INHOSPITABLE follows the story of patients and activists as they band together in an effort to fight UPMC, a multi-billion dollar nonprofit hospital behemoth in western Pennsylvania. In its quest for market domination, UPMC was planning to make vital care unaffordable for hundreds of thousands of vulnerable patients. These patients were taxpayers who had been subsidizing this supposedly nonprofit institution whose main mission as a charity was to serve the community. This illuminating documentary tells the inspiring story of these brave patients and activists who, faced with life-or-death consequences, fight to win the battle for their health — and their community.
01 - US Hospitals are a Big Business
Most Americans believe that if we can fix our insurance and pharmaceutical issues, we could have more affordable healthcare in the United States. Sadly, this just isn’t true. The Covid19 pandemic has further revealed one of the largest contributors to our broken healthcare system: HOSPITALS.
National Health Expenditures 2019 Highlights: More of our healthcare dollars go to hospitals than any other service (by far)
Health Care Cost Institute’s Price Index : The price of health care services can be dramatically different depending on where one receives those services. HCCI’s price index compares the prices paid for the same set of health care services in 112 metro areas across the country
02 - US HOSPITALS HAVE POWER
US HOSPITALS HAVE POWER
Hospitals have escaped scrutiny for many reasons: they’re pillars of the community, they’re the largest employers in most regions, people have emotional connections to their doctors. They also have a very powerful lobby in Washington and at the state level.
OpenSecrets.org : Provides a comprehensive resource for federal campaign contributions, lobbying data and analysis.
03 - US HOSPITALS ARE BUILDING MONOPOLIES
US HOSPITALS ARE BUILDING MONOPOLIES
In the past 20 years, health systems have been consolidating and buying up physician practices. Research shows that once they have the power and bargaining leverage, they begin to charge higher prices without the pressures of increasing quality of care. 90% of hospital markets in the United States are now consolidated. The map above illustrates some of the most consolidated health systems in the US.
LEARN MORE ABOUT HOSPITAL CONSOLIDATION
When Hospitals Merge to Save Money, Patients Often Pay More : New York Times article by Reed Abelson. She writes: “The nation’s hospitals have been merging at a rapid pace for a decade, forming powerful organizations that influence nearly every health care decision consumers make.”
Diagnosing the Problem: Exploring the Effects of Consolidation and Anticompetitive Conduct in Health Care Markets : Carnegie Mellon Healthcare Economist Martin Gaynor (InHospitable interviewee) speaks to the Judiciary Subcommittee on Antitrust, Commercial, and Administrative Law U.S. House of Representatives.
Provider Consolidation Drives Up Health Care Costs Healthcare Economists Emily Gee (InHospitable interviewee) and Ethan Gurwitz at the Center for American Progress provide a roundup all of the available research and provide policy recommendations.
Affordable Hospital Care Through Competition and Price Transparency Avik Roy, President of The Foundation for Research on Equal Opportunity (FreOpp) lays out the research on hospital consolidation and provides policy recommendations.
What We Know About Provider Consolidation Kaiser Family Foundation’s summary of the current state of provider consolidation
Health Care Cost Institute’s Hospital Consolidation Index Want to see how your area stacks up? HCCI’s website provides a user-friendly resource on hospital consolidation around the country
WHAT THE AMERICAN HOSPITAL ASSOCIATION SAYS
Hospital Merger Benefits: Views from Hospital Leaders and Econometric Analysis – An Update A study on consolidation commissioned by the American Hospital Association
American Hospital Association, Economists Debate Merits of Mergers Modern Healthcare’s article on the disagreement between prominent healthcare economists and the AHA on hospital consolidation.
Antitrust and Health Care Providers: Policies to Promote Competition and Protect Patients FTC Commissioner Slaughter (InHospitable interviewee) lays out the barriers at the FTC when it comes to hospital antitrust enforcement and solutions.
State Strategies to Address Rising Prices Caused by Healthcare Consolidations Director of the Center for Law, Health & Society at Georgia State College of Law, Erin Fuse Brown (InHospitable interviewee) provides practical policy recommendations for states.
