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Mariel needed buy vardenafil levitra a new gastroenterologist. Having just moved back to San Antonio, the 30-something searched for a doctor to manage her Crohn’s disease, an inflammatory bowel condition that is successfully managed with medications and lifelong monitoring — including regular colonoscopies. Mariel booked an appointment and learned she would be on the hook for a $1,100 colonoscopy — about three times what she had paid for buy vardenafil levitra the same test in a different state.

Almost three-quarters of the bill would be a “facility fee” for the in-office procedure at a colonoscopy clinic. (KHN agreed not to disclose Mariel’s last name because she is concerned speaking out might affect her doctor’s willingness to manage her medical condition.) Preventive colonoscopies are covered without patient cost sharing under the Affordable Care Act, but colonoscopies for patients with existing conditions, like Mariel, are not. A 2019 study found patients with inflammatory bowel diseases, including Crohn’s disease, incur about buy vardenafil levitra $23,000 in health care costs a year.

Medication treatments alone can cost tens of thousands of dollars annually. But shopping around proved frustrating. Although San Antonio has plenty of gastroenterology offices, more than two buy vardenafil levitra dozen of them are controlled by the same private equity-backed group.

In 2018, one of the nation’s largest independent gastroenterology practices, Texas Digestive Disease Consultants, announced a deal with the Chicago-based private equity firm Waud Capital to expand by offering management services to other physicians. At the time, the Dallas-based practice had 110 locations, mostly in Texas — including San Antonio. Today its management group, buy vardenafil levitra the GI Alliance, operates in a dozen states with more than 400 locations — and is growing fast.

With market dominance comes the business opportunity to set and maintain high prices. €œIt’s pretty buy vardenafil levitra much the only game in town,” Mariel said. Private equity, known for making a profit on quick-turnaround investments in struggling businesses across many industries, has taken an increasingly active interest in health care in the past decade.

It has invested in gastroenterology practices in recent years to tap into the revenue potential in meeting growing demand. €œWe are in the buy vardenafil levitra Golden Age of older rectums,” one investment manager wrote in 2017. Tired of having to manage the increasingly complicated business of running a practice and, often, lured by the sweet deals investors offer, more and more doctors have partnered with or even sold their practices to private equity funds.

So investment managers now control the financial decisions for many medical offices caring for patients with digestive ailments. With profit the buy vardenafil levitra primary driver, patients may find they pay much more for the same — or less — care. The Centers for Disease Control and Prevention recently lowered the age at which healthy Americans are urged to begin routine screenings for colon cancer — ensuring that most will undergo regular colonoscopies beginning at age 45.

And the population is aging, meaning more people will be needing the procedure. For those 65 and older, Medicare picks buy vardenafil levitra up the tab. But even when a benign polyp is found during a simple screening, patients sometimes end up with an unexpected bill.

And less-than-scrupulous providers often find ways to bill for some services, such as out-of-network anesthesia monitoring. Studies show that private equity buy vardenafil levitra investment in health care results in more surprise bills and overall higher costs for patients. Surprise billing is the practice of charging insured patients for out-of-network care unknowingly received, including in emergencies and at otherwise in-network facilities.

Before a federal ban on surprise billing took effect this year, it was common for patients to get slapped with an expensive bill after being treated by an emergency room doctor employed by a private equity-owned staffing service — a problem that policy experts say was buy vardenafil levitra not a glitch but rather a business model for private equity companies. Nearly 10% of the nation’s 14,000 gastroenterologists were partners in or employed by a private-equity backed organization as of last fall, according to a report by Physician Growth Partners, which represents independent physician groups in transactions with private equity. In 2021, the number of private equity acquisitions of gastroenterology practices grew by 28% over the previous year, according to Spherix Global Insights and Fraser Healthcare.

Complex government regulations, technological innovations, and insurance industry practices have driven many buy vardenafil levitra gastroenterologists to sell shares in their practices, said Praveen Suthrum, who runs a consulting company for physician practices. Many physicians argue reimbursement rates are too low to keep up with complex negotiations with insurers and the other rising costs of operating an independent practice. Private equity typically purchases a stake in a health care practice, then adjusts its operations to make it more profitable.

It may buy vardenafil levitra switch to cheaper suppliers, shorten appointment windows, bill aggressively, or lay off staff, to name a few strategies — the kind of changes that save money at the expense of patient care. In December, NBC News reported on how one private equity-owned group of dermatology practices overbooked patients, lost test results, and leaned on cheaper labor from physician assistants and nurse practitioners who may miss critical diagnoses. A study out last year from the National Bureau of Economic Research showed that when private equity owned a nursing home, patients were more likely to die in their first months there and much more likely to be prescribed antipsychotic drugs — which are known to increase mortality among the elderly.

