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Insurance, Healthcare Delivery, Risk

Hospital buy-ups of Drs practices under scrutiny
By David H Levien
Posted on 1/15/2021 4:39 PM
Read article here  In a recent article in “Healthcare Dive”, called to our attention by our Fellow, Mr. Abbas Bayat, it was pointed out that the Federal Trade Commission is scrutinizing the purchase by hospitals of doctors’ practices to see if it limits competition. To my mind this is analogous to what's happening in the Pharmaceutical industry where The FTC was previously more concerned about horizontal integration and less concerned about vertical integration until recently. During a recent consulting gig my research show that the FTC was concerned about large pharmacy benefit managers integrating vertically with pharmacy chains to capture profits they stood to lose when consumers get the rebates. I am not an expert on this arcane area of the law. Our highly knowledgeable fellow  Abbas Bayat writes:

"The data that the insurers will send is rigged. They have a million accounting gimmicks to show what they want. An analysis that I did on the payer/provider billing/payments clearly demonstrates that the insurers lie regarding  claims and payments.


The case of the PBMs is illustrative. GoodRx has substantially lower drug costs than the insurers claim as their cost. For example, I have a prescription that Silvercripts, my Medicare Part D insurer, says costs $84 but GoodRx gives a price of $46. Obviously I use GoodRx. This means that I will not have a cost to deduct from my deductible. Silverscript is owned by CVS Corp as is Aetna and a host of providers. GoodRx, now a multi billion dollar company in value, would not exist if the insurers were honest with their PBMs and charged the real cost to consumers".
The American College of Healthcare Trustees supports an outstanding program called RefillWise  

Save up to 80% on your prescription at all major pharmacies!

We have an example of a Fellow saving hundreds of dollars per month and the ACHT gets a few bucks too. 

You can download your card immediately by using the grey button above or get the app on your smartphone by texting our initials “ACHT” to 22822. We are told that both RefillWise and GoodRX are outstanding and in any given situation one or the other might be cheaper. Feel free to give the above information to your patients, colleagues, family, and friends and they will thank you for it.

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