Sutter Health Antitrust Case.” Kaiser Health News (blog), October 16, 2019. https://khn.org/news/surprise-settlement-in-sutter-health-antitrust-case/

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  16. Gold, Jenny. “California AG Details ‘Historic’ Settlement Agreement In Sutter Health Antitrust Case.” California Healthline (blog), December 20, 2019. https://californiahealthline.org/news/california-ag-details-historic-settlement-agreement-in-sutter-health-antitrust-case/

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  17. Abe Dunn and Adam Shapiro. “Do Physicians Possess Market Power?” Journal of Law and Economics 57, no. 1 (January 1, 2014). https://chicagounbound.uchicago.edu/jle/vol57/iss1/6

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  18. Laurence C. Baker, M. Kate Bundorf, Anne B. Royalty, and Zachary Levin. “Physician Practice Competition and Prices Paid by Private Insurers for Office Visits.” JAMA 312, no. 16 (October 22, 2014): 1653–62. https://doi.org/10.1001/jama.2014.10921

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  19. Thomas Koch and Shawn W. Ulrick. “Price Effects of a Merger: Evidence from a Physicians’ Market.” SSRN Scholarly Paper. Rochester, NY: Social Science Research Network, August 1, 2017. https://doi.org/10.2139/ssrn.3026344

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  20. Richard Scheffler, Arnold, Daniel and Whaley, Christopher. “Consolidation Trends In California’s Health Care System: Impacts On ACA Premiums And Outpatient Visit Prices.” Health Affairs 37, no. 9 (September 1, 2018): 1409–16. https://doi.org/10.1377/hlthaff.2018.0472

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  21. Cory Capps, David Dranove, and Christopher Ody. “The Effect of Hospital Acquisitions of Physician Practices on Prices and Spending.” Journal of Health Economics 59 (May 1, 2018): 139–52. https://doi.org/10.1016/j.jhealeco.2018.04.001

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  22. Hannah T. Neprash et al. “Association of Financial Integration Between Physicians and Hospitals With Commercial Health Care Prices.” JAMA Internal Medicine 2015;175(12):1932-1939.

     

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  23. Laurence C. Baker, M. Kate Bundorf, and Daniel P. Kessler. “The Effect of Hospital/Physician Integration on Hospital Choice.” Journal of Health Economics 50 (December 1, 2016): 1–8. https://doi.org/10.1016/j.jhealeco.2016.08.006

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  24. Melnick et al. 2011.

     

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  25. Richard M. Scheffler and Daniel R. Arnold. “Insurer Market Power Lowers Prices in Numerous Concentrated Provider Markets.” Health Affairs. 2017 36:9, 1539-1546.

     

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  26. Erin E. Trish and Bradley J. Herring. “How Do Health Insurer Market Concentration and Bargaining Power with Hospitals Affect Health Insurance Premiums?.” Journal of Health Economics. Vol. 42 (July 2015).

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  27. Unlike hospitals paid on the prospective payment system, Critical Access Hospitals are paid based on a percent of their costs.

     

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  28. MedPAC, “March 2020 Report to the Congress: Medicare Payment Policy,” March 13, 2020.

     

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  29. Gaynor, 2018

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  30. “TrendWatch Chartbook 2018 | AHA.” Chartbook. American Hospital Association, 2018. https://www.aha.org/guidesreports/2018-05-22-trendwatch-chartbook-2018

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  31. David M. Cutler and Fiona Scott Morton. “Hospitals, Market Share, and Consolidation.” JAMA vol. 310 no. 18 (November 13, 2013).

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  32. Brent D. Fulton. “Health Care Market Concentration Trends In The United States: Evidence And Policy Responses.” Health Affairs 36, no. 9 (September 1, 2017): 1530–38. https://doi.org/10.1377/hlthaff.2017.0556

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  33. Fulton, 2017.

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  34. Fulton, 2017.

     

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  35. Fulton, 2017.

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  36. Carol K. Kane. “Updated Data on Physician Practice Arrangements: For the First Time, Fewer Physicians are Owners Than Employees.” American Medical Association. April 2019. Available at: https://www.ama-assn.org/system/files/2019-07/prp-fewer-owners-benchmark-survey-2018.pdf

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  37. Fulton, 2017.

     

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  38. Dafny, 2015.

