CBS News Politics reports that health care consolidation often escapes antitrust review because many doctor-practice deals fall below the federal reporting threshold. Zack Cooper’s Health Care Affordability Lab found that over 99% of more than 275 hospital acquisitions of physician practices it examined were below that threshold. The Hart-Scott-Rodino Act requires mergers above a yearly dollar cutoff to be reported, and the cutoff is 133.9 million this year.
The Federal Trade Commission and the Justice Department share responsibility for policing health care mergers, but regulators have struggled to keep pace with the volume of deals. Over the past decade, the number of doctors working for hospitals instead of private practices has more than doubled, and 82% of physicians now work for hospitals, other corporate entities or private equity firms. UnitedHealth Group’s then-CEO said in 2024 that the company employed around 10,000 primary care physicians, separate from its 80,000 affiliated physicians. Studies cited in the report found that vertical integration has brought patients higher prices without benefits, or has produced worse health outcomes.
Soroush Saghafian said the transactions have been driven by financial efficiency rather than more seamless and attentive care. Anne Hug’s case illustrates how that structure can affect an individual patient. After an unsuccessful IVF attempt, her fertility doctor identified a uterine polyp and said it could be removed in a doctor’s office with local numbing, consistent with guidance from the American College of Obstetricians and Gynecologists. Instead, a physician at the same hospital planned to use an operating room and an anesthesiologist, while another obstetrician ultimately moved the procedure to a freestanding surgery center owned by the same health system. The system had bought the obstetrician’s practice in 2025, and Hug’s estimate rose from around 3,000 for an office procedure to around 6,000 at the surgery center after the last-minute change. Although anesthesia or sedation had been scheduled, Hug said the polyp was removed after her cervix was numbed, with only a few seconds of cramping.
Health policy experts have proposed site-neutral payment, under which providers would receive the same amount for a procedure regardless of where it occurred. Cooper said vertical integration can theoretically reduce friction in a fragmented system, and he cited Kaiser Permanente as an example of a popular hospital-insurer combination. But research on hospital purchases of gastroenterology practices found lower quality alongside higher prices and complication rates, while the main improvement was operational throughput, a financial measure. The Federal Trade Commission has brought eight health care merger or acquisition actions in President Trump’s second term, while the Justice Department has brought only two cases and settled a challenge involving UnitedHealth Group’s 3.3 billion acquisition of Amedisys. The report says the result is a regulatory system attempting to address consolidation after many smaller transactions have already gone unreported.