Do you know who owns your personal favorite doctor’s practice? Could it be a healthcare conglomerate? An insurance company? A private equity firm? Amazon?

Of course, it might be any of the above. And that’s a problem, according to the authors of a paper published Sept. 22 in Health Affairs.

“Patients need to know whether their physicians are employed by corporate entities with vested financial interests, as these relationships may influence the accessibility, affordability and quality of health care services,” write co-authors Yashaswini Singh, PhD, MPA, of Brown University and Erin Fuse Brown, JD, MPH, of Georgia State University.

Noting the considerable time and energy Washington lawmakers have spent advancing transparency in healthcare pricing and billing, Singh and Fuse Brown seek equal time for “ownership transparency.”

They offer several points to support the suggestion. Among the most potent, in the authors’ own words:

  1. Transparency in physician and provider ownership is necessary to understand and address the impact of the corporate transformation of the U.S. healthcare system. Yet the chain of corporate ownership and web of financial interests are almost totally opaque to patients, purchasers, policymakers, researchers and regulators.
  2. Historically, physicians often owned their own independent practice or were employees of a healthcare system. In recent years, however, an influx of commercial corporate investment has led to more complicated and obscure ownership relationships among interrelated entities.
  3. The research literature has long illustrated how variation in ownership structures can drive variation in healthcare prices, spending, quality and access to care. This is because decisions that directly affect care—such as commercial price negotiations, volumes, referral and coding practices, and staffing—are often driven by the financial interests and market power of the corporate owner.
  4. Lack of ownership transparency allows healthcare consolidation to intensify unchecked, with corresponding increases in prices. Opacity in ownership obscures the pattern of stealth consolidation through which a single acquirer may monopolize a local market through add-on acquisitions.
  5. While the Lower Costs, More Transparency Act (introduced in the House earlier this month) is a promising effort to improve healthcare transparency and lower costs, it lacks [attention to] ownership transparency. Ownership transparency can help prevent conflicts of interest, enhance accountability, promote competition and must be seen as a complementary measure to price and [billing] location transparency to achieve the overarching goal of lowering healthcare costs.

As for components needed to ensure the accuracy, longevity and usefulness of ownership transparency, Singh and Fuse Brown recommend the creation of a national database.

This should be capable of storing, updating and sharing details on who owns what in healthcare, they suggest. Its data should be granular enough to enable healthcare stakeholders and watchers to “track changes to ownership resulting from horizontal and vertical mergers, acquisitions and joint ventures between health systems, health insurers, retailers and private equity firms.”

Nutshell conclusion:

“To achieve true transparency in healthcare, it is essential to disclose who owns and controls healthcare facilities, physicians and other providers.”

Health Affairs has posted the paper in full for free.


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