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Mergers and acquisitions involving hospitals and other health care providers are drawing attention from federal and state regulators, including the Federal Trade Commission, and policymakers amid concerns that such consolidations can reduce competition and contribute to the high costs of health care.
This analysis for the Peterson-KFF Health System Tracker uses claims data from private, large employer-based plan to examine trends in complexity coding across outpatient practice settings from 2004 to 2021. It finds a trend toward higher complexity codes that contributes to higher outpatient spending.
Promoting price transparency in health care is a policy approach with bi-partisan support in Congress and the public at large. This analysis examines the vast troves of price transparency data that payers are required and finds unlikely prices, inconsistencies, and other oddities that pose major challenges for efforts to use it to promote competition and drive down prices.
Medicare Advantage enrollees were in a plan that included just under half (48%) of all physicians available to traditional Medicare beneficiaries in their area in 2022, on average. The limitations of provider networks illustrate one of the key tradeoffs for beneficiaries in choosing Medicare Advantage for their coverage.
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