Money takes over medicine: Risks, rewards & warnings

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Mark Masselli ( 00:04 ):
I think most Americans would be surprised by this factoid that private equity now owns one-third of
private hospitals in the country, and the percent is growing. And research shows that the rate of adverse
effects for patients goes up by 25% when private equity takes over. These investors also have their eyes
trained on doctors' practices.
Erin Fuse Brown ( 00:26 ):
The way in healthcare to decrease your costs is to cut your staffing. So we see this over and over again,
particularly in the nursing home and the healthcare facility context. You cut your staff, your nurse to
patient ratio goes down, you eliminate the, or you substitute sort of higher wage physicians and highly
trained nurse practitioners with lower skilled substitutes.
Margaret Flinter ( 00:51 ):
Erin Fuse Brown is a professor with the Center for Advancing Health Policy through Research at Brown
University. She's an expert on the legal and policy options for addressing private equity.
Erin Fuse Brown ( 01:02 ):
When they turn to these entities and say, "Yes, we will accept your help. We will let you manage our
practice and help us with these administrative tasks." They're really turning over the keys to the castle in
terms of the heart and soul of independent practice, which is their patient relationships and their
control over their own practice medicine.
Margaret Flinter ( 01:23 ):
This is Conversations on Health Care.
Mark Masselli ( 01:34 ):
Erin Fuse Brown, welcome to Conversations on Health Care.
Erin Fuse Brown ( 01:37 ):
Happy to be here.
Mark Masselli ( 01:39 ):
Oh, that's great. We recently saw a study published in JAMA that shows that hospitals owned by private
equity, on average, saw their total capital assets decrease by 15% two years after acquisition compared
to the increase of 9% for hospitals not backed by private equity. Not a great outcome, but let's start with
the basics for audience. Explain what private equity is and what role it's playing in healthcare.
Erin Fuse Brown ( 02:08 ):
Yeah, so private equity is a form of investment. It's private because it's not publicly traded, and so it
doesn't have as many disclosure requirements for the Securities and Exchange Commission. And usually,
it's a collection of investors, sovereign wealth funds, pensions, wealthy people who contribute money
and investment dollars to a fund run by a private equity fund. And these are the ones that we hear
about, Blackstone, JKR. These investors then collect this investment dollars from their investors, and
then they use that money to draw a loan. So even though it's called private equity, these are highly

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leveraged investments, meaning they use that seed money to go get a loan. Usually, it's about 70% debt,
30% equity, and they use that fund to go buy targets. And the targets that they look for, whether it's in
healthcare or other parts of the economy, are usually mature companies.
( 03:05 ):
So unlike venture capital, which are looking for startups or the next big thing, private equity is targeting
a mature company that could be run more efficiently, could be reorganized in some way to make more
money, to bring costs down, make more money for the investors. The investors typically load the debt,
the process of paying off the loan on the target company itself. So they get money by investing in
managing this new asset, this new, whether it's a hospital system or physician practice and then they
keep some of the profits and they also get management fees. They load the entity with debt, meaning
that the debt is serviced, secured by the assets of the hospital system.
( 03:47 ):
And then usually at some point, the private equity firm is not looking to keep and run this healthcare
system into the future, but rather to exit the investment within a very short period of time, usually three
to seven years. And they make most of their windfall at that point by what they think is their
improvements in the efficiency or operations of the entity. So that is the private equity model in short.
So it's basically outside private investors, looking to buy and invest in healthcare targets, usually with
debt.

Margaret Flinter ( 04:21 ):
Erin, that is a exceptionally clear description of what it is. And of course, the follow-up to that. I think we
know that you've identified the key public policy concerns that are raised by private equities entry into
physician and hospital markets for doctors, for patients, for the healthcare system overall. But having
defined what it is, go over those concerns with us. What are the concerns that you have about this from
a public policy perspective?

