Tag: Healthcare

Breaking Up is Hard to Do

Senate legislation introduced to target Pharmacy Benefit Managers

Neil Sedaka, a singer, songwriter, and pianist who died last week, hit the charts in the early 1960’s with the hit single, “Breaking Up is Hard to Do.”  He liked it so much that he released a newer version of it some 10 years later, with a slower tempo.

The Break Up Big Medicine Act

Senators Josh Hawley and Elizabeth Warren are looking to put that phrase to the test when it comes to going after Pharmacy Benefit Managers in the health care industry.

The act, officially titled, “The Break Up Big Medicine Act”, was released in February.  The bipartisan measure seeks to reign in the monopoly they feel exists with both prescription drug claims and prescription drug wholesalers, and the insurance companies, physician groups and pharmacists who are involved.

On their official website, Senator Warren is quoted as saying:

“There’s no question that massive health care companies have created layers of complexity to jack up the price of everything from prescription drugs to a visit to the doctor. The only way to make health care more affordable is to break up these health care conglomerates.  Our bill would be a monumental step towards ending the stranglehold that corporate giants have on our broken health care system.”

Senator Hawley says:

“Americans are paying more and more for healthcare while the quality of care gets worse and worse. In their quest to put profits over people, Big Pharma and the insurance companies continue to gobble up every independent healthcare provider and pharmacy they can find.  Working Americans deserve better. This bipartisan legislation is a massive step towards making healthcare affordable for every American.”

Pharmacy Benefit Managers

Pharmacy Benefit Managers (PBM), are companies hired by health plans to manage prescription drug benefits. Which drugs are covered, how much they cost, and where patients can fill prescriptions are determined.  Such things as to what pharmacies are “in network,” prior authorizations, and obtaining price discounts in exchange for favorable positioning are selected.  They started out mainly as an administrative service but grew in power to issue decisions in the daily operations of the pharmacy web.

The largest PBMs in the United States are CVS Caremark, Express Scripts, and Optum Rx. Together, they process nearly 80% of all U.S. prescription claims. 

The largest prescription drug wholesalers in the United States are McKesson, Cencora (formerly AmerisourceBergen), and Cardinal Health. They control over 90% of the U.S. drug‑distribution market.

On their website Warren and Hawley state the companies involved are “vertically integrated”.  This means one company can own or control every part of the health care supply chain—from health insurance companies and PBMs to pharmacists and physicians.

“By controlling both the company that pays for health care services (e.g., a health insurer) and also the entity that sets the prices for those health care services (e.g., a health care provider), these conglomerates may be steering business to their own affiliates, evading laws intended to rein in corporate profiteering, or using providers they employ to boost government payments and pad their bottom lines.”

Analysis

In my opinion this is an uphill fight for the two Senators.  Breaking up here is hard to do.  But it is a step in the right direction.  Legislation or court rulings can be part of the solution.  It is better than simply using social media to bad mouth corporations and their executives.  Social media is freedom of speech and can draw a lot of attention but leads to no solution.  It is also better than cheering on those who assassinate health care executives. 

The health care monopoly is bigger than pharmacy benefit managers.  For example, this legislation does not address its historical acquisition mania and the power it has produced.   Nevertheless, I encourage all of you to contact one or both of your U.S. Senators and express your support.  I am not sure it will garner the support, let alone the attention, of the Trump administration.  But, as I said, it is a step in the right direction.

 

 

Some Hospitals are Dying as well as their Patients – Here’s Why

Private Equity’s track record with acquisitions should be basis for anti-trust

Hospital in Financial Distress

The impact of private equity’s expansion into healthcare is important.

On April 9-10 the PBS NewsHour broadcast a two part report on the effect private equity firms have had on the hospital industry. In this case it was on Cerberus Capital Management

“The impact of private equity’s expansion into health care” was the first installment:

Steward Health Care was once the largest private hospital system in the country. When the private equity-backed network filed for bankruptcy last year, it devastated providers and patients. Five of the eight Steward-owned hospitals in Massachusetts were salvaged by the state and two were shuttered.

Narrated by Paul Solman, it introduced the audience to Carney Hospital and Nashoba Valley Medical Center, both located in Massachusetts. They were purchased by Steward Heath Care, a subsidiary of Cerberus to manage its hospital purchases. They both closed after Steward acquired them, primarily due to not paying bills

People will come in for surgery. They couldn’t get the equipment. So they had to send them home. Sorry. It happened all the time. They owed so much money to creditors for equipment That they wouldn’t give them anymore.

Elaine Graves, Former Nurse at Carney Hospital

On the Steward Health Care website, they actually list the hospitals in Massachusetts and ones in Texas that were closed. It shows only one operating hospital, in Pennsylvania.

Steward Health Care filed for bankruptcy. Its CEO, Ralph de la Torre resigned after refusing to testify before Congress citing his Fifth Amendment right. A website entitled “The Truth About the Steward CEO” justifies both de la Torre’s actions and compensation.

The second episode, entitled “How private equity’s increasing role in health care is affecting patients,” has interview with experts who venture further into the effect decisions by private equity owners have on others than the company’s shareholders.

Make money, leave, make it however you want, make it for people who are invested in making money, and then you have got health care, which is all about delivering care to people. The cost is not the first thing. The delivery care is the first thing. And those two things do not mesh.

State Sen. Cindy Friedman (D-MA)

Solman provided some additional information on the history of private equity in the health care industry:

Steward bought 37 hospitals around the country.  More than 450 hospitals nationwide have been taken over by private equity, as well as nursing homes, emergency rooms, doctor’s practices, and air ambulances. One analysis finds that private equity investors spent more than $200 billion on health care acquisitions in 2021 alone, and $1 trillion over the past decade.

Analysis

The impact of private equity’s expansion into healthcare is important. Hospitals are struggling through the country. When an outside buyer comes in with the possibility of infusing cash to get the financial position in shape, it may look like a good deal. If the acquired company is going bankrupt, and the private equity firm is earning profits, something is definitely wrong with this scenario.

There are several issues involved here. One is, are all private equity firms bad or are there just some bad performers. Related to that is, are there any private equity firms that have actually done a good job at creating a sound financial footing that employees/customers are happy with? If so, what is their business model? Hospitals are in financial straits because of their never-ending battle with insurance companies and discrepancies over payments. In addition, this situation with Steward Health Care also involves such issues as privatization, financialization, stakeholders versus shareholders and issues with small towns.

The history of a private equity’s acquisitions should be a basis for anti-trust violation.  Acquisitions that have either failed or gone into debt and bankruptcy are sold off as a tax write-off, there is something wrong here.  This is not capitalism.   There should be a law that required the private equity company itself to assume the debt for its acquisitions.  More on this will be coming in the later months.