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5. Policy Solutions for Hospital Consolidation

Author

Miller, Brian J. and Ehrenfeld, Jesse M.

Subjects
Health care industry -- Mergers, acquisitions and divestments -- Reorganization and restructuring -- Laws, regulations and rules, Health care industry, Government regulation, Company acquisition/merger, Social sciences
Abstract

Key Points * Addressing consolidation in the health care services market is an imperative, as health care services now represent over 51 percent of national health care expenditures, 90 percent [...]

Published
2022

6. RECONSIDERING THE BAN ON PHYSICIAN-OWNED HOSPITALS TO COMBAT CONSOLIDATION.

Author

Mandelberg, Matthew C., Smith, Michael H., Ehrenfeld, Jesse M., and Miller, Brian J.

Abstract

Ongoing consolidation by hospitals and providers threatens to further reduce competition in U.S. healthcare markets. Physician-owned hospitals (POHs) served as a rare countertrend for many years--a pathway for innovative and efficient alternatives to enter hospital markets and offer a bulwark against this consolidation. However, that countertrend came to an abrupt and enduring halt in 2010, when hospital incumbents leveraged passage of the Affordable Care Act to obtain an ill-conceived and unrelated ban on POHs. While health services researchers have scrutinized the POH ban, this Article analyzes it through a competition lens. It incorporates the growing attention in antitrust to labor markets and explores how physicians, through POHs, are particularly well-positioned to identify market opportunities. In doing so, physicians can defeat the market power possessed by hospital incumbents, upstream against physicians and downstream against payors and patients. This Article first provides an overview of the seemingly inexorable trends towards further consolidation among healthcare providers and the related competition concerns this consolidation raises. Next, the paper discusses the factors that positioned POHs to counterbalance these consolidation trends as market entrants and innovators, and how, after lobbying by incumbent hospitals and health systems, POHs faced regulatory pushback culminating in a federal ban on further POH growth and expansion. The Article then describes how market power by hospital incumbents in both upstream and downstream markets accentuates the incentives and importance of physicians in identifying opportunities for market entry and innovation. It further discusses how the POH ban affects healthcare competition, identifies the potential benefits of relaxing the ban, and suggests more narrowly tailored policy options that could mitigate policymakers' concerns about POHs--concerns that may not be unique to physician ownership and do not justify depriving the market of POH competition. The Article concludes with our recommendation that Congress remove the ban on POHs and apply more appropriately tailored policies. [ABSTRACT FROM AUTHOR]

Published
2024

7. I CHOOSE OPTIMISM.

Author

EHRENFELD, JESSE M.

Subjects
*INAUGURAL addresses of presidents, *LGBTQ+ communities, *HEALTH equity
Abstract

The article presents a speech by president Jesse M. Ehrenfeld's delivered as inaugural address at the American Medical Association (AMA) 2023 annual meeting. Topics include his experiences as a parent of a premature child, the challenges faced by the LGBTQ community in medical contexts, and the AMA's role in advocating for health equity, racial justice, and physician well-being.

Published
2023

9. Changes in health insurance coverage, access to care, and health services utilization by sexual minority status in the United States, 2013-2018

Author

Gonzales, Gilbert, Henning-Smith, Carrie, and Ehrenfeld, Jesse M.

Subjects
Medical care -- Utilization, Sexual minorities -- Health aspects -- Statistics, Health insurance -- User statistics, Business, Health care industry
Abstract

