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As hospitals, physician groups, insurers and pharmacies become more closely connected through mergers and acquisitions, patients can face higher bills and fewer choices about where they receive care or fill prescriptions.
Health-policy researchers describe the trend as vertical integration: one company controls multiple parts of the care system. A hospital might own physician practices and surgery centers, or an insurer might own a pharmacy benefit manager, specialty pharmacy and medical group. Supporters say the structure can coordinate care and reduce administrative friction.
Critics say patients can be steered to higher-priced locations even when a less expensive option would meet the same need. One patient described being moved from a planned office procedure to a surgery center connected to the same health system, raising the expected bill from about $3,000 to about $6,000.
Researchers have found that many smaller practice acquisitions fall below federal reporting thresholds, making it difficult for regulators to see consolidation as it develops. More than 99% of the physician-practice deals examined in one study were below the threshold that triggers mandatory federal merger reporting.
Patients can ask whether a procedure is available in a lower-cost setting, request a written estimate and compare in-network options before nonemergency care. Policymakers continue to debate site-neutral payments, a model that would pay the same amount for a service regardless of where it is performed.
