Our health care system is changing in ways patients feel every day – in longer wait times, higher bills, and fewer choices. One of the biggest drivers of these changes is the growing dominance of large hospital systems that control referrals and consolidate care. A federal program, known as the 340B Drug Discount Program, was designed to help low-income and uninsured patients. When used as intended, 340B has been a lifeline – supporting hospitals that provide critical care services to vulnerable communities.
As a community oncologist who has cared for patients for over 20 years – both within hospitals and now in my independent oncology clinic – I’ve seen firsthand how consolidation affects care. When decisions are guided more by institutional strategy than by what’s best for patients, trust and continuity of care can suffer.
Last March, CHRISTUS St. Vincent, a nonprofit hospital that has long served Santa Fe, revoked hospital privileges for several independent physicians, declaring those services would be “exclusive to employed or contracted providers.” The decision affected specialists from oncology to infectious disease, leaving many patients suddenly unable to see the doctors who had treated them for years.
The human impact is immediate. Imagine undergoing surgery with a trusted specialist, then learning that if you’re readmitted, that doctor can no longer care for you. Hospital leaders say their employed specialists can ensure continuity, but anyone who has faced serious illness knows that familiarity and trust can’t simply be reassigned.
This isn’t something that’s just happening in Santa Fe. Nationwide, hospital employment of physicians nearly doubled between 2008 and 2020. Studies show that when hospitals acquire independent practices, prices rise significantly, with no improvement in patient outcomes. That means patients pay more but don’t necessarily get better care.
The 340B Drug Discount Program, while invaluable to hospitals that truly serve vulnerable patients, has unintentionally accelerated this consolidation. Through 340B, hospitals can buy drugs at discounted prices but bill insurers at the full rate, keeping the difference. Congress intended for those savings to be reinvested in patient care, and many hospitals have done exactly that. In fact, nonprofit watchdogs have identified and ranked hospitals whose community investments exceed the value of their tax exemption.
However, profits are often used instead to expand hospital market share and acquire community practices.
It’s important to acknowledge that hospitals face real financial pressures, especially those serving rural or low-income populations, and 340B has helped many of them keep their doors open. We can both defend 340B and demand accountability. The program’s mission – to help underserved patients – remains essential. Strengthening oversight and transparency would ensure that 340B continues to support hospitals doing the right thing while preventing others from using it as a financial weapon.
Independent physicians play a key role in this balance. We provide more nimble, affordable, and personal care. In oncology, where every decision carries enormous weight, maintaining patient choice is not a luxury; it’s a necessity. Research shows that patients treated in independent settings often report higher satisfaction and lower out-of-pocket costs.
When hospitals restrict privileges or buy out local practices, patients lose access and competition disappears. In small communities like ours, that means fewer doctors and fewer options for those who can least afford disruption in their care.
We all want the same thing: a health care system that works for patients. Modernizing 340B, not dismantling it, by adding guardrails to ensure savings reach patients as Congress intended, would strengthen the program’s foundation. Doing so would protect the hospitals that depend on 340B to serve their communities while preventing its use in ways that undermine patient choice.
Reforming 340B to restore its original mission is not about politics – it’s about putting patients, not profits, back at the center of care.