Fred Schulte
Editor’s note: This is the second of two posts on covering private equity.
Lack of transparency is a giant hurdle in reporting on the growing influence of private equity in health care.
Reporters covering public corporations can easily obtain periodic financial reports and ownership disclosures that are filed with the Securities & Exchange Commission. Information about the finances and public benefits of nonprofit hospitals is readily available via the IRS’s Form 900.
A survey from KFF shows one in seven adults in the United States who have health care debt say a medical provider has denied them care due to their debt. Source: KFF Health Care Debt Survey (Feb. 25-Mar. 20, 2022). https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/ accessed dec. 23, 2022.
Recent news shows the need for health care journalists to investigate the aggressive measures hospitals use when patients can’t pay their medical bills.
On Dec. 21, Noam N. Levey, an award-winning senior correspondent for Kaiser Health News (KHN), reported that when patients can’t pay their bills, hundreds of the nation’s hospitals file lawsuits against those patients, sell patients’ bad-debt accounts to debt buyers and report patients to credit rating agencies.
From left to right: Sarah Jane Tribble, senior correspondent with Kaiser Health News and featured luncheon speaker Stephanie Boynton, F.A.C.H.E., vice president and chief executive officer of critical access hospitals for Erlanger Bledsoe Hospital and Erlanger Western Carolina Hospital.
When reporting on the state of rural medical facilities, there’s more to the story than the demand for health care services. Other factors influence the survival, closure, or changes to services offered by providers in more sparsely populated areas. The economic prosperity of those regions, for instance, appears to be tightly intertwined with the type and quality of care accessible to the people who live there — who tend to be in worse health than their urban peers.
That was among the potential story threads that emerged during a presentation at AHCJ’s Rural Health Journalism Workshop 2022 in Chattanooga earlier this month. Stephanie Boynton, F.A.C.H.E., featured luncheon speaker and vice president and CEO of critical access hospitals for Erlanger Bledsoe Hospital and Erlanger Western Carolina Hospital, talked about the impact of Erlanger Health System’s acquisition of facilities in East Tennessee and Western North Carolina.
Boynton described the perilous situation the hospitals were in. “Word was out: we weren’t paying vendors, we weren’t paying employees,” she said. “Well, we were paying them, but we were holding [the checks] to the eleventh hour. That gets out in the community, and people doubt the services that you offer.”
Those credibility issues went away when Erlanger, based in Chattanooga, stepped in — not just with cash but also credibility, she said.
In a collaboration between The Philadelphia Inquirer and Kaiser Health News, Harris Meyer looks at the case of colchicine, a drug used to treat gout that has been on the market so long that it predates the FDA approval process, and thus had never been approved. 
Like thousands of drugs it existed in a sort of grandfathered generic state. That ended in 2009 when URL Pharma earned FDA approval for a branded version of the drug, which it sells for 50 times more per pill than the generic.
The drug company convinced the FDA that its version was safer than the generic, a claim disputed by many physicians. Now, Meyer reports, it’s likely that the generic colchicine will be forced from the market over the coming months, driving customers of the centuries-old drug (a natural version was first mentioned by the ancient Greeks) into the arms of URL Pharma. According to Meyer, the case is just one of several that have resulted from post-2006 FDA efforts to gain control and approval over all those grandfathered-in unregulated drugs.
Kaiser Health News’ Jordan Rau reports that, even if current health care proposals (Rau focuses on the House bill) were to pass, the resulting coverage would still fall short of universal and affordable, with many families slipping through the cracks and facing medical expenditures every bit as onerous as those they face today. Rau carefully picks through the coverage and points out the biggest holes, explaining how they arose and identifying the relevant trade-offs and contributing factors.
Under the House proposal, people receiving government subsidies could still end up spending 20 percent or more of their annual incomes on premiums, deductibles and co-insurance, according to estimates prepared by the House Committee on Ways and Means and obtained by Kaiser Health News. That financial load could grow substantially if the proposal’s financing — $1 trillion over a decade — is pared back as congressional leaders come under pressure to reduce the legislation’s costs.