Erin Fuse Brown ( 04:50 ):
Yeah, from a public policy perspective, I think it's clear that this investment vehicle, this type of
investment that is short-term, highly leveraged with debt and where the investor exits the investment
within a short period of time leads to several risks to patients, to healthcare providers in the system and
to the public dollars. So that is that the private equity investor is very risk tolerant, meaning that they
are willing to come in and their goal is to cut costs and raise profits in a very short period of time.
They're not transforming healthcare. They're not going to, in two years, turn a struggling healthcare
system into one that is wildly profitable. The way they do it is they do so through financial engineering
tactics.
( 05:38 ):
So let's pick hospitals as an example. So the Steward Health Care system that we know declared
bankruptcy earlier this year was earlier owned by and invested by a private equity company. Private
equity used the same playbook for that health system as it has done in other hospital acquisitions. And
that is they bought the Steward Health Care system and then immediately sold the best asset, the most
valuable asset that the hospital system had, its hospital buildings and real estate to a real estate
investment trust. So it made money in the process of selling off the asset and then that real estate
investment trust, that entity leases back the hospital bricks and mortar that the hospital used to own
itself. And so then it can escalate those lease payments, increase those lease payments over time, which
is ultimately what bankrupted the Steward Health Care system.

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( 06:32 ):
That is one way that they say that they're injecting capital, but what they're doing is really removing
assets from the health system for their own benefit so that they make a ton of transaction fees, they get
to keep the profits, they get to collect the higher rent. So this is all part of their money-making, profit-
generating strategy.
( 06:52 ):
The other way that private equity makes money that threatens public policy is through the need to
create a large difference between that increasing profit margin and a decreasing costs, operating costs.
The way in healthcare to decrease your costs is to cut your staffing. So we see this over and over again,
particularly in the nursing home and the healthcare facility context. You cut your staff, your nurse to
patient ratio goes down, you eliminate the, or you substitute sort of higher wage physicians and highly
trained nurse practitioners with lower skilled substitutes. And so what that turns into is a lower
employee compensation payroll, but it means worse patient care in many instances. I think that is what
we see as leading to the greater risks of mortality and adverse events for hospital and nursing home
patients after private equity acquisition. So that is a big concern is both the cost-cutting is a concern and
the asset stripping is another concern from public policy standpoint.

Mark Masselli ( 07:59 ):
I would say in addition to Steward hospital systems, in Connecticut, Prospect Medical looms large in lots
of similar situations, and yet we hear from the American Investment Council, which says that private
equity funded innovations have delivered more effective treatments and save lives. They say they're also
help lower healthcare costs and increase access to care. I'm wondering, do these claims really hold up?

Erin Fuse Brown ( 08:24 ):
I think that that certainly is the promise. When a private equity investor approaches a health system, it's
usually because the health system is somewhat vulnerable or struggling financially. And so the promise
of this, again, injection of capital or resources into the health system is very attractive. And the private
equity investor promises innovation, investments and instead what we see is exactly the opposite.
There's a disinvestment, a stripping not only of assets and personnel, but also the threat of closures.
What we're seeing is Steward hospitals, several of them are planning to close because they cannot seem
to find a way to financially operate in the black.
( 09:05 ):
And so I think that the access issue, I don't see any evidence that access is improved. In terms of cost-
cutting, it might be cost-cutting because again, the staffing levels go down or certain volumes of less
profitable services are reduced, but that doesn't necessarily translate into the care that that community
needs. It doesn't help that community access the care they need in a timely, high quality way. And if you
talk to the physicians that are practicing in those affiliated and the nurses that are practicing in those
hospitals and nursing homes, I think that they will attest to the fact that the morale can also be
threatened by the sort of corporate takeover and the cost-cutting. And the corporate manager private
equity company is not, again, in the business of running a health system. They're in the business of
making money for investors. And so that cultural clash where the professionals' fiduciary obligation to
do what's best for patients comes straight and directly into conflict with the need to answer to the
bottom line demands of the new owner or operator.