     

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  39. Meredith Freed, Anthony Damico and Tricia Neuman. “A Dozen Facts About Medicare Advantage in 2020.” Kaiser Family Foundation. Apr 22, 2020.

     

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  40. Jane M. Zhu, Lynn M. Hua, and Daniel Polsky. “Private Equity Acquisitions of Physician Medical Groups Across Specialties, 2013-2016.” JAMA 323, no. 7 (February 18, 2020): 663–65. https://doi.org/10.1001/jama.2019.21844

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  41. Zhu et all , 2020.

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  42. Zhu et al., 2020.

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  43. Jack S. Resneck. “Dermatology Practice Consolidation Fueled by Private Equity Investment: Potential Consequences for the Specialty and Patients.” JAMA Dermatology 154, no. 1 (01 2018): 13–14. https://doi.org/10.1001/jamadermatol.2017.5558

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  44. Suhas Gondi and Zirui Song. “Potential Implications of Private Equity Investments in Health Care Delivery.” JAMA 321, no. 11 (March 19, 2019): 1047–48. https://doi.org/10.1001/jama.2019.1077

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  45. Joseph D. Bruch, Suhas Gondi and Zirui Song. “Changes in Hospital Income, Use, and Quality Associated with Private Equity Acquisition.” JAMA Internal Medicine (August 24, 2020).

     

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  46. Christine S. Wilson. “The FTC’s Ongoing Efforts to Promote Competition and Choice in Our Health Care System.” Keynote Remarks at the Council for Affordable Health Coverage: The Price of Good Health – 2020 and Beyond, January 16, 2020.

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  47. Rebecca Slaughter. “Antitrust and Health Care Providers Policies to Promote Competition and Protect Patients Center for American Progress.” Washington, DC: Federal Trade Commission, May 14, 2019.

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  48. Slaughter, 2019.

     

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  49. MedPAC, “March 2020 Report to the Congress: Medicare Payment Policy,” March 13, 2020.

     

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  50. Slaughter, 2019.

     

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  51. Gaynor, 2018.

     

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  52. Slaughter, 2019.

     

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  53. Kaiser Family Foundation. “Hospitals by Ownership Type.” 2018.

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  54. Kaufman, Hall & Associates, LLC. “2019 M&A in Review: In Pursuit of the New Bases of Competition,” 2020. https://www.kaufmanhall.com/sites/default/files/documents/2020-01/2019_mergers_and_acquisitions_report_kaufmanhall.pdf

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  55. Jaime S. King “Preventing Anticompetitive Healthcare Consolidation: Lessons from Five States.” The Source on Healthcare Price and Competition. Petris Center. June 2020. https://2zele1bn0sl2i91io41niae1-wpengine.netdna-ssl.com/wp-content/uploads/2020/06/PreventingAnticompetitiveHealthcareConsolidation.pdf

     

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  56. Ibid.

     

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  57. Gaynor, 2018

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  58. MedPAC, “March 2020 Report to the Congress: Medicare Payment Policy,” March 13, 2020.

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  59. Jeff Goldsmith, Lawton Burn, Aditi Sen, and Trevor Goldsmith. “Integrated Delivery Networks: In Search of Benefits and Market Effects.” National Academy of Social Insurance, February 2015. https://www.nasi.org/research/2015/integrated-delivery-networks-search-benefits-market-effects.

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  60. J. Michael McWilliams, Michael E. Chernew, Alan M. Zaslavsky, Pasha Hamed, and Bruce E. Landon. “Delivery System Integration and Health Care Spending and Quality for Medicare Beneficiaries.” JAMA Internal Medicine 173, no. 15 (August 12, 2013): 1447–56. https://doi.org/10.1001/jamainternmed.2013.6886.

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  61. Marah Noel Short and Vivian Ho. “Weighing the Effects of Vertical Integration Versus Market Concentration on Hospital Quality.” Medical Care Research and Review: MCRR, February 9, 2019, 1077558719828938. https://doi.org/10.1177/1077558719828938.

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  62. Daniel P Kessler and Mark B McClellan. “Is Hospital Competition Socially Wasteful?” NBER Working Paper, July 1999.

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  63. Thomas Koch, Brett Wendling, and Nathan E. Wilson. “Physician Market Structure, Patient Outcomes, and Spending: An Examination of Medicare Beneficiaries.” Health Services Research 53, no. 5 (2018): 3549–68. https://doi.org/10.1111/1475-6773.12825.

