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Can We Talk About the 800-lb Gorilla in the Room?

Myers, Bre, AuD, PhD

doi: 10.1097/01.HJ.0000554347.38575.e7

Dr. Myers is an assistant professor in the Osborne College of Audiology at Salus University. Her areas of teaching and research include vestibular diagnostics, best clinical practices, and inter-professional education.

On my commute home, a billboard caught my eye announcing that a local hospital had just purchased five other regional hospitals and created a new “health system” in my backyard. While I never considered the hospital's audiology department a disruptive force to my private practice, now that Big Health had officially come to roost, my concern began to build. I was curious as to how others around the country felt about Big Health and whether it has impacted their practices, so I posted a poll on a professional social media page. Within minutes I received the fair question, “What do you mean by ‘Big Health’?” The American Hospital Association1 describes Big Health as taking various forms; “systems” are generally composed of multiple hospitals, while “networks” can include universities, medical schools, and other community and insurance agencies in their business structure.

The results from my simple poll were not surprising. The majority of respondents (17) reported that Big Health had negatively affected their practice, six were unsure, one experienced no effect, and two actually reported positive effects. But what concerned me was that very few people in our field seem to be talking about the current and potential impact of Big Health on independent practice models and the profession as a whole.

Health care mergers have been allowed to occur with little pushback from the federal government at an alarming rate—over 200 mergers per quarter for the past 15 quarters.2 Of the 4,840 community hospitals in the United States, 67 percent are part of a health system and 37 percent are connected to a larger health network.1 The U.S. Department of Justice3 reported that the few antitrust suits brought forth have all been dismissed. The primary arguments in support of these mergers are that inpatient hospital-based care cannot be provided outside of a hospital, and that mergers will increase access to services in underserved areas and ultimately lower health care costs. Only one case included outpatient services as a significant portion of the hospital system, the United States vs. Carillion Health System, 4th circuit, in 1989. Sahadi4 found that health care mergers make up a significant portion of the U.S. economy. Individual health care spending eats up 17.9 percent of a family's yearly budget and is expected to increase to close to 20 percent by 2025.

Another gorilla is beginning to stir in response to the rising cost of health care: Big Business is starting to take health care into its own hands. Large employers recognize the ever-increasing cost of providing insurance to their employees and are devising less traditional approaches to meeting this need.

What is the viability of private audiology practices in the age of Big Health? Will physician referrals continue if they join a large health network? The shift away from private practice toward larger group practice and hospital-based employment is trending in many health care fields. There are significant academic and professional implications as that 800 lb gorilla has taken a seat and doesn't appear to want to move anytime soon.

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1. American Hospital Association. Available from [Accessed December 21, 2018].
    2. LaPointe, J. Healthcare merger and acquisition deals announced in Q2. RevCycle Intelligence. Available from: [Accessed December 21, 2018].
      3. The United States Department of Justice. Available from: [Accessed December 21, 2018].
        4. Sahadi, J. Healthcare costs eating the economy. CNN Business. Available from: [Accessed December 21, 2018].
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