Mark Masselli ( 10:15 ):

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And this is not about the long-term best interest of the organization, which regular capital might be
interested in. This is really about this time horizon that is so truncated, not thinking about the lives of
patients over the long term, but really thinking about returns in a very short time, which really is one of
the key drivers of all this change in transactions that they're having.

Erin Fuse Brown ( 10:43 ):
Yeah, so the private equity investors that initially invested in the Steward Health Care system have long
gone and they've made their money and exited. And then what's left is this sort of financially struggling
hospital system that is again, threatening access. And so the private equity investor, because of that
short time horizon makes money whether or not the long-term outlook is improved, it makes money
whether or not the entity ends up in bankruptcy. And so I think the incentives are simply misaligned.

Margaret Flinter ( 11:16 ):
Well, given all of the concerns that you've pointed out, and I would think also from a lawmaker's
perspective watching what might happen when traditionally a great employer in a community, the
community hospital goes under another negative effect. Not surprising that lawmakers certainly in
Massachusetts and California are looking at limits on this, on private equity, medical acquisitions and
considering requiring pre-merger reviews, debt limits. What's your analysis of these ideas? Do they go
far enough and what are other states looking at? I don't think it's limited just to Massachusetts and
California at this point.

Erin Fuse Brown ( 11:53 ):
Yeah, I think that there are several mechanisms that states in particular are concerned about and that
they're using and putting into place or at least attempting to put into place. And you're right,
Massachusetts and California have had bills that have advanced the farthest this legislative session and
reintroduce it next legislative session. So of course, Massachusetts is where several of the Steward
hospitals exist. What Massachusetts' bill sought to do is to increase the oversight over healthcare
transactions that already exists in the state and expand that oversight to include acquisitions of
physician practices by private equity investors that might be too small or to somehow fall between the
cracks of the prior definitions of transaction oversight. And another thing that Massachusetts specifically
does is to make that real estate transaction, the stripping of assets from a healthcare entity. Itself, a
notifiable healthcare material change transaction that would require review by the Health Policy
Commission and ultimately the Attorney General's office.
( 13:02 ):
So I think that those are two closures of healthcare systems, all of those things, each of them are one of
those examples of, it's not just mergers and acquisitions anymore, of hospital buying hospital down the
street. It's about these other types of investment vehicles and the types of transactions they engage in
once they operate the hospital system that can be problematic. So that's Massachusetts. I think one of
the things California is doing, it also has previously implemented a transaction oversight law, but that
transaction oversight law is in a California bill, supposed to really expand particular oversight when
private equity tries to buy a healthcare entity, a physician practice, and expand the sort of oversight, but
also the restrictions on what a private equity practice can do to control physicians.
( 13:54 ):
So I think in the physician context, one of the concerns is that this sort of for-profit motive, again,
conflicts with the physician's professional and ethical obligations. And so the idea there is to say that

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private equity backed physician management organizations, MSOs, which stands for management
service organizations or staffing companies, that those entities cannot take control over all aspects of
operation of the physician's practice to the point where it starts to interfere with the physician's clinical
and professional decision making, which we, I think are seeing and it becoming an increasing problem.
So I think both of those expanding attorney general oversight over these transactions when they
happen, and then even when they are allowed to go forward, these types of existing management
arrangements where private equity or for-profit actors are in control of entities, revenues and assets
and bottom lines and operations to say that that cannot bleed over into professional and clinical
decision-making.

Mark Masselli ( 14:56 ):
Well, I know we want to get into some of the regulatory issues, talk about the FTC, but Erin, I want to
just focus in on something you've written. That multi-billion dollar acquisitions by Amazon and CVS
reflect a trend towards corporate investment in primary care, which could threaten equitable access to
care, raise costs, and reduce physician's clinical autonomy. And yet we hear from others the view from
Ann Greiner, chief executive of the Primary Care Collaborative, who's also been a guest on our show.
She says, these companies are, and I quote, "infusing practices with sorely needed funds and may
improve access to care for people in underserved areas." I'm wondering what your reaction is to that.

