Physician consolidations can both hurt and help comp: Experts

As health care system mergers become more commonplace, workers compensation experts are monitoring how physician consolidations might affect issues such as medical costs, patient access and quality of care.

“From my perspective, we’ve seen this trend for a while,” said Jason Beans, CEO and founder of Chicago-based Rising Medical Solutions, which provides medical cost containment services to comp insurers and employers. “The independent practices and independent doctors have been getting gobbled up, oftentimes by either larger groups or by the hospital systems.”

Mr. Beans said his company analyzes annual medical inflation trends and the effect on comp. The recent takeaway: where there has been an increase in medical costs there is often a related merger or acquisition of a health care system.

A recent report by the Workers Compensation Research Institute confirmed this, finding an increase in the average payment per medical procedure in comp claims involving consolidation of physician practices.

“It definitely can cause spikes,” Mr. Beans said. “The biggest impact is when a hospital system buys (a private practice) because it shifts to another fee schedule. That’s where you see kind of a jump in cost.”

Hospital systems typically tout mergers as benefitting patients, with a goal of expanding access to care and improving overall community health.

But workers comp experts worry that these physician consolidations can create monopolies, thereby decreasing competition and possibly diminishing access to care for injured workers.

“A system can just say, ‘we’re not going to take workers comp,’” said Dr. Michael Choo, chief medical officer of Walnut Creek, California-based medical management service company Paradigm Corp., during a panel discussion at the National Council on Compensation Insurance’s Annual Insights Symposium earlier this month.

Dr. Choo said previous hospital consolidations have resulted in a 40% increase in pricing, and that 74% of U.S. physicians are now considered employees of a large health system.

While cost is one potential downside of consolidation, quality and access to care for injured workers also need to be factored in, experts said during a panel discussion at the NCCI symposium.

Dr. Choo said consolidation can sometimes lead to improved quality of care for injured workers.

Kenji Saito, Augusta, Maine-based president of the American College of Occupational and Environmental Medicine, said practice consolidations can help promote shared digital platforms for virtual care.

Consolidation can also result in the sharing of “some of the wealth of knowledge around specialty care and advanced care,” he said.

Comp patients, particularly those in rural communities, can benefit from these integrations, since they can allow them to access specialty care, Dr. Saito said.

However, physician autonomy when it comes to caring for patients can be a challenge if the purchaser of the physician practice is more motivated by revenue than care, he said.

“It’s a little unfortunate that it’s happening that way, but I think we’re seeing now that it is a trend,” he said.