Private Equity Acquiring Large Shares Of The Opioid Treatment Market Without Changing Market-Level Methadone Supply.

Private equity (PE) acquisitions of opioid treatment programs (OTPs) are growing, with the potential to expand access to methadone, a critical yet underused medication that can cut the risk for overdose deaths by more than half. At the same time, PE's emphasis on short-term profitability has raised concerns from policy makers that PE acquisitions can consolidate ownership of OTPs among financial firms without expanding access to treatment. Using a difference-in-differences design with novel data on PE acquisitions of OTPs and methadone shipments to all OTPs during the period 2006-19, this study examined the effects of PE acquisitions on methadone supply.

Association of Private Equity and Hospital Consolidation and Negotiated Prices of Radiologic Services.

Purpose: The consolidation of radiology practices by hospitals and private equity (PE) firms has accelerated in recent years, reshaping the landscape of radiology practice ownership. There is limited systematic evidence on the growing prevalence of hospital and PE ownership in radiology and its association with negotiated prices for imaging services. The aim of this study was to examine how commercial insurance negotiated prices for radiologic services vary by practice ownership structure, including independent, hospital, and PE-affiliated radiology practices.

The Repeal of Noneconomic Damage Caps and Medical Malpractice Insurance Premiums.

Noneconomic damage caps are controversial because they seek to balance uncertain benefits through reductions in physician precautionary costs, against uncertain harms to patient welfare. Opposing policy actions at the state-level reflect this controversy as some states have enacted noneconomic damage caps over the past few decades while others repealed their caps. Our difference-in-differences analyses suggest that repeals increase premiums.

Pay Gap Between Nonprofit Hospital CEOs And Employees Grew, 2009-23.

Nonprofit hospital workers represent a significant portion of the US health care workforce. Previous research indicates that wage inequalities exist within nonprofit hospitals, varying by hospital characteristics. To explore whether these inequalities have grown over time, particularly during the COVID-19 pandemic, we used Internal Revenue Service Form 990 and Medicare cost reports from the period 2009-23 to examine trends in wages and wage inequalities within nonprofit hospitals and assess differences by hospital characteristics.

Sharp Rise In Urban Hospitals With Rural Status In Medicare, 2017-23.

In 2016, in response to two federal court decisions, the Centers for Medicare and Medicaid Services began allowing geographically urban hospitals to be dually classified as both rural and urban simultaneously. This dual classification enables hospitals to use urban wage indexes for calculating Medicare reimbursements, while also benefiting from Medicare policies solely intended to support rural health. Using Medicare cost reports and impact files, we documented a substantial increase in administratively rural hospitals in the US, driven by the dual classification of existing hospitals located in urban areas, which rose from 3 in 2017 to 425 in 2023, with prevalence varying by state.

Affordable access to GLP-1 obesity medications: strategies to guide market action and policy solutions in the US.

Glucagon-like peptide 1 receptor agonists and glucagon-like peptide 1/gastric inhibitory polypeptide receptor agonists offer weight reduction and associated health benefits that, if sustained over time, have the potential to markedly improve population health. However, over 40% of US adults have obesity, translating into more than 100 million potential new users of obesity medications. Standing in the way of the major opportunity to improve health for these individuals is the massive and likely ongoing cost of treating such a large segment of the population, even though use of the treatments is estimated to be cost-effective over a lifetime.

Commercial Price Variation in Ophthalmology.

Objective: To assess the variation in commercial insurance payment rates for common ophthalmology procedures across major national insurers and identify patterns in professional and facility fees.

Design, Setting, And Participants: This cross-sectional study used January 2025 Transparency in Coverage data, payment rates negotiated between insurers and health care professionals from 4 large national insurers (Blue Cross Blue Shield, United Healthcare, Cigna, and Aetna) for 10 common ophthalmology procedures. Data included approximately 684 506 professional fee price points from 15 788 physicians and 55 930 facility fee price points from 4697 facilities.

Back to school: The effect of school visits during COVID-19 on COVID-19 outcomes.

The effects of school closures on COVID-19 transmission remain unclear, even after the conclusion of the national Public Health Emergency. We use healthcare claims data from 130 million household-week observations linked to smartphone mobility data to measure the effects of changes in county-level visits to schools on COVID-19 outcomes. We use a triple-differences approach that leverages within-county differences in exposure between families with and without school-age children and find modest impacts.

Site-Neutral Payment And Biosimilars Competition Are Complementary Purchaser Strategies For Cancer Biologics.

Two policy strategies have been pursued to moderate spending on infused cancer biologics. The competition strategy seeks to stimulate market entry by biosimilars, under the principle that newer entrants will charge lower prices than current branded products and that branded products will offer price reductions to slow the loss of their market share. The site-neutral payment strategy seeks to reduce insurers' reimbursements to hospitals to the levels paid to physician practices, instead of having prices be determined by the hospitals' and physicians' relative market power.

