The Hospital Industry Is A Big Game Of Monopoly Right Now

The hospital industry is participating in a massive flea market, with large chains buying and selling hospitals like Pokémon cards or Monopoly properties.

The hospital industry is a big game of Monopoly right now

Rebecca Zisser / Axios

The hospital industry is participating in a massive flea market, with large chains buying and selling hospitals like Pokémon cards or Monopoly properties. Buyers want to bulk up their market power, while sellers want to reduce huge loads of debt or focus their attention elsewhere.

What’s happening: The main action this week is coming from three large for-profit companies: HCA, Tenet Healthcare and Community Health Systems. There also have been a bevy of deals among not-for-profit health systems. These transactions can be easily overlooked, but they are important because they alter the pricing power in local markets.

Here’s the latest deal-making from this week:

HCA: Bought three acute-care hospitals in Houston from Tenet and two hospitals, also in Texas, from Community Health Systems. HCA missed Wall Street’s profitability expectations in the first quarter, so the easiest way to make investors happy is by acquiring high-margin assets. Brian Tanquilut, an analyst at Jefferies, said HCA now has the most inpatient hospital beds in Houston and should “see improved commercial payer pricing” because of the deals.

Tenet Healthcare: Sold the Houston hospitals to HCA for $725 million. Those facilities had high profit margins — 14% — but Tenet didn’t have a lot of market share in the area and wanted money to invest in its outpatient surgery centers. CEO Trevor Fetter has made it clear Tenet will only own hospitals if they have a dominant negotiating position in the local market to extract better prices from health insurers. Tenet sold its Atlanta hospitals last year for the same reason.

Community Health Systems: The most active seller right now. In the past week, CHS has announced or closed on the sales of 14 hospitals. CHS is hemorrhaging money and has $14.6 billion of debt that needs to be paid off, so it has set a goal of divesting 30 hospitals. Steward Health Care, Curae Health and Christus Health are some of the health systems that are buying from CHS.

Not-for-profit deals: Hackensack Meridian Health is acquiring JFK Health, which will give Hackensack an even stronger grip on the New Jersey hospital market. Baptist Memorial Health Care and Mississippi Baptist Health Systems merged, creating a powerful hospital giant around Arkansas, Mississippi and Tennessee.

The systems say the deals are about enhancing quality care, but look past that. Hospitals are recording fewer admissions as more people seek care in outpatient settings, and that inevitably leads to lower revenue. Acquiring more hospitals builds up a bigger revenue base and creates more leverage to milk higher prices out of commercial health insurers.

“The evidence and the impact of these mergers is becoming clearer and clearer, which basically shows…an increase in price and in some instances a reduction in quality,” said Zack Cooper, a Yale University professor who has studied hospital consolidation