Consolidation in Healthcare (Good or bad?)

Government Agencies Take Interest

In March, 2024, the U.S. Department of Justice, U.S. Department of Health and Human Services (HHS), and Federal Trade Commission opened a Request for Information (RFI) for public comment. As part of the request, they stated,

"Academic research and agency experience in enforcement actions has shown that patients, health care workers, and others may suffer negative consequences as a result of horizontal and vertical consolidation of a range of different types of providers—including not for-profit providers. In this RFI, we request information on the effects of transactions involving health care providers, facilities, or ancillary products or services, conducted by entities where there are concerning trends and recent research indicating these categories of transactions may harm health care quality, access, and/or costs."

The public comment window closed June 5th and consisted of over 2,000 comments available within a data file and hundreds of PDF's/Word Documents.

I spent some time last month reviewing the overall public sentiment regarding this RFI and as I combed through the data, at least 11 questions began to shape how I would organize, comprehend, and ultimately share the public feedback.

Questions to consider for Docket No. ATR 102:

1. Who is writing the comment?
2. Is the comment relevant to the topic?
3. Could the commentor have an agenda/bias for or against government intervention?
4. Are there patterns across states?
5. Are there patterns across roles? For example, are the majority of healthcare providers for consolidation or against it?
6. How are the different political parties represented in the data and what implications might this have on state policy?
7. What healthcare specialties are screaming the loudest (the answer so far is surprising & sad).
8. What organizations are "bulk loading" their comments and what are their affiliations/interests?
9. To what extent was the RFI shared with the public and was it broadly communicated to enhance the variety of respondents?
10. What MSO's, PE groups, Law Firms, Hospitals, and Advocacy Groups are speaking up on this issue by providing public comment?
11. Most importantly, why am I doing this?

Considering the volume of data, I will begin sharing my findings through LinkedIn posts along with future articles. However, I would like to answer #11 in this article.

Why am I doing this?

I believe that healthcare is as simple as taking care of ones health. Any person, process (often dictated by laws), or organization, that assists an individual with becoming and remaining healthy, has provided "healthcare" to that person.

On the contrary, when any of the above offer guidance or treatment that does not have the ultimate aim of health in mind, that person/process/organization should no longer be considered an advocate of healthcare. For the sake of definitions, we'll call this "Health Neglect".

Personal Example of Healthcare:

In 2004, I decided I would let my (deeply) suspicious high school friend "teach" me to surf. On my first trip out, I wound up with 21 staples in my head and a $3,000 bill. The medical providers provided health care by:

• Easing my pain with a painful needle (anaesthetic) in the head
• Stopping the bleeding with 21 staples
• Sending me home with a prescription to treat the massive headache

Personal Example(s) of Health Neglect:

1. In 2008, my father died of an accidental drug overdose. A "friend" gave him some of his methadone prescription to help him relax and his girlfriend encouraged it. In this scenario, his closest friends demonstrated health neglect.
2. In 2010, my first son was being born. The health neglect workers encouraged my wife to "get induced" at 40 weeks. This brought on a traumatic birthing experience and ultimately required a vacuum delivery. Praise God, we later learned that home births, done on God's time, provide the ultimate care for my wife and children.
3. In 2020, my mother died unexpectedly at 58 years old. She was being provided health neglect for decades byway of pharmaceuticals, electrotherapy, and "faith in self" based programs. Proper healthcare for my mother was unconditional love and attention from her family.
4. In 2022, someone dear to me, started behaving erratically, hearing and seeing things that did not exist. Medical providers, and Elder Abuse organizations completely disregarded her situation and left her perceived schizophrenia undiagnosed for years. She is currently homeless by choice at 82 years old.
5. In 2024, another relative attempted to commit suicide on Christmas day. The authorities finally forced him to be admitted at a behavioral health facility. This was his second time going through this exercise. On both occasions, the health neglect workers confirmed he was "better" at 21 days, when Medicare would no longer pay for treatment. He is also a 20+ year user of prescribed anti-depressants and his whereabouts are unknown.

If healthcare is working, why aren't people getting healthy?

Truth be told, I would be hard pressed to find true healthcare examples in my own life and those closest to me. My philosophy is simply eat healthier, get outside more, laugh more, and try not to get hurt.

I am doing this because we are fortunate enough to live in a country where the government is asking for our input on a tremendous issue and the response has been overwhelming (when compared to other RFI's). This is clearly a topic people want to discuss and unlike counting votes or relying on polls, we can view the comments word for word and put them in perspective.

Some macro questions I'd like to answer throughout this journey are:

1. Does the U.S. government care about the health of it's citizens, and if so, what are they doing to foster true health care?
2. How could restrictive government policy around consolidation impact existing PE groups, provider networks etc?
3. Are there PE backed organizations out there that are truly improving patient care, reducing costs, and promoting competition?
4. Are there independent practices setting the bar for how to properly address the agencies' concerns, without being absorbed by PE?
5. Should data from public comment be used to assess the overall sentiment of an issue or is it just another example of "the squeaky wheel gets the oil"?
6. Without government intervention, where does this environment of big fish eat small fish end? How many whales will remain and what happens when there are a handful?
7. Can we tie specific policy changes to these types of RFI's and/or can we deduce any actionable steps from reviewing this data (i.e. contact your congressman).
8. Are people willing to publicly discuss these issues despite working in healthcare and potentially being a product of consolidation?

I hope you enjoyed this article and will follow along as I share more about my findings.