Comparative Health System Performance (CHSP) Initiative | Agency for Healthcare Research & Quality

Comparative Health System Performance (CHSP) Initiative | Agency for Healthcare Research & Quality

Analysis Finds Significant Rise in Common Corporate Ownership Across Health Systems

Cases in which the same corporate investors have ownership stakes in multiple U.S. health systems have nearly doubled since 2005, according to an AHRQ-funded study recently published in Health Affairs. The study appears to provide the first description of common investor ownership trends in health care. Researchers used data from the Centers for Medicare & Medicaid Services’ Provider Enrollment, Chain, and Ownership System to identify common investor ownership across acute care, post-acute care and hospice providers within the same geographic markets within the United States. They found that the percentage of acute care hospitals having common investor ties to the post-acute or hospice sectors increased from about 25 percent in 2005 to 49 percent in 2015. The authors suggested that these trends have important antitrust, regulatory and policy implications. This research was funded by AHRQ’s Comparative Health System Performance Initiative, which studies how health care delivery systems promote evidence-based practices and patient-centered outcomes research in delivering care. Access the abstract.

Corporate Investors Increased Common Ownership In Hospitals And The Postacute Care And Hospice Sectors

1. Annabelle C. Fowler1,*, 
2. David C. Grabowski2, 
3. Robert J. Gambrel3,
4. Haiden A. Huskamp4 and 
5. David G. Stevenson5

+Author Affiliations

1. ¹Annabelle C. Fowler (afowler@g.harvard.edu) is a PhD candidate in health policy at Harvard University, in Cambridge, Massachusetts.
2. ²David C. Grabowski is a professor in the Department of Health Care Policy, Harvard Medical School, in Boston, Massachusetts.
3. ³Robert J. Gambrel was a data analyst in the Department of Health Policy, Vanderbilt University School of Medicine, in Nashville, Tennessee, at the time of writing. He is now a data specialist at Intermedix, in Nashville.
4. ⁴Haiden A. Huskamp is the 30th Anniversary Professor of Health Care Policy in the Department of Health Care Policy, Harvard Medical School.
5. ⁵David G. Stevenson is an associate professor in the Department of Health Policy, Vanderbilt University School of Medicine.

1. ↵*Corresponding author

Abstract

The sharing of investors across firms is a new antitrust focus because of its potential negative effects on competition. Historically, the ability to track common investors across the continuum of health care providers has been limited. Thus, little is known about common investor ownership structures that might exist across health care delivery systems and how these linkages have evolved over time. We used data from the Provider Enrollment, Chain, and Ownership System of the Centers for Medicare and Medicaid Services to identify common investor ownership linkages across the acute care, postacute care, and hospice sectors within the same geographic markets. To our knowledge, this study provides the first description of common investor ownership trends in these sectors. We found that the percentage of acute care hospitals having common investor ties to the postacute or hospice sectors increased from 24.6 percent in 2005 to 48.9 percent in 2015. These changes have important implications for antitrust, payment, and regulatory policies.

VOL. 36| NO. 9September 2017Market Concentration

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