Our Publications

Hospital Consolidation Across Geographic Markets: Insights from Market Participants on Mechanisms for Price Increases

By Katherine Gudiksen, Andréa E. Caballero, Paul Ginsburg, Bruce Allain, Thomas Greaney, Brent D. Fulton | Published April 2025 in Journal of Health Politics, Policy and Law | Link to article.

Consolidation among health systems has resulted in increased prices and caused the cost of employer-sponsored health benefits to increase much faster than inflation over the past few decades. Prior quantitative research demonstrates small, but significant price increases resulting from transactions that expand the geographic footprint of health systems, but the mechanisms by which these cross-market acquisitions raise prices is not completely resolved.

State-Level Hospital Quality in the United States: Analyzing Variation and Trends From 2013 to 2021

By Arjun Teotia, Brent D. Fulton, Dan R. Arnold, Richard M. Scheffler | Published February 2025 | Link to article

A new study by Teotia, Fulton, Arnold and Scheffler introduces a hospital quality index to assess variations in hospital performance across the U.S. from 2013 to 2021, using data from 3,000 hospitals. The index combines three key metrics from the CMS Hospital Compare dataset—30-day readmission rates, 30-day mortality rates, and patient experience scores—weighted by hospital size.

The study reveals significant state-level disparities in hospital quality. While Utah led the nation, 14 states fell behind the national average. Despite overall improvements in readmissions and mortality, patient experience scores declined.

This innovative index provides crucial insights for policymakers and healthcare professionals aiming to reduce disparities and improve care quality nationwide.

New evidence on the impacts of cross-market hospital mergers on commercial prices and measures of quality

By Daniel R. Arnold, Jaime S. King, Brent D. Fulton, Alexandra D. Montague, Katherine L. Gudiksen, Thomas L. Greaney, Richard M. Scheffler| Published in Health Services Research in April 2024 | Link to full report.

“As hospital systems have expanded, they’ve extended into regions where they previously had no presence. A recent study found 55% of the 1500 hospitals targeted for a merger or acquisition from 2009 to 2019 operated in a commuting zone that the acquirer did not previously operate in. The price and quality effects of these “cross-market” hospital mergers and acquisitions (M&A) are the focus of this paper.”

What this study adds: 

  • Serial acquirers are significant contributors to estimated cross-market price effects.
  • We find no discernible impact of cross-market mergers on mortality and readmission rates for heart failure, heart attacks and pneumonia.
  • Overall, this study provides further evidence that cross-market hospital mergers lead to price increases and novel findings of no quality effect and the impact of serial acquirers on the price effect. More antitrust scrutiny of these mergers—particularly those of serial acquirers—appears prudent given the current state of highly concentrated hospital markets in the United States.

Questions should be addressed to Daniel Arnold, [email protected]

Private Equity–Acquired Physician Practices And Market Penetration Increased Substantially, 2012–21

By Ola Abdelhadi, Brent D. Fulton, Laura Alexander, Richard M. Scheffler | Published March 2024 in Health Affairs | Link to full report.

“Private equity (PE) firms have been acquiring physician practices at an increasing rate, raising concerns about such firms’ penetration at the physician level into local markets and the impact on health care quality and prices. However, limited knowledge exists about the extent of PE firms’ control in local markets. By linking data on PE acquisitions to physician data and using full-time-equivalent physicians as the base of assessment, we estimated the local market share of each PE firm within ten physician specialties at the Metropolitan Statistical Area (MSA) level.”

Monetizing Medicine: Private Equity and Competition in Physician and Practice Markets Addendums

“The addendums provide additional data and more detailed information regarding metropolitan statistical areas (MSAs) that had a private equity (PE) firm with 30+% or 50+% market share in 2021 for one or more of the ten physician specialties analyzed in the report. Addendum 1 provides the physician specialty, the name of the physician practice, and the PE firm with the 30+% or 50+% market share for most of the MSAs mentioned in the original report. Addendum 2 presents the MSA-level three year post-PE price increase for the affected specialty.”

Addendums authored by Richard M. Scheffler and Daniel R. Arnold | Link to the addenda and full report.

Monetizing Medicine: Private Equity and Competition in Physician and Practice Markets

Check out the Petris Center’s recent report on the rise of private equity firms in acquiring physician practices, in collaboration with AAI and the Washington Center for Equitable Growth. The study covers ten medical specialties across the United States, offering insights into private equity’s impact on market concentration and healthcare expenditure. Lead author Richard Scheffler expresses concerns over shifts towards prioritizing profits over patient care, with far-reaching implications in the practice of medicine.