Commercial price variation for common imaging studies.

Introduction: Commercial insurance payment rates for imaging studies have significant price variation, yet understanding this variation has been limited by lack of transparency and data limitations.

Methods: Using newly available Transparency-in-Coverage insurer-posted data on negotiated rates, we analyzed price variation for the 2023 contract year across four major commercial insurers (Blue Cross Blue Shield, United, Cigna, and Aetna) for 30 imaging studies. Our analysis encompassed 12.

The Effects of a Digital Digestive Care Management Program on Employee Absenteeism: A Case-Control Study.

Objective: 60 to 70 million people in the US have chronic gastrointestinal (GI) disorders. Employers bear a significant economic burden for GI conditions. The purpose of this study was to evaluate the effects of a digital digestive care program on absenteeism.

Rhode Island's Affordability Standards Led To Hospital Price Reductions And Lower Insurance Premiums.

Beginning in 2010, Rhode Island's affordability standards capped hospital price growth for the fully insured commercial segment of the state's health insurance market. The long-term impact of the standards on hospital prices and insurance markets is unknown. We used a series of national data sources from the period 2006-22 to compare hospital prices and margins and insurer premiums and fees in Rhode Island and comparison states before and after the initiation of the standards in 2010.

Private Equity-Owned Physician Practices Decreased Access To Retinal Detachment Surgery, 2014-22.

Private equity (PE) firms have increased their ownership stake across health care sectors in the US. PE's focus on short-term profitability may decrease the provision of unprofitable services, reducing access for patients in vulnerable populations. This is a particular concern for certain eye conditions such as retinal detachment, for which access to timely surgery is necessary to prevent irreversible vision loss and for which reimbursement is below cost for the fee-for-service Medicare population.

Prices Paid to Hospitals by Private Health Plans: Findings from Round 5.1 of an Employer-Led Transparency Initiative.

Because employer-sponsored spending comes from employee wages and benefits, employers have a fiduciary responsibility to administer benefits in the interest of participants. The lack of transparency of prices in the health care market limits employers' ability to knowledgeably develop or implement benefit design decisions. This study uses 2020-2022 medical claims data from a large population of privately insured individuals, including hospitals and other facilities from across the United States, to allow an easy comparison of hospital prices.

Physician Turnover Increased In Private Equity-Acquired Physician Practices.

Consolidation of physician practices by private equity (PE) firms has accelerated, raising concerns that PE's emphasis on short-term profitability may exacerbate physician turnover, with implications for care continuity. Despite their significance, evidence on how PE acquisitions affect physician turnover is limited. Using clinician-level data linked to practice acquisition data from the period 2014-21, we used a difference-in-differences design to examine changes to physician employment and turnover after PE acquisition of 200 ophthalmology practices with 1,980 clinicians.

Understanding health care price variation: evidence from Transparency-in-Coverage data.

Competition in health care markets should lead to lower prices and less dispersion, with consumer choice as the driving mechanism. Several studies document price variation, suggesting room for improvement; however, they relied on selected data from insurers who provide access to data, limiting generalizability. We document the nature of price variation in the private US market across geography, payer, and provider by leveraging a new dataset, implementing a descriptive analysis using the most comprehensive data available: Transparency-in-Coverage.

Growth of Private Equity and Hospital Consolidation in Primary Care and Price Implications.

Importance: Consolidation of physician practices by hospitals and private equity (PE) firms has increased rapidly. This trend is of particular importance within primary care. Despite its significance, there is no systematic evidence on the emerging trends in ownership affiliation of primary care physicians (PCPs) and its association with prices paid for physician services.

Upcoding Linked To Up To Two-Thirds Of Growth In Highest-Intensity Hospital Discharges In 5 States, 2011-19.

Diagnosis-based payment systems can create incentives to upcode patients to a higher level of severity to increase payment. In some instances, upcoding can be a form of fraud if providers code patients to a higher complexity than is appropriate, whereas in other instances, upcoding can accurately reflect patient acuity. We estimated the increase in Medicare Severity Diagnosis-Related Group (MS-DRG) upcoding during the period 2011-19, using all-payer discharge-level data from five states.

Hospital Payment Caps Could Save State Employee Health Plans Millions While Keeping Hospital Operating Margins Healthy.

State employee health plans are consuming an ever-larger portion of state budgets because of rising health insurance premiums. Often the largest purchaser of commercial health insurance in their state, state employee health plans possess a unique opportunity to implement cost containment strategies. This study estimated potential savings from hospital payment caps among state employee health plans and the impact on commercial hospital operating margins.