Objective: To examine the changes in health insurance coverage, access to care, and health services utilization among nonelderly sexual minority and heterosexual adults between pooled years 2013-2014 and 2017-2018. Data Sources: Data on 3223 sexual minorities (lesbians, gay men, bisexual individuals, and other nonheterosexual populations) and 86 181 heterosexuals aged 18-64 years were obtained from the 2013, 2014, 2017, and 2018 National Health Interview Surveys. Study Design: Unadjusted and regression-adjusted estimates compared changes in health insurance status, access to care, and health services utilization for nonelderly adults by sexual minority status. Regression-adjusted changes were obtained from logistic regression models controlling for demographic and socioeconomic characteristics. Principal Findings: Uninsurance declined for both sexual minority adults (5 percentage points, P < .05) and heterosexual adults (2.5 percentage points, P < .001) between 2013-2014 and 2017-2018. Reductions in uninsurance for sexual minority and heterosexual adults were associated with increases in Medicaid coverage. Sexual minority and heterosexual adults were also less likely to report unmet medical care in 2017-2018 compared with 2013-2014. Low-income adults (regardless of sexual minority status) experienced relatively large increases in Medicaid coverage and substantial improvements in access to care over the study period. The gains in coverage and access to care across the study period were generally similar for heterosexual and sexual minority adults. Conclusions: Sexual minority and heterosexual adults have experienced improvements in health insurance coverage and access to care in recent years. Ongoing health equity research and public health initiatives should continue to monitor health care access and the potential benefits of recent health insurance expansions by sexual orientation and sexual minority status when possible. KEYWORDS health care access, LGBT health, sexual minorities, 1 | INTRODUCTION Previous research has documented substantial disparities in health insurance coverage and access to care for sexual minorities (ie, lesbians, gay men, bisexual individuals, and other nonheterosexual populations). [...]

Published
2021
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19. Understanding the Information Needs and Context of Trauma Handoffs to Design Automated Sensing Clinical Documentation Technologies: Qualitative Mixed-Method Study of Military and Civilian Cases

Author

Novak, Laurie Lovett, Simpson, Christopher L, Coco, Joseph, McNaughton, Candace D, Ehrenfeld, Jesse M, Bloos, Sean M, and Fabbri, Daniel

Subjects
Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract

BackgroundCurrent methods of communication between the point of injury and receiving medical facilities rely on verbal communication, supported by brief notes and the memory of the field medic. This communication can be made more complete and reliable with technologies that automatically document the actions of field medics. However, designing state-of-the-art technology for military field personnel and civilian first responders is challenging due to the barriers researchers face in accessing the environment and understanding situated actions and cognitive models employed in the field. ObjectiveTo identify design insights for an automated sensing clinical documentation (ASCD) system, we sought to understand what information is transferred in trauma cases between prehospital and hospital personnel, and what contextual factors influence the collection, management, and handover of information in trauma cases, in both military and civilian cases. MethodsUsing a multi-method approach including video review and focus groups, we developed an understanding of the information needs of trauma handoffs and the context of field documentation to inform the design of an automated sensing documentation system that uses wearables, cameras, and environmental sensors to passively infer clinical activity and automatically produce documentation. ResultsComparing military and civilian trauma documentation and handoff, we found similarities in the types of data collected and the prioritization of information. We found that military environments involved many more contextual factors that have implications for design, such as the physical environment (eg, heat, lack of lighting, lack of power) and the potential for active combat and triage, creating additional complexity. ConclusionsAn ineffectiveness of communication is evident in both the civilian and military worlds. We used multiple methods of inquiry to study the information needs of trauma care and handoff, and the context of medical work in the field. Our findings informed the design and evaluation of an automated documentation tool. The data illustrated the need for more accurate recordkeeping, specifically temporal aspects, during transportation, and characterized the environment in which field testing of the developed tool will take place. The employment of a systems perspective in this project produced design insights that our team would not have identified otherwise. These insights created exciting and interesting challenges for the technical team to resolve.

Published
2020
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24. In Response

Author

Freundlich, Robert E., Wanderer, Jonathan P., Rothman, Brian S., Sandberg, Warren S., and Ehrenfeld, Jesse M.

Published
2019
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44. Balanced Crystalloids versus Saline in Critically Ill Adults

Author

Semler, Matthew W., Self, Wesley H., Wanderer, Jonathan P., Ehrenfeld, Jesse M., Wang, Li, Byrne, Daniel W., Stollings, Joanna L., Kumar, Avinash B., Hughes, Christopher G., Hernandez, Antonio, Guillamondegui, Oscar D., May, Addison K., Weavind, Liza, Casey, Jonathan D., Siew, Edward D., Shaw, Andrew D., Bernard, Gordon R., and Rice, Todd W.

Published
2018
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