Indiana residents and federal officers are urging state well being regulators to cease two rival hospitals in Terre Haute from merging. The deal, if permitted, would go away residents with a hospital monopoly.
Union Health, a nonprofit whose most important hospital is licensed as a 341-bed facility, would purchase the county’s solely different acute care hospital, the 278-bed Terre Haute Regional Hospital, owned by for-profit chain HCA Healthcare and positioned 5 miles south throughout the town’s downtown space. Union says the merger to create one bigger nonprofit well being system would enhance the world’s poor public well being rankings.
The Indiana Department of Health acquired tons of of feedback on the proposed merger, in accordance with paperwork KFF Health News obtained by means of a state public data request. Most folks expressed opposition to the deal, citing issues about longer journey instances to get emergency care, increased costs, and fewer decisions for Terre Haute’s 58,000 residents and people in Vigo County’s close by rural communities.
“Monopoly should be just a board game. Not a healthcare system,” a commenter listed as H. Osborne wrote to the state well being company.
Doctors, well being economists, and the Federal Trade Commission referred to as on the Indiana Department of Health to disclaim Union Hospital’s merger software. Such mergers grew to become doable after Indiana enacted a Certificate of Public Advantage legislation, or COPA, in 2021, shielding the offers from federal anti-monopoly legal guidelines.
Two dozen states have had COPA legal guidelines on their books in some unspecified time in the future, regardless of FTC warnings that such mergers can turn into tough to regulate and will lower the general high quality of care. The development has come amid a broader wave of hospital consolidation, which research shows fuels worth hikes and well being care spending, driving up prices for households, employers, and taxpayers who foot the invoice for Medicare and Medicaid.
Union Health stated its proposed deal would enhance care and enhance entry to companies whereas “maintaining cost efficiency” for sufferers.
“This is not merely a business transaction; it is a strategic effort to improve healthcare delivery in our community,” Union said in a statement.
John Collett, an government with Garmong Construction who additionally serves on the board of the Terre Haute Chamber of Commerce, wrote that the deal would assist the area obtain its objective of boosting inhabitants and revenue ranges. (Garmong Construction served as building supervisor for Union on a number of tasks, together with one price tons of of thousands and thousands of {dollars}, in accordance with an online brochure of its previous tasks.)
“I firmly believe this to be a step in the right direction,” Collett wrote.
But the FTC — utilizing italics for emphasis — stated the deal is “unlikely to result in improved quality and access” and “would not lead to a healthier workforce or a stronger local economy,” in accordance with comments the agency submitted to Indiana regulators.
Zack Cooper, a well being economist and affiliate professor at Yale University, stated the merger would in all probability injury the native economic system and squeeze residents’ wallets. Cooper’s analysis estimates the value of care would rise by a minimum of 10% for space residents and result in 500 misplaced jobs, whereas nurses’ pay would drop by a minimum of 7%. His analysis predicts the deal additionally would result in pointless deaths from suicide or overdose, stemming from these job losses.
“I firmly believe this merger would harm members of the public in Terre Haute and Vigo County,” Cooper wrote.
As a situation of these kind of mergers, state businesses sometimes agree to observe hospital high quality and costs to make up for the lack of competitors. Union stated monitoring would maintain it accountable, in accordance with its response to the FTC’s public feedback opposing the deal.
The FTC pushed again, saying the oversight mechanism “would be insufficient to contain costs” and is a “poor substitute” for competitors. Even although Union would face limits on elevating costs in Vigo County, the FTC stated, the system may be capable of hike them elsewhere, together with at its hospital in neighboring Vermillion County to the north.
Indiana has among the highest hospital costs within the nation, in accordance with studies by Rand Corp., a analysis group.
In Terre Haute, some docs fear the deal would exacerbate current issues. Kathleen Stienstra, a doctor in non-public follow, voiced her issues about Union’s administration type, saying it has led to an exodus of docs.
“A monopoly will lead to further deterioration in services,” she wrote.
Separately, the FTC referenced KFF Health News’ reporting on Tennessee’s Ballad Health, a 20-hospital monopoly in Appalachia, as a cautionary story towards such mergers.
COPAs, such because the one which Ballad operates beneath, “have proven unwieldy,” are “difficult to manage,” and “have failed to protect local communities from the harmful effects of anticompetitive hospital mergers,” the FTC stated in its feedback on the Union-Regional merger.
Since Ballad launched in 2018 and have become the nation’s largest state-approved hospital monopoly, it has not lived up to some of its promises, KFF Health News reported. It has fallen quick on assembly high quality and charity care objectives, in accordance with annual reports from Ballad and the Tennessee Department of Health. After years of issues and complaints from sufferers, the state is now making an attempt to hold Ballad more accountable for its high quality of care.
Ballad declined to reply to KFF Health News inquiries concerning the FTC’s feedback.
Now the Indiana Department of Health should contemplate the feedback and determine by early December whether or not the proposed merger would enhance well being outcomes, entry to companies, and high quality of care. Under the division’s requirements, these advantages should “outweigh any potential disadvantages.”
KFF Health News correspondent Brett Kelman contributed to this report.
Samantha Liss:
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