Erin Fuse Brown ( 15:38 ):
Yeah, so this isn't one. The first point that you make is, I just want to highlight it, and that is it's not just
private equity that is doing this sort of corporate transformation of the healthcare system. It's also
publicly traded companies like Amazon retailers, like Walmart, Amazon, but also insurers. So CVS is both
a retailer and a big insurer. UnitedHealthcare, same thing. Both the biggest physician employer, but also
the biggest PBM and one of the biggest insurance company in the country. So we have these other types
of corporate entities. Again, we think of them as corporate in the sense of for-profit, operating for the
benefit of their investors or their shareholders and not necessarily for the community or for the
patients.
( 16:26 ):
And so a lot of these entities are making big investments like multi, multi-billion dollar investments in
physician practices, in primary care practices, in home health. And maybe this is a good thing because
we know that primary care is under-invested in. You talk to any independent primary care practice, and
they are struggling to make it work with the increasing administrative burden of, say, value-based care,
all the data collection, all the quality metrics, all of the population health requirements that a small
practice has to take on. It has to affiliate with a bigger operation in order to manage that financial risk
and just manage the data collection aspect of it.
( 17:08 ):
So given that, we know that practices are struggling, we know that they're looking to partner with either
a large health system or one of these other large entities that can help them manage the sort of new
care environment that we're in. But when they turn to these entities and say, "Yes, we will accept your
help. We will let you manage our practice and help us with these administrative tasks." They're really
turning over the keys to the castle in terms of the heart and soul of independent practice, which is their
patient relationships and their control over their own practice medicine.
( 17:44 ):

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I think that that is the part that we have to think about what regulatory levers are available to protect
that sort of, I think sacred physician-patient and practitioner-patient relationship because it is bound by
professional ethical obligations that corporate owners frankly do not owe to the patient and owed
instead to their shareholders. But also the corporate managers are not the ones who've gone to medical
school or nursing school. They do not understand what patients need. They're not there at the bedside.
They're not there talking to the patients. And so I think that protecting that relationship is extremely
important.

Mark Masselli ( 18:21 ):
Well, they've on one hand, as an insurance company, lessen the investments in primary care, which is so
desperately need. We need to get to about a 10% spread. And then the other side, they're going out and
buying them on the cheap because they need capital. It would simply make a lot more sense that
primary care, which is a focus that we have and health centers around the United States have are so
important, and yet we see a diminution of the resources they're given.

Erin Fuse Brown ( 18:53 ):
Yes. And I think that the reason that primary care is an attractive investment target for these insurance
companies is not because because they want to again improve primary care so much. It's because these
primary care physicians come with an associated patient base, particularly they also come with
associated patient data, which for Medicare Advantage in particular and other sort of value-based
payment arrangements means they can have access to all the diagnostic codes that they need to
maximize the capitated payment revenue that they get for Medicare Advantage. So it's a very clear
profit motive for the insurance companies, particularly Medicare Advantage plans to get into an
arrangement with these primary care practices. But what we're seeing is that it's, again, not an even
trade where the primary care practice doesn't necessarily see this large infusion of resources to the
benefit of their patients. Instead, they see it's largely a way that this large entity can then access their
patient data and information.

Mark Masselli ( 19:55 ):
I think we saw recently that in our previous show that 54% of all Medicare patients who are on
Medicare Advantage now, a growing number.

Margaret Flinter ( 20:05 ):
Sure. And Medicare is certainly the CMS folks, as Erin knows well, CMS folks are not immune to taking a
hard look at that, and we wonder if there'll be some changes in the coming months. But Erin, I think
you're doing a great job of shedding some transparency on this whole area, but when it comes down to
it, how does a consumer learn the details about the type of plan they might be joining or what is
happening with their own primary care provider practice? How apparent is this to somebody if they
want to make a choice? How is it apparent to an employer who sponsors health insurance for their
employees and wants to make a choice with this in mind? Are the details fairly public or does it really
require somebody with your research skills to get to the bottom of the ownership of the practices or the
plans they may be choosing to go with?

