This month in health policy research, surprise billing and changes in market structures fuel concerns about competition and consumer choice.  In addition, some studies on pharmaceutical costs produced hopeful reports.   Healthcare Market Competition and Consolidation Consolidation Trends In a Health Affairs study, Consolidation of Providers into Health Systems Increased Substantially, 2016-18, Michael Furukawa et al. analyzed provider consolidation trends.  The rate of physician affiliation with a health system increased by 11 to 51 percent in 2018.  Based on the 556 health systems the authors identified, the median number of …

By: Danika Rothwell, Student Fellow Paul DeWolfe needed back surgery.  He knew the operation would be covered by his insurance and was careful to make sure the hospital he chose was in his insurer’s network.  DeWolfe sat down and did the math. He figured his portion of the bill would cost roughly $3,000.  When DeWolfe recovered from his procedure, he was shocked to receive a bill for $18,590.83.[1]  Despite all his attentive preparation, some of the physicians who treated him at his in-network hospital were, in fact, out-of-network.  This story …

By: Swaja Khanna, Student Fellow With the coronavirus pandemic causing shelter-in-place restrictions around the world, we here at The Source hope you are staying safe and healthy as we catch you up on some of the articles and reports in health policy this month. In this edition of the Source Roundup, we cover articles and reports that discuss: (1) the cost of hospital care for COVID-19 for the uninsured, (2) how health costs may change in the pandemic, (3) surprise out-of-network billing from ambulance transportation, (4) in-network ASC episodes that …

[Post Updated: April 20, 2020] Earlier this year, the federal government appeared poised to address the problem of surprise billing,[1] but the coronavirus pandemic shifted policy priorities before Congress had a chance to act. While some lawmakers may try to include surprise billing protections in the next COVID-19 stimulus package, the pandemic and its ripple effects make action by lawmakers to address surprise billing critical. Surprise bills, also known as balance bills, may occur when a patient unavoidably sees an out-of-network provider for an emergency situation or unexpectedly sees an …

By: Swaja Khanna, Student Fellow In this edition of the Source Roundup, we highlight articles and reports from February that discuss: (1) the prevalence of out-of-network billing during elective procedures with in-network services, (2) affordable care organizations’ potential to limit out-of-network spending, (3) findings from the new Health Care Cost and Utilization Report, (4) private health care spending growth  varies by hospital referral regions, (5) U.S. has highest healthcare spending despite worst health outcome, and (6) how states policies encourage provider market competition and lower healthcare spending.   The Prevalence …

See UFCW & Employers Benefit Trust v. Sutter Health case page.   The high-profile antitrust case against Sutter Health settled on the eve of trial in October 2019, when the Northern California hospital giant reached a preliminary settlement agreement with the California Attorney General’s office and class action plaintiffs after five years of litigation. The terms of the settlement were released late December, which include both monetary compensation for the private plaintiffs and injunctions against Sutter’s conduct that will restore competition and promote transparency in the provider market. In this …

  Health Policy Researcher Sammy Chang was quoted in the 1/13/2020 California Healthline article “Loopholes Limit New California Law To Guard Against Lofty Air Ambulance Bills”: “It’s a very big step in balance billing, but it’s not a definitive one,” said Samuel Chang, a health policy researcher at the Source on Healthcare Price and Competition, a project of the University of California-Hastings.

Updated 10/14/2019: Governor Newsom has signed AB 651, which will take effect January 1, 2020.   There are few bills in the 2019 California Legislative cycle more supported by the Legislature than AB 651, which would reauthorize the Emergency Medical Air Transportation Act (“Act”) and prohibit balance billing by air ambulances. To fully understand the impact and significance of AB 651, we will first examine the history and evolution of the Emergency Medical Air Transportation Act, starting in 2010, to better appreciate the original intent of the Act. Second, we …

By: Hayden Soria, Student Fellow Hello September! As we see cooler days slowly roll in, there are still many sizzling topics in this month’s health policy literature. In this Roundup, we take a dive into article and reports that discuss 1) the prevalence of surprise billing, 2) the effects of California’s AB 72 on provider networks, 3) increasing hospital prices, 4) hospital quality ratings, 4) increasing insurance premiums and out-of-pocket costs, and 5) health plan profitability.   Surprise Billing and Provider Networks Eric C. Sun, Michelle Mello, and Jasmin Moshfegh explore …

The Lower Health Care Costs Act, released in May 2019 by Senators Lamar Alexander and Patty Murray, addresses many inefficiencies in healthcare markets and has the potential to both increase competition and lower costs for healthcare services. The 195-page draft federal bill, also known as the Alexander-Murray Bill (S 1895), contains more than three dozen provisions designed to address health care costs. The bill is divided into five titles: 1) Ending Surprise Medical Bills, 2) Reducing the Prices of Prescription Drugs, 3) Improving Transparency in Health Care, 4) Improving Public …