The Health Policy Commission said community hospitals are being challenged by lower payment rates for commercially insured patients and the decision by more patients to go to larger hospitals in Boston for routine care, particularly commercially insured patients. The study states community hospitals are also being challenged by a lack of resources to invest in programs, staff, marketing fundraising and infrastructure to effectively compete for and attract patients.
In 2014, the most recent year for which data are available, the five largest healthcare systems in Massachusetts accounted for 61 percent of discharges for commercially insured patients, compared to 54 percent in 2012, according to the study.
Meanwhile, the study found primary care physician affiliations with hospitals have grown rapidly in recent years, and the majority of PCPs are now associated with a few provider systems. In 2012, 75 percent of visits to PCPs were to PCPs affiliated with one of the eight largest provider systems, and these visits constituted nearly 79 percent of all revenue for PCP visits in the state, according to the study.
The Health Policy Commission warned this migration to higher-cost facilities by some patients may result in higher total medical spending and increased costs for all patients with commercial insurance through higher premiums. The study found average spending per commercial discharge at a Boston hospital was $981 to $4,775 higher than average spending per discharge, adjusted for severity, in other regions of the state.
“The migration of patients for low-acuity care that could be provided in community settings also contributes to lower occupancy rates and less revenue for community hospitals,” the Health Policy Commission wrote.
The Health Policy Commission plans to meet with hospital executives and other stakeholders in the near future and eventually get behind specific proposals to help struggling community hospitals and address price variations, according to The Boston Globe.
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