1. Medical Consolidation – Concerns and Impacts

2. Methodology Research Objectives – Why Research was Conducted
LUGPA approached YouGov to understand better how adults feel about doctor-owned physician practices, including their advantages over hospital-owned physician practices and American opinions about the endangerment of doctor-owned physician practices, partly as a result of current compensation practices by the government and insurance companies.
Research Methodology – YouGov Omnibus
The survey was conducted using an online interview administered to members of the YouGov Plc panel of 2 million individuals who have agreed to take part in surveys. s are sent to panelists selected at random from the base sample. The invites them to take part in a survey and provides a generic survey link. Once a panel member clicks on the link they are sent to the survey that they are most required for, according to the sample definition and quotas. (The sample definition could be "US adult population" or a subset such as "US adult females"). Invitations to surveys don’t expire and respondents can be sent to any available survey. The responding sample is weighted to the profile of the sample definition to provide a representative reporting sample. The profile is normally derived from census data or, if not available from the census, from industry accepted data.
The survey was run on YouGov’s Omnibus platform and weighted to match a nationally representative sample of adults.
Surveys conducted:
8/27/2018 – 8/28/2018
N = 1,191

3. Consolidation Is A Problem To Americans
Americans trust smaller enterprises, including independent physicians, more than their counterparts backed by large entities.
Americans think independent physicians deliver patient-focused, personalized, trustworthy, quality care. Independent physicians are rarely associated with negative qualities concerning care and care management.
More than six in ten adult Americans are worried about how consolidation will impact their access to affordable care (62%) and think some kind of action should be taken by the government to prevent the continued trend of consolidation (69%).
One-quarter (25%) think consolidation is a threat to their health.
For most Americans, the impact on their bottom line is the main concern with medical practice consolidation, as higher costs consistently come out on top.
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Older Americans are more concerned about the disappearance of independent physicians and the impact of consolidation under hospitals. 3

4. Independent Physicians Win On Trust
Independence wins trust over large institutions every time. Independent physicians are no exception.
Who They Trust More
Adults (n=1,191)
Chain Bookstore Manager
Franchise Tax Prep Professional
Nationwide Bank
Chain Grocer Employee
Car Dealership Service Center
Hospital-Employed Physician
Independent / Sole Proprietor Trust
Institution / Franchise Trust
Q1. Considering each pair below, who do you trust to give you the best recommendation?

5. A Generational Trust Gap
The gap in trust between large entities and local entities narrows for younger respondents, but is wider for older respondents.
Gen Z/Millennial Trust (n=379)
Baby Boomer Trust 55+ (n=453)
Chain Bookstore Manager
Franchise Tax Prep Professional
Nationwide Bank
Chain Grocer Employee
Car Dealership Service Center
Hospital-Employed Physician
Chain Bookstore Manager
Franchise Tax Prep Professional
Nationwide Bank
Chain Grocer Employee
Car Dealership Service Center
Hospital-Employed Physician
Independent Trust
Institution Trust
Independent Trust
Institution Trust
Q1. Considering each pair below, who do you trust to give you the best recommendation?

6. Concerns Around Consolidation
4 in 10 experience common concerns associated with consolidation, with the top issues being timely and personalized care.
Do They Have Common Consolidation Concerns
Adults (n=1191)
What Healthcare Concerns They Have Adults (n=1191)
Q2. Do you experience any of these healthcare related concerns? Check all that apply

7. Consolidation Is A Threat
8 in 10 feel threatened by common concerns with healthcare. Among those concerned, the rising cost of prescription drugs is ranked first, while 1 in 4 feel threatened by consolidation.
Do They Feel Threatened?
Adults (n=1191)
Threats To Their Health Adults (n=1191)
Q3. Which of the following do you feel are threats to your health? Check all that apply.

