Health workers, researchers and observers warned federal regulators at a public hearing on Wednesday that the integration would harm employees and patients.

The FTC and DOJ seek comments as they redesign guidance on horizontal and vertical mergers. Most speakers claimed that mergers and acquisitions involving hospitals, doctors, pharmacy benefit managers and insurance companies increased prices, suppressed wages and reduced the quality of care.

“One of the things we often hear from hospital executives trying to make deals is that a merger will be efficient, it will reduce costs and allow them to improve quality,” FTC Chair Lina Kahn after hearing comments from nurses, doctors said, pharmacists and patients. “As we’ve heard from several of you, sometimes cost cutting can come at the expense of quality of care.”

Regulators have been closely watching the impact of mergers on the labor market, Kahn added, noting that mergers allow employers to determine wages and reduce working conditions.this Public Comment Period Ends April 21st.

Here are five takeaways from the meeting:

1. a nurse claims HCA Healthcare Cut service, cut staff and raise prices afterwards get Mission Health in 2019. HCA closed primary care clinics, rural cancer facilities and other specialty clinics and raised prices by 10 percent after the deal, said Kelley Tyler, a nurse at Mission Hospital in Asheville, North Carolina. At the same time, the nurse-to-patient staffing ratio has increased, from about 1 to 2 to 1 to 7, Tyler said, leaving only 8 minutes with each patient. “We think HCA uses its monopoly over western North Carolina to take control of its health care system and then send it back to Wall Street and its shareholders,” Taylor said during the meeting, adding that HCA also owns supply chain companies, debt collection companies. company and a nursing school. “How can companies be allowed to influence and control every aspect of healthcare?” HCA did not immediately respond to a request for comment.
2. ScionHealth, this is form after last year life point health St. Joseph’s nurse Joe Thon said the Kindred Health merger cut benefits for employees at St. Joseph’s Regional Medical Center in Lewiston, Idaho. When premiums soared, their health-care coverage network shrank, he said. Management also cut sick pay and retirement benefits, Thon said. The outsourcing of certain pharmacy services increases nurses’ workload and hurts patient care, he said. “Our hospital lost so many employees that our entire department was closed for nearly two years,” Thon said. LifePoint responded but did not issue a statement prior to publication.
3. M&A saves hospitals from closing COVID-19 pandemic, said Lisa Goldstein, senior vice president of Kaufman Hall. She said small, rural and medium-sized hospitals were able to access personal protective equipment, ventilators and staff as part of a larger health system. Small hospitals may not have the resources to address issues such as social determinants of health, Goldstein said. “Without being part of a larger system, small hospitals will face closure or bankruptcy as they fail to absorb large and permanent increases in labor costs, recruiting future workforces and clinicians, and treating an aging population,” she said.
4. Mergers tend to disproportionately impact communities of color and low-income communities, said Lois Utley, senior advisor to the Hospital Equity and Accountability Program. The health system has expanded through mergers into predominantly white suburbs with a high concentration of commercially insured patients, while abandoning hospitals in urban and rural communities of color, she said. They also tend to shrink or close obstetrics, emergency rooms and other loss-making lines of service, Utley said. “The consequences of these actions have been laid bare by the COVID-19 pandemic, which has found Black, Latino and Indigenous peoples to struggle to find care in their own communities,” she said.
5. New Orleans rheumatologist Dr. Madelaine Feldman said the merger between the big three pharmacy benefit managers and insurance companies reduces access to the lowest-cost drugs. PBMs often support the highest-cost rheumatoid arthritis drug options by removing generic alternatives from prescriptions, she said. “Now that the big three PBMs are merging with some of the largest health insurers, our oligopoly has led to a breakdown of the system, full of conflicts of interest,” Feldman said. “This creates a huge black box, and if someone tries to pull the curtain, PBM protects it with high premiums and drug prices.” The Medical Care Management Association, which represents PBM, responded that PBM serves PBM in the form of negotiated discounts and rebates for each Spend $1 and save $10, 99.6% of which is passed on to patients and employers.