Erin Fuse Brown ( 21:00 ):
Well, I can guess from the way you've asked the question that ideally it would be transparent. That
someone who's shopping for a doctor or who's looking for a new practice would be able to tell, is my

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practice primary? Is it independent or is it private equity owned? Is it owned by Optum or is it owned by
my insurance company? And unfortunately, that is an extremely opaque and difficult piece of
information to find. It is almost impossible for an individual patient or even an employer purchaser to
find out who owns and who's controlling the physician practice with whom I'm getting into a
relationship with, whether it's they're part of my provider network or they're going to be my primary
care physician.
( 21:47 ):
And so that is really difficult because it's also hard for researchers to figure out which of the 90,000
physicians that Optum claims to be affiliated with and managing, who are they, which 90,000 physicians
across the country. It's very, very difficult to see that information even in the most sophisticated data
sets. It takes painstaking manual matching, and even then it is not totally comprehensive. So not only is
it difficult for the individual patient to make informed decisions. Even if they understand that there are
risks associated with this, they cannot make those decisions. Regulators and enforcers cannot find this
information. And researchers, we cannot shed light on the problem because it's very difficult or makes it
harder to shed light on the problem and study what is the effect of Optum buying my physician practice?
Is this a good thing? Is this a bad thing? Are there risks to me?
( 22:45 ):
It's difficult to answer that question because we can't even figure out which physicians are Optum
affiliated, which physicians are... Again, we painstakingly have to manually come up with lists of
providers that are private equity affiliated in order to study that effect. But that takes time, it takes
resources, and it's not something that is certainly not available to the average patient out there.

Mark Masselli ( 23:08 ):
Erin, a couple of regulatory issues, and let me sort of mush them together here. On one hand, you've got
some state activities going on, and then you have some federal. There's a state law that prohibits what's
called corporate medicine. And of course, these statutes prevent a company that employs doctors from
interfering with patient treatment and wondering what your thoughts about the strength of those laws.
And then you've got the FTC working on the non-compete clause, and I think that a federal judge
blocked that the other day. And maybe talk a little bit about this, but just to let our audience know that
we've got action at state levels. And I think Erin, you talked a little bit about Massachusetts and
California, and you also have actions at the federal level. So maybe try to address them both, but also in
this larger framework of what is out there in terms of oversight that might be in place.

Erin Fuse Brown ( 24:01 ):
Yeah. So I think the concern that all of these federal and state regulatory actions, the corporate practice
of medicine, the federal and state equivalent non-compete bans are really getting at this idea of
corporate control over physician and clinician decision making. And that is at the heart of this concern, is
that traditionally and for many, many years, there's been this concept that lay unlicensed corporations
that have, again, owe their primary obligation to their shareholders, do not have the right financial
interests and right training to be interfering with or dictating to a physician how they should practice
medicine. So for a long time, there've been on the books in many states, these prohibitions on lay
unlicensed corporations, owning, employing or controlling physicians in the practice of medicine. And of
course, this has also been extended to independent practitioners like nurse practitioners and physician
assistants.
( 24:59 ):

