THE SOURCE BLOG

A new research article examining the impact of “cross-market” hospital mergers on prices and quality published in Health Services Research has been co-authored by The Source’s own Jaime King, Katherine Gudiksen, Alexandra Montague, and Thomas Greaney, along with our long-time collaborators, Daniel Arnold, Brent Fulton, and Richard Scheffler, from The Petris Center at UC Berkeley. The study is the first to measure the impact of cross-market hospital acquisitions on quality and the first to identify price effects from multiple cross-market acquisitions (i.e. serial acquisitions).  The study used commercial claims data …

This spring, court cases are dealing with a variety of issues relevant to healthcare marketplace competition issues.  These include a Federal Trade Commission’s (FTC’s) action to block a sale of hospitals in North Carolina, examining the fiduciary duties employer-sponsored health plans have in selecting drug plans, and looking at the acceptability of non-compete clauses in physician contracts. FTC Files suit in North Carolina In February, the FTC authorization of a suit to block Novant Health’s proposed acquisition of two hospitals owned by Community Health Systems (CHS) in North Carolina.  On …

The preponderance of research evidence demonstrates that a lack of meaningful healthcare market competition is bad for consumers – resulting in higher prices, and insurance premiums, without a commensurate increase in quality of care.  New merger guidelines issued in 2023 by the Federal Trade Commission and Department of Justice are just one indication that the Federal government is more closely examining proposed health system mergers.  Increased regulatory scrutiny, among other factors, appears to be causing a slow-down in healthcare merger activity. In addition to merger challenges by state and federal …

For Health Affairs Forefront, the Source’s Katherine Gudiksen and Jaime King have analyzed changes from the draft version to the final 2023 Merger Guidelines released by the Federal Trade Commission (FTC) and Department of Justice (DOJ). In a previous Health Affairs Forefront piece, Source staff examined the draft guidelines.  This new post examines key elements of the new guidelines, concluding that while the final version better aligns the Guidelines with the underlying antitrust laws and caselaw, the Guidelines create more grey area for companies to demonstrate that mergers do not …

On January 25th, 2024, the Federal Trade Commission (FTC) announced that it had authorized a suit to block Novant Health’s proposed acquisition of two hospitals owned by Community Health Systems (CHS) in North Carolina. Nearly a year ago, in February of 2023, Novant Health and Community Health Systems (CHS) signed an Asset Purchase Agreement for Novant to pay $320 million to acquire two North Carolina hospitals from CHS. Novant is currently one of the largest hospital systems in the southeastern United States, and already owns a local hospital that serves …

On January 18, 2024, Victoria Ross, a former University of Pittsburgh Medical Center (UPMC) nurse, filed an antitrust class action suit in the US District Court for the Western District of Pennsylvania against UPMC.  The suit claims UPMC used its “monopsony power to prevent workers from exiting or improving their working conditions, to suppress workers’ wages and benefits, and to drastically increase their workloads, through a draconian system of mobility restrictions and widespread labor law violations that lock employees into sub-competitive pay and working conditions.” Parties to the Suit According …

The Milbank Memorial Fund has published a report titled “Models for Enhanced Health Care Market Oversight — State Attorneys General, Health Departments, and Independent Oversight Entities” authored by Erin C. Fuse Brown and The Source’s own Katherine L. Gudiksen. The report looks at tools state policymakers are using to address harmful health care market consolidation, focusing on how states have expanded the review authority of the Attorney General (or other state agencies), and have given authority to review transactions to additional oversight entities.  The authors reviewed applicable state statutes and …

On December 14, 2023, the North Carolina Attorney General (AG) filed suit against HCA Healthcare, Inc. alleging that HCA violated the Asset Purchase Agreement (APA) it signed when it acquired Mission Health System. HCA is the largest for-profit hospital chain in the United States and in 2018, it acquired Mission Health System, which serves western North Carolina. At the time of the merger, the North Carolina AG required the signing of an APA that included assurances that HCA was committed to continuing certain critical services (including emergency, trauma care, and …

Research indicates that concentrating control of healthcare providers and facilities into a handful of massive health systems leads to higher healthcare costs, without improving quality of care.  There are often limited possibilities available for smaller marketplace participants who are attempting to compete with the giants in the field, especially when the giants engage in unfair business practices. On November 20, 2023, Emanate Health filed an antitrust with the US District Court for the Central District of California.  The complaint alleges that Optum engaged in unfair and unlawful business practices and …

In a new piece published in Health Affairs Forefront titled “How Will the New Draft Merger Guidelines Impact Health Care Markets?”, The Source’s Amy Gu, Katherine Gudiksen, and Jaime King examine new draft Merger Guidelines released by the Federal Trade Commissions and Department of Justice building on a previous executive order intended to strengthen competition and enhance antitrust enforcement. The authors analyze the new guidelines, as well as the harms caused by health care consolidation.  The piece concludes that the draft merger guidelines break new ground by addressing the increasingly …