By Richard M. Scheffler, Laura Alexander, Brent D. Fulton, Daniel R. Arnold, Ola A. Abdelhadi | Link to the full report here

Comments of Professors of Law and Economics, Economists, and Health Policy Researchers on the Draft Merger Guidelines

By Thomas L. Greaney, Richard M. Scheffler, Katherine L. Gudiksen, Jaime S. King, Amy Y. Gu, Brent D. Fulton, Paul B. Ginsburg, and Daniel R. Arnold | Link to Full Comment

The Draft Merger Guidelines (DMGs) constitute a major step forward in providing economically sound guidance to practitioners and courts for evaluating the potential competitive impact of mergers and acquisitions. These comments are offered by a group of law professors, economists, and policy experts who have devoted most of their professional careers to issues concerning market and regulatory issues involving health care providers and payors. The comment focus on several proposed changes that are of particular importance to improving oversight of consolidation in the health care sector.

The Better Care Plan: a blueprint for improving America’s healthcare system

By Stephen M Shortell, John S Toussaint, George C Halvorson, Jon M Kingsdale, Richard M Scheffler, Allyson Y Schwartz, Peter A Wadsworth, Gail Wilensky | Published June 20, 2023 in Health Affairs Scholar | Link to Full Article

The United States falls far short of its potential for delivering care that is effective, efficient, safe, timely, patient-centered, and equitable. We put forward the Better Care Plan, an overarching blueprint to address the flaws in our current system. The plan calls for continuously improving care, moving all payers to risk-adjusted prospective payment, and creating national entities for collecting, analyzing, and reporting patient safety and quality-of-care outcomes data. A number of recommendations are made to achieve these goals.

Private Equity and Your Doctor: Profits Before Patients | Public Policy & Aging Report

By Richard M. Scheffler, Ola Abdelhadi | Published April 21, 2023 in Oxford Academic | Link to Full Article

Older Americans have unique health needs that require specialized care and support. As people age, they are more likely to develop multiple chronic conditions such as cancer, diabetes, heart disease, and arthritis, which can greatly affect their quality of life (Boyd et al., 2019). Additionally, older adults may also experience physical and cognitive declines, which can make it difficult for them to manage their own healthcare. Access to healthcare and supportive services is crucial for older Americans to maintain their health and independence. Services such as home healthcare, nursing homes, and hospice care play a vital role in helping older adults lead fulfilling lives and maintain their quality of life for as long as possible. The majority of hospice patients are diagnosed with one or more chronic conditions, with cancer being the most common (29.6%), followed by circulatory or heart disease (17.4%) and dementia (15.6%) (Hospice Facts & Figures, 2020). Meanwhile, as the American population of persons aged 65 years and over will soon outnumber those under 18 year of age, there are concerns about the quality of care for older Americans as the healthcare industry shifts towards private equity (PE) ownership (Braun, Stevenson, et al., 2021).

Association Between a Capitated, Low-cost, County-Based Public Health Insurance Option and Affordable Care Act Premium Growth in California

By Arjun Teotia, Daniel R. Arnold, Richard M. Scheffler | Published April 21, 2023 in JAMA Health Network | Link to Full Article

Is a low-cost, county-based public insurance option associated with slower premium growth on the California Affordable Care Act exchange?

On Covered California (CC), the state-run Affordable Care Act (ACA) exchange in California, gross annual premiums for members have increased by 41% since CC started in 2014 ($9612 in 2022 vs $6804 in 2014).1 Through CC, individuals and their families can purchase private health insurance plans. Exchange coverage is generally intended for those who do not have access to health insurance through their employer, Medicare, or Medicaid. Nearly 90% of CC enrollees receive subsidized coverage in the form of reduced (often 0) premiums and reduced cost sharing.1 California is one of the few states that uses an active purchaser model for its exchange, which allows it to standardize benefits and cost sharing, selectively contract with insurers, and negotiate premiums.2 Premiums and insurers vary across the 19 regions of CC. Los Angeles (LA) has some of the lowest premiums and premium growth rates on CC. It is also the only region with a public plan—LA Care—which competes with 6 private insurers on the exchange.

Our work extends this research and is the first known study to empirically evaluate how a county-based public option performs in the ACA Marketplace in California. Specifically, we statistically evaluated whether LA Care was associated with reduced premium growth in LA compared with premium growth in other regions of CC.