Indiana residents and federal officers are urging state well being regulators to cease two rival hospitals in Terre Haute from merging. The deal, if accepted, would go away residents with a hospital monopoly.
Union Well being, a nonprofit whose foremost 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 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 Division of Well being acquired tons of of feedback on the proposed merger, in line with paperwork KFF Well being Information obtained by a state public data request. Most individuals expressed opposition to the deal, citing issues about longer journey instances to get emergency care, increased costs, and fewer selections for Terre Haute’s 58,000 residents and people in Vigo County’s close by rural communities.
“Monopoly ought to be only a board sport. Not a healthcare system,” a commenter listed as H. Osborne wrote to the state well being company.
Docs, well being economists, and the Federal Commerce Fee known as on the Indiana Division of Well being to disclaim Union Hospital’s merger utility. Such mergers turned doable after Indiana enacted a Certificates of Public Benefit regulation, or COPA, in 2021, shielding the offers from federal anti-monopoly legal guidelines.
Two dozen states have had COPA legal guidelines on their books sooner or later, regardless of FTC warnings that such mergers can develop into troublesome to regulate and will lower the general high quality of care. The pattern has come amid a broader wave of hospital consolidation, which analysis exhibits 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 Well being stated its proposed deal would enhance care and enhance entry to companies whereas “sustaining value effectivity” for sufferers.
“This isn’t merely a enterprise transaction; it’s a strategic effort to enhance healthcare supply in our neighborhood,” Union stated in an announcement.
John Collett, an government with Garmong Building who additionally serves on the board of the Terre Haute Chamber of Commerce, wrote that the deal would assist the area obtain its aim of boosting inhabitants and revenue ranges. (Garmong Building served as building supervisor for Union on a number of initiatives, together with one value tons of of tens of millions of {dollars}, in line with a web-based brochure of its previous initiatives.)
“I firmly imagine this to be a step in the proper path,” Collett wrote.
However the FTC — utilizing italics for emphasis — stated the deal is “unlikely to lead to improved high quality and entry” and “would not result in a more healthy workforce or a stronger native financial system,” in line with feedback the company submitted to Indiana regulators.
Zack Cooper, a well being economist and affiliate professor at Yale College, stated the merger would most likely harm the native financial system and squeeze residents’ wallets. Cooper’s evaluation 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 imagine this merger would hurt members of the general public in Terre Haute and Vigo County,” Cooper wrote.
As a situation of all these mergers, state companies sometimes agree to watch hospital high quality and costs to make up for the lack of competitors. Union stated monitoring would maintain it accountable, in line with its response to the FTC’s public feedback opposing the deal.
The FTC pushed again, saying the oversight mechanism “can be inadequate to include prices” and is a “poor substitute” for competitors. Though Union would face limits on elevating costs in Vigo County, the FTC stated, the system would possibly be capable to hike them elsewhere, together with at its hospital in neighboring Vermillion County to the north.
Indiana has a number of the highest hospital costs within the nation, in line with research by Rand Corp., a analysis group.
In Terre Haute, some docs fear the deal would exacerbate current issues. Kathleen Stienstra, a doctor in personal follow, voiced her issues about Union’s administration type, saying it has led to an exodus of docs.
“A monopoly will result in additional deterioration in companies,” she wrote.
Individually, the FTC referenced KFF Well being Information’ reporting on Tennessee’s Ballad Well being, a 20-hospital monopoly in Appalachia, as a cautionary story in opposition to such mergers.
COPAs, such because the one which Ballad operates underneath, “have confirmed unwieldy,” are “troublesome to handle,” and “have failed to guard native communities from the dangerous results 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 as much as a few of its guarantees, KFF Well being Information reported. It has fallen quick on assembly high quality and charity care objectives, in line with annual studies from Ballad and the Tennessee Division of Well being. After years of issues and complaints from sufferers, the state is now making an attempt to carry Ballad extra accountable for its high quality of care.
Ballad declined to reply to KFF Well being Information inquiries concerning the FTC’s feedback.
Now the Indiana Division of Well being should think about 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. Below the division’s requirements, these advantages should “outweigh any potential disadvantages.”
KFF Well being Information correspondent Brett Kelman contributed to this report.
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