By Lynn Bailey, special to Statehouse Report | Health care is big business in South Carolina, amounting to 22 percent of the state’s total economic output, compared to 18 percent nationally.
But the big health story impacting South Carolina in 2018 was the growth in health mergers, both national and across the state. Health care is getting big or bigger. Big Pharma, for example, controls the quality and prices of old and new medicines. Large hospital-centered health systems control inpatient care, outpatient care and many of our doctors. They compete for the dollars controlled by Big Government (Medicare, Medicare and big health insurance companies).
It gets bigger nationally. United Healthcare, the country’s largest insurance plan, now owns providers hospitals, outpatient surgery, urgent care and physician practices. It is now Big versus Big versus Big! CVS acquired Aetna; Optimum (owned by United Healthcare) acquired DiViata, a large physician group; and a variety of pharmaceutical companies were acquired by other pharmaceutical companies. As Big gets Bigger, the rich get richer, mostly thanks to the Trump federal tax reform from last year.
Health care is betting bigger in South Carolina where Prisma Health was the new brand unveiled by the creation of a large health care entity developed between Greenville Health System and Palmetto Health System. There is also the Spartanburg Regional Health System’s acquisition of Mary Black Health System, Spartanburg and Mary Black Health System Gaffney. This consolidated health care delivery is in Spartanburg, Cherokee and Union Counties. The deal closes on or before the end of the year.
In the Lowcountry, MUSC announced at Thanksgiving that it will acquire four S.C. facilities from Community Health Systems, a large but shrinking for-profit hospital system,. These are Chester Hospital and Springs Hospital in Lancaster, along with two hospitals in the Pee Dee — Carolinas Hospital System in Florence and in Marion. Big hospital-centered systems then acquire regional physicians’ clinical practices. Think big fish eating small fish. Example: Fairfield Memorial closed its doors to be replaced by a freestanding 24-hour Emergency Department owned by Providence Hospital in Columbia which is also owned by a large health system that’s merging with another large system. These days, health care is all just a big business.
Also in 2018:
Nurse practitioners. Among other health professionals this year, nurse practitioners were able, thanks to a change in their scope of practice, to expand their capacity to directly provide care with minimal oversight by physicians. This greatly allows advanced nurse practitioners to care for patients across rural South Carolina and in many scarce medical specialties.
Urgent care. This also has grown, Blue Cross Blue Shield of South Carolina’s subsidiary, Doctors’ Care, has expanded across South Carolina. Minute Clinics expanded across South Carolina’s CVS stores and MedCare and locally owned urgent/emergent care practice has also grown.
Other care. Home health care providers have blossomed across the state providing much needed in home care. Telemedicine keeps growing, though it’s still not as convenient and accessible as promised.
Managed care. These companies routinely provide most of the care South Carolina’s 1 Medicaid beneficiaries/patients receive. But for one more year, the S,C, Legislature declined to expand Medicaid to cover more low-income and working residents who fall through the cracks.
Addiction. What didn’t change was how South Carolina doesn’t treat addiction. Many insurance plans don’t adequately provide coverage for the residential or inpatient care that detoxes and rehabs those addicted to opioids. Public health plans, Medicare and Medicaid coverage have gaps. Public mental health and substance abuse treatment is still under funded and understaffed so that prisons and country jails are of the first stop for the addicted or mentally ill, regardless of resources. The good news, I guess, is almost all S.C. first responders have Narcan onboard to revive an overdose victim.
Earlier this month, enrollment numbers for the Affordable Care Act were down a few thousand from last year’s. This might be because more people are now employed and have employer-sponsored coverage. Or it might be because with the new tax reform act, they are no longer penalized for not having health insurance or they just rolled with automatic renewal. Only Blue Cross Blue Shield of South Carolina was providing plans again this year. But South Carolina now has a non-profit health insurance agency in Columbia to help consumers navigate all aspects of finding care from Medicare, Medicaid and private plans.
Next year: The prognosis is about the same as this year – big will get bigger and the more things change, the more they remain the same.
- Lynn Bailey is a Columbia-based health care economist. Have a comment? Send to: feedback@statehousereport.com.
We Can Do Better, South Carolina!