Thread by @EileenAppelbaum

THREAD: The private equity industry often uses aggressive tactics to enrich itself.

The growing problem of surprise medical billing is one of them, as the industry buys up doctors' practices and medical facilities — then bills Americans exorbitant amounts for the same care. 1/14

Although Congress has taken note, private equity's outsized role in healthcare could present a hidden obstacle to reforms, like Medicare for All.

We'll explain how. 2/14

In a 2019 poll, 41% of Americans said they received some type of "surprise" medical bill, not covered by their insurance.

A large portion is due to care received "out-of-network" — out of an insurance company's approved list of providers. 3/14

Since Medicare and Medicaid have fixed reimbursement rates, surprise billing happens mostly to those with private insurance — unsurprisingly, this is who PE is going after. 4/14

PE realized there is a lot of $$$ to be made from this. So, it bought up doctors' practices, focusing on those with patients who can’t "shop around," like anesthesiologists and ER docs. TeamHealth and Envision are two large PE-owned companies, with thousands of employees. 5/14

Usually, surprise bills are a few thousand bucks. But they can be higher: a surgeon once billed a patient $117K 🙀

And the bills are hard to avoid. Despite prior research, a patient might discover they are in an in-network facility being treated by out-of-network doctors! 6/14

Let’s walk through an example. You might be at home and think you have appendicitis. You call an ambulance because you can barely walk due to the pain. AMR — a PE-owned ambulance service — is dispatched to get you. 7/14

You tell the ambulance to take you to the hospital that’s in-network for your insurance and has doctors you know. But you didn't know that the ER was recently outsourced to a PE-owned company that staffed it with out-of-network doctors. 8/14

You did have appendicitis! PE is in the operating room too, although you wouldn't know it. The surgeon's assistant and the anesthesiologist are out-of-network, PE doctors. The recovery room is no different: the substitute for the attending physician is a PE doc as well. 9/14

Once you’re at home recovering, 1 of 2 things can happen:

You get surprise bills from the ambulance, ER doc, surgeon's assistant, anesthesiologist, and the attending doctor’s substitute...

OR

...the cost from these providers is passed on to you via higher premiums. 10/14

But the net result is the same: for similar care, PE drives up costs in an already broken healthcare system.

Luckily, Congress wants to do something about this. 11/14

But rather than benchmarking rates (e.g. using avg cost as a reference), which will rein in costs, reduce PE's power, and open the door to Medicare for All, some want to let PE negotiate for their own, higher rates for care, effectively entrenching it in our healthcare. 12/14

Advocates who support Medicare for All must not only take on insurance companies, but also private equity and their surprise billing — and support changes now that will make reform easier in the future. 13/14

To learn more about PE's role in surprise billing, read my new, in-depth article which includes more details on its expansion into healthcare, and critically, how it is lobbying to protect these profit centers amid congressional action. cepr.shorthandstories.com/private-equity… 14/14