As health system mergers become more common, workers’ compensation experts are monitoring how physician consolidations can affect issues such as medical costs, patient access and quality of care.
“From my perspective, we’ve seen this trend for a while,” said Jason Beans, CEO and founder of Chicago-based Rising Medical Solutions, which provides medical cost containment to insurers and employers. “The independent practices and the independent doctors have been absorbed, often by either larger groups or by the hospital systems.”
Mr. Beans said his company analyzes annual medical inflation trends and the impact on comp. Recently: where there has been an increase in health care costs, it is often a related merger or acquisition of a health care system.
A recent report by the Workers Compensation Research Institute confirmed this, finding an increase in the average payment per medical procedure in comp claims involving consolidation of medical practices.
“It can definitely cause spikes,”; Mr. Beans. “The biggest impact is when a hospital system buys (a private clinic) because it moves to a different fee schedule. That’s where you see kind of a jump in cost.”
Hospital systems typically tout mergers as benefiting patients, with the goal of expanding access to care and improving the overall health of the community.
But workers’ compensation experts worry that these physician consolidations could create monopolies, thereby reducing competition and potentially reducing access to care for injured workers.
“A system can just say, ‘we’re not going to take workers,'” said Dr. Michael Choo, chief medical officer of Walnut Creek, Calif.-based medical management services firm Paradigm Corp., during a panel discussion at the National Council on Compensation Insurance’s annual symposium earlier this month.
Dr. Choo said past hospital consolidations have resulted in a 40% price increase and that 74% of U.S. physicians are now considered employees of a large health system.
While cost is a potential downside to consolidation, quality and access to care for injured workers must also be considered, experts said during a panel discussion at the NCCI symposium.
Dr Choo said consolidation can sometimes lead to improved quality of care for injured workers.
Kenji Saito, Augusta, Maine-based president of the American College of Occupational and Environmental Medicine, said practice consolidations could help foster shared digital platforms for virtual care.
Consolidation could also result in sharing “some of the wealth of knowledge around specialty care and advanced care,” he said.
Comp patients, especially those in rural areas, can benefit from these integrations because they can give them access to specialty care, said Dr. Saito.
But physician autonomy in caring for patients can be a challenge if the buyer of the practice is motivated more by revenue than care, he said.
“It’s kind of unfortunate that it’s happening that way, but I think we’re seeing now that it’s a trend,” he said.