hospitals

Another boom in hospital volumes?

Adobe

Whether you like it or not, the number of hospitalizations, outpatient visits, and prescriptions — known as “health care utilization” in business jargon — remains a foundational metric to gauge the health care industry. It sure seems like those numbers have soared in the fourth quarter, similar to what happened in the third quarter.

Last week, some Wall Street research firms looked at the initial data from their own hospital surveys or private utilization reports. The October data appeared to show significant bumps in revenue and a lot of activity, especially in outpatient clinics, where visits were up 5% year over year, according to Leerink Partners. That could mean big profits for hospital systems, and more tempered results for insurance companies. 

Part of this makes sense. The last three months of a calendar year are usually busy months for surgeries, doctor appointments, and hospital services because people have more time off around the holidays — and people often reach their deductibles, which means insurance will cover most of the care. 

One data point to note: Outpatient visits at hospitals in the South appear to have increased 10% year over year. “This is a very big, eye-popping number,” Whit Mayo of Leerink Partners wrote in a research note to investors.

physicians

Optum, allegedly: Stay out of our doctor ‘domain’

A new lawsuit out in California provides some fresh insight into just how far UnitedHealth Group’s Optum division will go, allegedly, to employ primary care physicians and control that market.

My colleague Brittany Trang found the lawsuit, and one of the most interesting parts involves a dinner in 2021. Optum executives allegedly told the CEO of Emanate Health, a nonprofit group of hospitals and physicians, that the physician business was Optum’s “domain.” The executives told Emanate it should “stay in its lane” in the hospital business, arguing that when Emanate’s affiliated physician groups competed with Optum for primary care physicians, it created competition and drove up wages, according to the suit.

That’s not all: The lawsuit also alleges that when some Optum physicians left to join Emanate’s medical group, Optum told its patients that those doctors who left were retired or on vacation, in the hopes that those patients would not leave Optum. Aaron Albright, an Optum spokesperson, said “these are baseless assertions related to a contractual dispute in a highly competitive market, and we will defend ourselves vigorously.” Read Brittany’s story and the entire complaint (it’s well worth your time).

antitrust

USAP, Welsh Carson face class action

Union health plans that represent electricians and plumbers in Texas have filed a class action lawsuit against physician group U.S. Anesthesia Partners and private equity firm Welsh, Carson, Anderson & Stowe.

The lawsuit builds on the Federal Trade Commission’s complaint filed in September, which argued USAP and Welsh Carson illegally bought up anesthesia practices across Texas as a way to concentrate market power, gain negotiating leverage over health insurance companies, and raise prices.

One part of the lawsuit that caught my eye: The unions said USAP also had “price-fixing agreements” with anesthesia groups that it could not acquire, and therefore kept those rivals at bay. USAP and Welsh Carson had no comment on the class action, but they are trying to dismiss the FTC’s lawsuit. Read the story, which includes the class action complaint.