Is hospital consolidation creating new efficiencies or does it give health care providers clout over health care insurers? A well-publicized study published in Health Affairs last year by Robert Berenson, Paul Ginsburg, et. al said the latter: hospital consolidation has resulted in “growing provider market clout.”
The Berenson study’s key conclusion is that growing hospital clout has resulted in insurers not aggressively containing their claims payments, a view that will stun every patient who has had a health insurance company deny coverage for a procedure, prescription or preferred health care provider.
Because the Berenson study’s finding are counterintuitive to consumer experience, and because they have been widely discussed in publications ranging from Forbes to National Journal, the Center for Regulatory Effectiveness, a regulatory watchdog with extensive experience in analyzing federal health policies, undertook an analysis to see if the study complied with the Data Quality Act (DQA).
The DQA, administered by the White House Office of Management and Budget (OMB), sets standards for virtually all data disseminated by the agencies. Under the DQA, agencies may not use or rely on data in federal work products (reports, regulations) which don’t comply OMB’s government-wide Data Quality standards. Thus, unless the Health Affairs study complies with federal Data Quality standards, it is useless to Executive Branch policy officials.
The primary data source cited by the Berenson study as the basis for their conclusions regarding trends in relative clout between hospitals and health insurers is a well-respected, longitudinal tracking study which included interviews with heath care leaders from insurance companies, hospitals, and academia. The health care interviews, however, were only conducted in a single year following a change in longitudinal study’s methodology.