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So what does that look like in practice however, it just has invited clever lawyers to contractually work
around it so that physicians look on paper to be employed by professional corporations and other
physician controlled entities, and then contractually get into relationships, whether it's with hospitals or
management service organizations for administrative and operational support. Physicians don't want to
do their own billing and collection, for example. So over time, these administrative back end service
providers are called management service organizations, MSOs have become more than just the back
room administrative support organization. Rather, they have started to take over the keys again to the
practice. In this case, physicians turn over not only their billing and collection and their payer contracting
and their hiring and firing and their supervision and their leases and their equipment ordering and their
supply ordering, but really all of the clinical protocols, the scheduling, the amount of time they get to
spend with patients, which patients they get to see, and for how long.
( 26:03 ):
All of these things start to really impede and interfere with the profession and the practice of medicine
and clinical judgment. And so what state and the federal government are trying to do is to untangle,
while leaving some of these support mechanisms in place, these relationships in place, to really create a
structural divide between those who are empowered to practice medicine and those who provide
operational administrative supports to say that there are certain types of arrangements that you cannot
enter into because essentially that would cause you to seize control over the practice of medicine. And
so states like Oregon, Massachusetts are trying to strengthen their corporate practice of medicine
prohibition to make it so that it's more difficult to contractually work around it. And for an insurance
company or an MSO that's private equity owned, to really again, acquire the keys to a practice
contractually through these types of management service organization arrangements.
( 27:02 ):
Similarly, the non-compete ban that happened at the federal level, the FTC, but also have been on the
books and are being added to laws at the state level every year is getting at the same concern. And that
is that non-competes, which tell a physician, you cannot work in a 50-mile radius or 25-mile radius of
any of the practice locations of your employer for a period of up to two years after you depart the
employer for any reason. That is a very onerous restriction. It's a restrictive covenant that is put into the
employment agreement. And increasingly, of course, physicians are employed, they're not operating
their own practices. And so these physicians feel utterly chilled, utterly silenced by the inability by their
non-compete, their gag clauses or non-disclosure agreements.
( 27:53 ):
They cannot speak out if they feel that the practice is being run in an unethical or unprofessional way.
They cannot leave because they are bound by a non-compete. They would have to move their family
two states over in order to escape the confines of their non-compete or stop practicing for several years.
Again, these are not practical realities for most practicing physicians. So that existence of non-competes,
again, really prevents physicians from practicing medicine in an independent and autonomous way
because they're locked in essentially to their existing arrangements.
( 28:26 ):
So these two in combination, strengthening the corporate practice of medicine, prohibition, and those
protections traditionally been done at the state level and regulating or restricting non-competes for
employed physicians. Again, traditionally at the state level and then more recently through a federal
non-compete ban, are seen as ways to protect professional health practitioners from corporate control
and protect their autonomy and their clinical decisions from corporate interference.
( 28:59 ):

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As you alluded to the federal non-compete ban was slated to go into effect shortly in September of this
year. The rule was finalized earlier in April of this year, and immediately of course, there were three
lawsuits challenging the non-compete ban. The non-compete ban by the FTC didn't just apply to
physicians, it did apply to physicians, but it applied to workers across the economy. And so the Chamber
of Commerce in Texas and several other different business groups sued under various federal laws to
say that the FTC's non-compete ban was invalid. In fact, they got the federal judge in Texas to agree and
issue a nationwide injunction just last week saying that the federal, the FTC lacks the statutory authority
to impose a ban on non-competes, and that should stop the implementation and enforcement of the
non-compete ban nationwide. Of course, there are competing cases. The federal court in Florida
signaled that it probably will agree with the Texas court. And then there's another case in Pennsylvania,
which went the opposite way and said, "No, the FTC has the authority to issue the non-compete ban."
( 30:12 ):
Well, what does this mean for the regular physician who's sitting there with their own non-compete
ban? Is it still enforceable? Is it not? It is still enforceable. I think that the federal challenges means that
at least for the time being, the FTC's rule will not go into effect, but you would have to also check with
state law because more estates are entertaining the idea of either enforcing or passing similar non-
compete bans, particularly for physicians in their state.
( 30:41 ):
So California has a non-compete ban. Indiana passed one particularly for primary care physicians. And so
increasingly states are interested in this as well. So even while we're waiting for litigation, I think
ultimately the Supreme Court will need to decide what the status of the FTC's non-compete ban will be.
And that may not go so well for the FTC. But here again, states can fill in a gap that the federal
governments, even while there's a legal challenge to the FTC's non-compete ban. States can pass one at
the state level, and that can offer similar if not broader protection for practicing physicians and clinicians
and nurses and other types of healthcare workers within their borders. I think that that is where
increasingly we see the action being held. But again, it's all to this eye of protecting autonomy,
protecting professional clinical judgment, and protecting the rights of workers who are increasingly
feeling squeezed by corporate ownership.

