October 2018 Volume 20 Issue 10
Providing Current Information on

Health Insurance Industry Issues and Legislation

States Fighting Hospital System Physician Group Purchases
The national share of hospital-employed physicians is skyrocketing. It rose from
30% in 2010 to 48% in 2016. Health systems are purchasing physician groups to
build their referral networks, send more patients to their hospitals and charge
facility fees to account for hospital overhead. The results are higher Affordable
Care Act premiums, sizable increases in physician fees and greater payments to
hospitals, even in the face of reduced patient days. Increased health plan ownership
of physician practices by health systems limits competition and can be used to
squeeze out rivals. States like California, Washington and Idaho are fighting back,
filing lawsuits and legislation to prevent competition reducing acquisitions.
Paying the Appropriate Amount for Healthcare
As healthcare systems gobble up more and more physician practices and charges
continue to escalate, it is more important than ever to ensure that providers receive
only the appropriate amount for the services provided. For the last 23 years HHC
Group's mission has been to assist its clients in achieving this goal. We are experts
in first determining what that appropriate amount is and then to finding ways to
get providers to see the light and accept that amount as payment in full. To learn
more about the ways we do it or have us start helping you minimize your client's
healthcare spend.
Cutting the Cost of Inappropriate Healthcare
It's estimated that unnecessary or inefficient healthcare services account for $750
billion or about 27.5% of total U.S. healthcare costs. Inappropriate care ranges
from unnecessary tests and procedures to over-prescription of painkillers and
antibiotics. Employers have had enough and are fighting back. Innovative ways
they are attacking the problem range from redirecting low-value services to
getting second opinions to utilizing centers of excellence.
U.S. Healthcare Spending More and Getting Less
Once again in 2016, the U.S. spent almost twice as much as 10 other high income
countries and, once again, the U.S. was one if the least healthy countries in the
developed world. Healthcare spending accounted for 17.8% of U.S. GNP in 2016.
Switzerland was a distant second at 12.7%. While healthcare spending was greatest in
the U.S., life expectancy was lowest and the infant mortality rate was the highest. The
primary cause of the difference was higher prices for prescription drugs, devices, labor,
services and administration. Differences in utilization and overutilization of services
were not a factor in the spending differences.
Three Star Preferred Provider Program Additions
Pilsen Wellness Center
Chicago, IL 606085

Aracell Feria, M.D., S. C.
Oaklawn, IL 60453

Massoud Benhuri, MD
North Massapequa, NY 11758