8. A Generational Threat Gap
Younger Americans feel less threatened by consolidation, while older Americans are more concerned about what it means for them.
Threats To Health
18-34 [Gen Z/Millennials] (n=379)
55+ [Baby Boomers] (n=453)
Q3. Which of the following do you feel are threats to your health? Check all that apply.

9. Hospital-Owned Care Is A Plurality
4 in 10 say their last visit was to a hospital-owned practice. However, 1 in 4 American adults are unaware if their last doctor’s visit was to a hospital-owned or independent practice.
Practice Most Recent Doctor’s Office
Hospital Owned
Independent
Don’t Know
Q4. Is the doctor’s office you visited most recently doctor-owned or hospital-owned?

10. Personalized, Patient-Focused Care
Americans are most likely to associate independent, doctor-owned medical practices with personalized, patient-focused care. They also associate independent medical practices with trustworthiness and high quality.
Associations With Independent, Doctor-Owned Medical Practices Adults (n=1191)
Positive Associations
Independent, doctor-owned medical practices associated with all things positive
Negative Associations
Q5. Which of the following do you associate with independent, doctor-owned medical practices?

11. Consolidation Threatens Affordable Care
A majority of American adults are concerned about consolidation under hospitals, and for older Americans the main reason is the impact this consolidation is having on getting the care they want.
Concerned About Consolidation Adults (n=1,191)
Reasons For Concern Among Concerned (n=736)
Q6. Over the last five years more than 12% of the nation’s 4,369 non-government owned hospitals have been subjected to mergers and acquisitions totaling more than $125.4 billion. Are you concerned this growing consolidation will affect your access to affordable care?
Q7. Please indicate the reason you are most concerned about the increase in hospital acquisitions

12. Americans Want A Solution To Consolidation
More than two-thirds of American adults want a solution to increasing consolidation under hospitals, and the most desired solution is requiring insurers to compensate all medical practices equally.
Solutions Desired by Americans
Insurers: Equal Pay For Same Procedure
Nothing: Free Market
Congress: Level Playing Field
Congress: Regulate Market Share
Q8. Recent research shows 42% of physicians were employed by hospitals in July 2016, compared to just 25% of physicians in July 2012, an increase of 86%. Other studies show that geographic locations with the greatest consolidation have the highest costs. What should be done, if anything, to prevent hospital purchases of physician practices?
Insurers should be required to pay hospitals, hospital owned physician groups, and independent physicians the same amount for the same procedures
Congress and states should do more to incentivize independent physicians and level the playing field for them with hospitals
Congress should empower federal authorities to more closely regulate the purchase of physician practices to prevent hospitals from gaining excessive market share
Nothing should be done. Hospitals and physicians need to be free to compete with one another to attract patients based on cost, quality and patient preferences

13. Americans Want A Solution To Consolidation
Across all generations, Americans want actions taken to prevent consolidation and think the best action is requiring equal pay for the same procedures.
Solutions Desired by Americans by Generation
Congress: Level Playing Field
Congress: Regulate Market Share
Nothing: Free Market
Insurers: Equal Pay For Same Procedure
Congress: Level Playing Field
Congress: Regulate Market Share
Nothing: Free Market
Insurers: Equal Pay For Same Procedure
Congress: Level Playing Field
Nothing: Free Market
Congress: Regulate
Q8. Recent research shows 42% of physicians were employed by hospitals in July 2016, compared to just 25% of physicians in July 2012, an increase of 86%. Other studies show that geographic locations with the greatest consolidation have the highest costs. What should be done, if anything, to prevent hospital purchases of physician practices?
Insurers should be required to pay hospitals, hospital owned physician groups, and independent physicians the same amount for the same procedures
Congress and states should do more to incentivize independent physicians and level the playing field for them with hospitals
Congress should empower federal authorities to more closely regulate the purchase of physician practices to prevent hospitals from gaining excessive market share
Nothing should be done. Hospitals and physicians need to be free to compete with one another to attract patients based on cost, quality and patient preferences