From the October 2015 issue of HealthCare Business News magazine
by Jill Rathbun
In coming back from the August recess, Congress got to work addressing an area that has become a hot topic in the health care community — consolidation.
Even before the mergers between Anthem/ Cigna and Aetna/Humana were announced, there was concern regarding the number of hospital and hospital systems, and physician practices that had merged or been acquired. Hospital acquisition physician practices have already prompted studies by the congressional advisory body, MedPAC. Their testimony regarding this phenomenon and its potential impact on the health care system and patients has been given to several Congressional committees.
A series of hearings in the U.S. House of Representatives was kicked off on Sept. 10, 2015, by the Subcommittee on Regulatory Reform, Commercial and Antitrust Law of the House of Representatives Judiciary Committee. This first hearing entitled, “The State of Competition in the Health Care Marketplace: The Patient Protection and Affordable Care Act’s Impact on Competition,” served to set the stage on a variety of topics. These included the impact of these various types of mergers on competition, and what the effect is on providers and patients; and what, if any, new regulations are necessary to ensure choice and value for all in the U.S. health care system, given these types of mergers. Future hearings will serve to go into more depth on these discussions.
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For imaging services, there were two themes at the hearing that are important to be aware of as these hearings continue this fall. One is the concept of providers needing to “get bigger,” to be able to take on risk. The second is the issue of site-of-service for the provision of imaging services and the concept of site-neutral payment, which is a source of concern.
Regarding the concept of needing to take on risk, most of the alternative payment models such as Accountable Care Organizations or shared savings demonstrations require the provider to take on some level of risk, usually in the form of bonuses and penalties, for the overall cost of the patient’s care. To handle this type of risk, many providers have felt the need to increase in size as a way to better coordinate care and save money for the health care system. However, just increasing in size with no additional tools to help with the rendering of more appropriate care may not be producing the intended cost-savings results.