Category: Health Economics & Costs

Aging Colons a Goldmine for Private Equity Investors

Posted on by Devon Herrick

Private equity investors are increasingly buying gastroenterology practices. Around 1,400 of the nation’s gastroenterologists are employees or partners in practices backed by private equity. According to a recent whitepaper, acquisitions of gastroenterology practices by private equity grew by 28% last year. As one investment manager noted:

We are in the Golden Age of older rectums—from a supply side, at least. Elderly people will make up 20% of the population by 2030, and health care costs are projected to approach 20% of the nation’s gross domestic product—the highest in the world, according to the U.S. Census Bureau. It would seem a boom time for gastroenterologists.

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Can Medical Associations Gut the No Surprises Act?

Posted on by Devon Herrick

The Arizona Medical Association (ArMA) is considering a state ballot measure to remove a key provision of the No Surprises Act (NSA), in order to boost fees of out-of-network physicians. The NSA is a federal law protecting patients from surprise medical bills, which went into effect January 2022. Balance billing is the term in industry parlance for surprise medical bills. Balance billing occurs when out-of-network physicians (who patients could not avoid) charge fees higher than what their health plans reimburse. Prior to the NSA, patients were responsible for any portion of out-of-network fees their insurers did not pay. The ArMA does not wish to gut so-called patient protections. However, the ballot measure would result in higher fees and higher premiums for consumers nonetheless. More on this below.

Surprise medical bills are unfair to patients and health plans alike. Health plans try to steer patients to providers who have agreed to specific terms and have negotiated fee agreements with a network. Selecting network providers reduces patient cost-sharing and in some health plans out-of-network care is not covered at all. Thus, patients have a strong financial incentive to seek care within their network.

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