AAEM Comments on Draft Merger Guidelines

Dear Attorney General Garland and Chair Khan:

On behalf of the American Academy of Emergency Medicine (AAEM), thank you for the opportunity to comment on the draft update of the Merger Guidelines, issued on July 19, 2023. AAEM was established in 1993 to promote fair and equitable practice environments necessary to allow emergency physicians to deliver the highest quality of patient care. AAEM has been a leader in protecting board certification in emergency medicine and confronting the harmful influence of the corporate practice of medicine.

AAEM recognizes the harms that anticompetitive mergers can impose, and in particular, we see the detrimental effects of such mergers in the delivery of health care. For 2018, the American Medical Association (AMA) conducted its yearly Physician Practices Benchmark Survey and concluded that, for the first time, more physicians were employees rather than owners of their practices, (1) and the share of employed physicians has continued to rise through 2022.(2) While this may not seem like a significant finding, the systematic consolidation and buy-out of private practice physicians is harmful to both patients and physicians. Physicians take the Hippocratic Oath upon embarking on the practice of medicine, an ethical code of conduct which requires that their duty be first and foremost to their patients. This code obligates physicians to put the needs of the patients first, both in the practice of medicine and their business. In contrast, non-physician owned/operated practices are not bound by this ethical code, which in our experience can lead to poorer patient care and higher costs. Unfortunately, we have repeatedly seen this trend play out with emergency department corporate management groups (CMGs) with private equity backing and/or ownership, as we will discuss further in our comments below.

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