By NextBestFitRemove the profit opportunity through rate setting
Uniform rates and no out-of-network billing remove the arbitrage PE roll-ups rely on.
Uniform rates remove out-of-network arbitrage.
Review ledgerHow this path connects
Addresses
Private equity roll-ups in medicineThis path
Remove the profit opportunity through rate setting
Requires:
All-payer rate settingU.S. prices are far higher than in other countriesChosenConcrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Apply uniform rates and end out-of-network billing
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Private equity roll-ups in medicine
Uniform rates and an end to out-of-network billing remove the pricing arbitrage used by private-equity roll-ups. This does not require banning ownership or defining harmful ownership in law.
What it creates or worsens
- Solves only part of the problem
Private equity can still enter areas with remaining margins, including hospice and dermatology.
- Nursing and direct-care shortages and burnout
Firms may cut staff to maintain returns under fixed rates.
Who's affected
Who gains
- People with ongoing or specialist care needs
- Private equity roll-ups in medicine: Practice and facility buyouts can raise prices and cut staff.
- Older and disabled people needing long-term care
- Private equity roll-ups in medicine: Practice and facility buyouts can raise prices and cut staff.
- Doctors, nurses, and other clinicians
- Private equity roll-ups in medicine: Private equity ownership reduces their autonomy.
- Health insurers, brokers, and their shareholders
- Private equity roll-ups in medicine: Uniform rates and an end to out-of-network billing remove the pricing arbitrage used by private-equity roll-ups. This does not require banning ownership or defining harmful ownership in law.
- Health care staffing agencies
- Nursing and direct-care shortages and burnout: Shortages allow them to charge premium rates.
- Hospitals, clinics, and care organizations
- Nursing and direct-care shortages and burnout: Operators benefit from keeping staffing thin.
Who loses
- Private equity firms and investors
- Private equity roll-ups in medicine: Investors gain from buying and consolidating medical businesses.
- People with ongoing or specialist care needs
- Nursing and direct-care shortages and burnout: Understaffed hospitals and nursing homes leave them with too few caregivers.
- Older and disabled people needing long-term care
- Nursing and direct-care shortages and burnout: Understaffed hospitals and nursing homes leave them with too few caregivers.
- Doctors, nurses, and other clinicians
- Nursing and direct-care shortages and burnout: High turnover and low aide pay burden care workers.
Where it has been tried
- No Surprises Act: Hurt PE-backed staffing firms that relied on out-of-network billing.
- United States: After the No Surprises Act began, out-of-network emergency bills declined 24% in 2022 compared with 2019, according to a federal evaluation.