Commonwealth Fund: Medicare inpatient spending concentrated among 2 systems in most regions

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来源: FierceHealthcare

A new Commonwealth Fund analysis showed that HCA Healthcare made up 5% of all inpatient traditional Medicare spending in 2021.

Medicare inpatient spending was highly concentrated among two systems in most regions in 2021, a new analysis found.

The analysis, released Wednesday by the Commonwealth Fund, comes amid increased scrutiny on the impact of hospital consolidation on care quality and costs.

“If hospital consolidation continues to increase prices in the commercial market, there could be pressure on Medicare to raise rates in line with commercial insurers to avoid access issues for beneficiaries,” the analysis said.

Researchers analyzed Medicare claims data from 2021 to determine the concentration of fee-for-service Medicare spending in regional healthcare markets known as hospital referral regions (HRRs). The data only applied to fee-for-service as Medicare Advantage data were not available.

It found that two hospital systems accounted for more than half of traditional Medicare inpatient hospital spending in 258 out of 306 HRRs in 2021. Two or more hospital systems also accounted for more than three-quarters of spending in 110 of 306 HRRs.

“The extent to which spending was concentrated varied greatly across the country,” the analysis said. “In 2021, the HRR with the most concentrated Medicare inpatient spending was Bloomington, Ill., where 100 percent of such spending was attributable to the only two health systems in the HRR.”

Rural areas Bend, Oregon, and St. Joseph, Michigan, had three hospitals that accounted for 99% of Medicare inpatient spending.

Other parts of the country had less concentrated spending. For instance, San Bernadino and Chicago only had 27% of their spending concentrated among two systems.

“In 16 states plus D.C., a single system accounted for at least one-quarter of all Medicare inpatient hospital spending,” the analysis added.

Major hospital chain HCA Healthcare had the largest share of all fee-for-service spending in the country with $21 billion, accounting for 5% of all national inpatient expenditures.

“In eight states, HCA was among the two largest systems with the greatest share of Medicare inpatient hospital spending,” Commonwealth Fund wrote.

Researchers said more studies need to be done to help understand how such concentration can affect quality and the satisfaction of care.

In the meantime, policymakers could address hospital consolidation via federal merger review tools.

The Federal Trade Commission (FTC) has started to take a longer look at hospital deals, suing to block mergers in several states. An executive order issued in July 2021 also called for the Department of Justice (DOJ) and the FTC to review the hospital merger guidelines for any deal that may lead to a higher price.

Hospital advocates such as the American Hospital Association (AHA) push back that mergers can lead to higher costs and lower-quality care. The AHA wrote to DOJ and the FTC last March opposing stricter measures for merger reviews, noting that “deceptive conduct” by insurers such as “bait and switch” tactics on coverage has raised prices and restricted competition.

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