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  64. Nancy D. Beaulieu, Leemore S. Dafny, Bruce E. Landon, Jesse B. Dalton, Ifedayo Kuye, and J. Michael McWilliams. “Changes in Quality of Care after Hospital Mergers and Acquisitions.” The New England Journal of Medicine 382, no. 1 (02 2020): 51–59. https://doi.org/10.1056/NEJMsa1901383.

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  65. M. Noether and S. May, “Hospital Merger Benefits, a Review and Extension” American Hospital Association, December 2018. https://www.aha.org/system/files/2019-01/hospital-merger-benefits-a-review-and-extension-jan-2-19.pdf

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  66. Cory Capps, Dennis W. Carlton, and Guy David, “Antitrust Treatment of Nonprofits: Should Hospitals Receive Special Care?.” Econ Inquiry, 58: 1183-1199. (2020) doi:10.1111/ecin.12881

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  67. Liz Hamel, Audrey Kearney, Ashley Kirzinger, Lunna Lopes, Cailey Munana, and Mollyann Brodie. “KFF Health Tracking Poll – May 2020 - Health and Economic Impacts.” KFF (blog), May 27, 2020. https://www.kff.org/report-section/kff-health-tracking-poll-may-2020-health-and-economic-impacts/.

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  68. Rachel Garfield, Gary Claxton, Anthony Damico, and Larry Levitt, “Eligibility for ACA Health Coverage Following Job Loss” KFF, May 13, 2020. https://www.kff.org/coronavirus-covid-19/issue-brief/eligibility-for-aca-health-coverage-following-job-loss/

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  69. Garfield et al, 2020.

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  70. Gary Claxton, Matthew Rae, Larry Levitt, and Cynthia Cox. “How have healthcare prices grown in the U.S. over time?” Peterson-KFF Health System Tracker. May 8, 2018.

     

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  71. Karyn Schwartz and Jennifer Tolbert. “Limitations of the Program for Uninsured COVID-19 Patients Raise Concerns.” Kaiser Family Foundation. August 24, 2020.

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  72. Schwartz and Damico, 2020

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  73. Peterson-KFF Health System Tracker, “National Health Spending Explorer.” Peterson-KFF Health System Tracker. Available at: https://www.healthsystemtracker.org/health-spending-explore.

     

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  74. Juliette Cubanski, Karyn Schwartz, Jeannie Fuglesten Biniek, and Tricia Neuman. “Medicare Accelerated and Advance Payments for COVID-19 Revenue Loss: Time to Repay?” Kaiser Family Foundation. August 07, 2020.

     

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  75. CMS. “Medicare Accelerated and Advance Payments State-by-State and by Provider Type.” Available at: https://www.cms.gov/files/document/covid-accelerated-and-advance-payments-state.pdf.

     

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  76. HHS, “Fact Sheet: Expansion of the Accelerated and Advance Payment Program for Providers and Suppliers During COVID-19 Emergency.” https://www.cms.gov/files/document/accelerated-and-advanced-payments-fact-sheet.pdf.

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  77. Bertha Coombs. “Hospitals push Congress to forgive $100 billion in coronavirus aid Medicare loans.” CBNC. July 28, 2020. https://www.cnbc.com/2020/07/28/hospitals-push-congress-to-forgive-100-billion-in-medicare-loans.html

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  78. Small Business Administration. “Paycheck Protection Program (PPP) Report: Approvals through 07/10/2020.” Available at: https://home.treasury.gov/system/files/136/SBA-Paycheck-Protection-Program-Loan-Report-Round2.pdf.

     

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  79. This total excludes the $46 billion appropriated for loans for the aviation industry and businesses “critical to maintaining national security.”

     

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  80. Glenn Hubbard and Hal Scott. “‘Main Street’ Program Is Too Stingy to Banks and Borrowers.” Wall Street Journal. July 20, 2020.

     

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  81. Federal Reserve Board, “Federal Reserve Board modifies Main Street Lending Program to provide greater access to credit for nonprofit organizations such as educational institutions, hospitals, and social service organizations,” July 17, 2020. Available at: https://www.federalreserve.gov/newsevents/pressreleases/monetary20200717a.htm.

     

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