Horizontal hospital mergers will not escape strict scrutiny from regulators in 2020, a Republican-appointed Federal Trade Commissioner said Thursday, adding the group could review mergers after the fact to determine whether they achieved the cost and quality metrics companies claimed they would.
Christine Wilson said at an event sponsored by the Council for Affordable Health Coverage, a coalition that includes private payers and pro-business groups, that her agency will keep pressing on key healthcare competition stances in 2020, including repeal of state certificate of need laws. FTC will also push for more flexibility in scope of practice laws, particularly for mid-level practitioners, and for keeping biosimilars on the market.
Wilson even suggested support for allowing government programs like Medicare to negotiate drug pricing, a contrast to the traditional GOP stance. The government being a price taker in those situations "seems like a problem," she said.
But she said many factors that work against competition in the marketplace aren't under FTC control and need to be fixed by the industry. The key problem is that patients don’t have enough reason or ability to shop around for the best value.
"Information asymmetry and weak or adverse incentives are endemic up and down the healthcare supply chain, unfortunately," she said.
John Frenzel, director of The Learning Health System at MD Anderson Cancer Center, said during a panel at the same event burdensome and costly technology and reporting regulations are additional factors in reduced competition in the provider marketplace.
Hospitals and health systems are employing more doctors as clinicians find it increasingly difficult to manage a business along with treating patients.
A small or individual practice doesn't have the capital to meet requirements for a secure, interoperable EHR that meets federal review. Also, shared cost agreements force reporting of various data metrics that also takes time and money, Frenzel said.
"How does a smaller organization bear the increased cost of some of the solutions that are being put on them?" Frenzel asked.
Rep. David Schweikert, R-Arizona, was not optimistic lawmakers would be much help fixing the industry's problems, calling Congress a "protection racket" too invested in the status quo. "The model is screwed up because we protect incumbents and we do everything we can to slow down the disruption that would make us healthier and crash the price of healthcare," he said.
Still hope for surprise billing ban
A push to pass legislation curbing surprise billing hit a roadblock late last year, as lawmakers squabbled over jurisdiction and payers and providers offered competing policy options.
Still, Rep. Ami Bera, D-Calif., said he expects Congress will do "something on surprise billing" soon, noting the issues standing in the way are policy-related rather than partisan. "I think you’ll find something in the middle where no one got everything that they wanted but everyone got something that they wanted," he said.
David Merritt, EVP for public affairs and strategic initiatives at America's Health Insurance Plans, agreed that a surprise billing ban is possible this year, especially as funding for some Medicare and Medicaid programs face another extension deadline in May. The "larger political landscape" was the key problem last session. "I think we can absolutely get it over the finish line," he said. "To me, this is one of these issues that is totally solvable if people just come together."
But payers and providers remain far apart on the policy questions, and their respective lobbies will continue heavy spending to try to get their way.
CAHC President Joel White said he was frustrated by the failure to pass a ban last year despite public support and bipartisan proposals. "We couldn't stop that, how are we going to take on some of these thorny issues?" he said. "I'm convinced we need to make some process changes as well as policy changes."
Public support for change in the healthcare industry is still high. A poll presented Thursday by North Star Opinion Research showed strong voter support for a public option and weak approval of the current healthcare system. When it came to privacy issues, people weren't particularly worried about having their personal health information stolen (financial and retail purchasing information was more of a concern) they were split over whether privacy or access was more important.
The online survey found that healthcare cost and access was voters' top issue, beating out the economy and national security, and half believed it should be a right guaranteed by the federal government.
Transparency about more than prices
While HHS wages a public and legal battle on healthcare price transparency, efforts continue more behind the scenes to tackle transparency of quality data, Deputy Secretary Eric Hargan said Thursday at the event.
Industry players are defensive of many of the current methods for measuring and reporting quality information, despite intense pressure from the outside to reform. HHS is pushing back on providers that don't want change with a "bottom-up scrub" of current metrics used for federal programs, but the process is a long and involved one, Hargan said.
Keeping up with tracking measures is a huge cost for practices, but "in many cases we're finding out they're not necessarily moving the needle in terms of providing better care to the American people," he said.
Proposals range from having no government requirements or only the market incentive of consumer satisfaction to using numerous and strict reporting mechanisms, but there is likely a middle ground that finds the most appropriate and useful measures, he said.
"Fortunately, we have the backing of the White House and the administration broadly to undertake broad-scale reform," he said.