Mark Masselli ( 31:44 ):
Let me just get one last question about the election since it's right around the corner. I'm wondering
how do the presidential candidates stack up on the issues that we've been talking about, and have they
been transparent enough on these issues?

Erin Fuse Brown ( 32:00 ):
Yeah, I think in some ways healthcare has not been at the center of the political debates as it has in prior
elections. I think that there are other concerns that are taking up the space that health policy typically
does. I don't know exactly where the candidates have aligned on some of the issues that we're talking
about. Some of them are fairly bipartisan in the sense that everyone seems to be equally for increasing
transparency. That seems to have a lot of support on both sides of the aisle, at least in Congress. I would
imagine that that's similar, you know the Trump administration put in some of the hospital and
transparency and coverage rules, for example. So some of those things are not necessarily partisan
surveillance, but again, transparency doesn't get you all the way there. It just gives you the data so you
can study the effects. It doesn't solve the problem.
( 32:54 ):

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And on the more important issue, I think one thing to watch is to see where the candidates stack up on
their antitrust and competition policy. I think that there, we see a little bit more of a partisan divide
where the Trump-appointed judges and the sort of Trump-era FTC commissioners are more skeptical of
their power, for example, to do things like the non-compete ban, to take aggressive action against the
type of healthcare consolidation and acquisitions that FTC chair, Lina Khan and the Biden
administration's FTC commissioners and DOJ and competition policy. There's a Tri-agency work group,
for example, across HHS, the Department of Justice and FTC. Very, very pro-competition policy, strong
antitrust enforcement approach. It remains to be seen whether or not Vice President Harris will
continue that trajectory or whether she will take a different approach. And so I think that that's an
interesting place to watch is just to see where the candidates fall when it comes to antitrust
enforcement and competition policy.

Mark Masselli ( 34:02 ):
And your thought about the FTC Commissioner in terms of the work she's done.

Erin Fuse Brown ( 34:08 ):
I think that the FTC Commissioner Chair Khan, but also the Commissioners, Rebecca Kelly Slaughter and
Bedoya have been very, I think in some ways very forward-thinking. It's been a breath of fresh air.
They've taken several important steps in the area of private equity enforcement. There's the big
antitrust case against the U.S. Anesthesia Partners that the FTC brought in Texas, which is I think a huge
move. The updated merger enforcement policies that the FTC and the DOJ co-issued in 2023 and the
FTC non-compete rule. I think in some ways, the leadership of the FTC and the Department of Justice
have been very pointed, very aggressive and pro competition in a way that's sort of meaningful. It's not
sort of stuck in the past, but is looking at the ways in which we see new consolidation, new and
competitive conduct being played out in the current market, not just the market of the 1950s, '60s, '70s.
I would like to see that trajectory continue.

Margaret Flinter ( 35:19 ):
Well, Erin Fuse Brown, this has been a fascinating and important conversation, and I think we look
forward to having you back on the show as things evolve over the coming months during this most
interesting year and the year to come.
( 35:32 ):
Thank you for your time. Thank you to our audience for being here. Please be sure to subscribe to our
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( 35:51 ):
Erin, thank you so much for the important work that you're doing and for joining us today on
Conversations on Health Care.
( 36:01 ):
This copyrighted program is produced by Conversations on Health Care and cannot be reproduced or
retransmitted in whole or in part without the expressed written consent from Community Health
Center, Inc. The views expressed by guests are their own, and they do not necessarily reflect the opinion
of conversations on healthcare or its affiliated entities.

Transcript by Rev.com

This transcript was exported on Nov 05, 2024 - view latest version here .
Transcript by Rev.com