RESEARCH PAPERS ON HOSPITAL CONSOLIDATION
Changes in Quality of Care after Hospital Mergers and Acquisitions 2020: Nancy D. Beaulieu, Ph.D., Leemore S. Dafny, Ph.D., Bruce E. Landon, M.D., M.B.A., Jesse B. Dalton, M.A., Ifedayo Kuye, M.D., M.B.A., and J. Michael McWilliams, M.D., Ph.D.
Impacts of Health Care Industry Consolidation in Pittsburgh, Pennsylvania: A Qualitative Study 2020: Claire E. O’Hanlon.
The price effects of cross-market mergers: theory and evidence from the hospitaL industry 2019: Leemore Dafny, Kate Ho,Robin S. Lee.
The Price Ain’t Right? Hospital Prices and Health Spending on the privately Insured 2018: Zack Cooper, Stuart V. Craig, Martin Gaynor, John Van Reenen.
The Risks to Patient Safety From Health System Expansions 2018: Susan Haas, Atul Gawande, Mark E Reynolds.
04 - THE MAJORITY OF US HOSPITALS ARE NONPROFIT
THE MAJORITY OF US HOSPITALS ARE NONPROFIT
Many of the nonprofit health systems in the US are billion-dollar organizations that pay their CEO’s multi-million dollar salaries. Research shows that these nonprofit hospitals behave in similar ways as for-profit hospitals, except they are exempt from federal and local taxes, including property tax. As a result, as these corporations grow larger, the city and counties in which they reside receive less and less property tax needed for services such as transportation, roads and schools. The taxpayers and smaller businesses end up having to subsidize these money-making institutions.
LEARN ABOUT THE IMPACT OF NONPROFIT HOSPITALS
Tax exemptions for nonprofit hospitals: It’s time taxpayers get their money’s worth Article in Stat News by Ge Bai about her study that found that nonprofit hospitals spent $2.3 of every $100 in total expenses incurred on charity care, which was less than government ($4.1) or for-profit ($3.8) hospitals
Why Are Nonprofit Hospitals So Highly Profitable? Op-Ed by Danielle Ofri, physician at Bellevue Hospital and a clinical professor of medicine at New York University Grossman School of Medicine.
Top Not-For-Profit Hospitals Offer Disproportionately Less Charity Care, Study Finds Modern Healthcare article citing the research of Johns Hopkins Healthcare Economists Darrell Gaskin (InHospitable interviewee), Bradley Herring, Hossein Zare, and Gerard Anderson.
How Nonprofit Hospitals Get Away With The Biggest Rip Off In America Medical Economics Op-Ed by Marni Jameson Carey, Executive Director of the Association of Independent Doctors.
Top U.S. “Non-Profit” Hospitals & CEOs Are Racking Up Huge Profits Forbes’ contributor Adam Andrzejewski from Openthebooks.com.
HOW DOES YOUR HOSPITAL STACK UP?
Washington Monthly’s 2020- Hospital Guide and Rankings Washington Monthly teamed up with the Lown Institute to not only measure how well hospitals care for their patients but also to gauge the contributions hospitals make to the country and their communities. Their rankings use three main criteria. First, patient outcomes: a hospital’s patient mortality, safety, and satisfaction record. Second, civic leadership: the degree to which a hospital treats patients with the same income and other demographics as its surrounding community; how much it contributes in community benefit, from providing charity care to building and operating free clinics; and how much it pays its senior executive compared to its frontline workers. Third, value of care: how much a hospital overuses low-value tests and procedures.
RESOURCES FOR STATES
States Use a Sharper Lens to Scrutinize Nonprofit Hospitals’ Community Benefit Spending Resources for states from the National Academy for State Health Policy.
University of Kansas- Community Toolbox Resource guide including models, practical skill-building, trouble-shooting, evaluation and best practices for community health development in diverse cultures and contexts. Provides a five point model for community improvement: Assess, Plan, Act, Evaluate, and Sustain.
Community Benefit Insight The interactive Community Benefit Insight tool, supported by the Robert Wood Johnson Foundation (RWJF) in partnership with RTI International and the Public Health Institute, draws on IRS and other data to show how hospitals spend their community benefits dollars.