Taxpayer spending per procedure or service in a private equity-owned facility goes up buy vardenafil levitra about 11%. Private equity has shown a lot of interest in health care practices that perform high-volume procedures, especially those with growth potential. €œLots of people are needing injections in the eye for macular edema, and lots of people need colonoscopies, and lots of people need skin biopsies,” said Dr.

Jane Zhu, buy vardenafil levitra a health services researcher at Oregon Health and Science University in Portland who has studied the role of private equity in health care. €œAnd these are things that will only grow in volume over time as the population ages.” Zhu said usually the investors start by acquiring a well-performing practice, or group of practices, in one geographic area — called a “platform practice.” “It’s well established. It has some brand recognition,” Zhu said buy vardenafil levitra.

€œIt has good market reach. There may be multiple sites. It has lots of patients that are already affiliated with that practice, and they buy that up, and there are opportunities for consolidation.” Mergers create larger buy vardenafil levitra groups with more power to negotiate rates with insurance companies and charge what they’d like.

The possibility of capitalizing on the good name of a respected practice alone may make it a valuable investment. Zhu said these medical practices are considered a short- to medium-term investment, with an average period of three to eight years before the investors sell. Suthrum said private equity firms are good at making their case to doctors, assuring them they’ll let the doctors buy vardenafil levitra do the medicine while the businesspeople do the business.

Doctors think, “If I’m going to survive, then I will either have to sell myself to the hospital or, what is the alternative?. € Suthrum said in an interview. €œThe alternative buy vardenafil levitra is private equity.” This article was adapted from a recent episode of “An Arm and a Leg,” a podcast about the cost of health care, produced in partnership with KHN.

Emmarie Huetteman. ehuetteman@kff.org, @emmarieDC Related Topics Contact Us Submit a Story Tip.

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These germs can directly infect the ear, such as with otitis externa (swimmer's ear), or they infect other parts buy vardenafil levitra of the body but lead to inflammation that also affects the ears. Symptoms will vary depending on the , and may include fever, earache, itchiness, swelling, stuffy, clogged or muffled hearing, ringing in the ears, and dizziness. -based hearing problems usually only affect one ear, which causes unique problems with hearing.

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Childhood viral s Along with the common cold, several other childhood bacterial and viral s can lead to hearing loss, buy vardenafil levitra tinnitus, and balance problems. They include meningitis, congenital cytomegalolevitra (CMV), chickenpox, measles, and mumps. (Before routine vaccination was common, the mumps in particular were a major cause of childhood hearing loss.) While less common, many of these can also affect adults, too.

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In one study, nearly half of people being treated for Lyme disease at a Polish clinic reported buy vardenafil levitra new problems with hearing and ear ringing. Zika levitra, transmitted by mosquitoes, can cause hearing loss, too. and sudden hearing loss Some people develop sudden hearing loss in one ear after a known , or they may lose their hearing seemingly out of nowhere.

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Labyrinthitis Labyrinthitis is a general term used to describe widespread inflammation in the inner ear, where the body's hearing and balance buy vardenafil levitra organs are located. This can cause hearing loss and tinnitus along with disabling bouts of vertigo (intense dizziness). Often the cause is unknown, but reactivation of a dormant levitra—especially varicella zoster (chickenpox)—can trigger what's known as labyrinthitis and Ramsay Hunt syndrome.

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Sometimes s can buy vardenafil levitra trigger this kind of response, over-reacting to the presence of germs. While most people recover normally, some people develop a lifelong an autoimmune disease, which can carry its own hearing loss complications. Drugs to treat s can be 'ototoxic' In some cases, it's not the but the treatment that leads to hearing loss, tinnitus or dizziness.

This is buy vardenafil levitra especially the case for a class of antibiotics known as aminoglycosides, such as gentamicin, used to treat severe bacterial s. But even common painkillers to treat earaches can lead to hearing problems if taken incorrectly. When this happens, it's known as ototoxicity.

Always report ear-based side effects to your doctor buy vardenafil levitra. Who can help?. If you are sick and experiencing any hearing problems—such as hearing loss, ringing in the ears or sudden dizziness—you may be wondering what hearing specialist to see.

Reach out to buy vardenafil levitra your general healthcare provider as a first step. In some cases, they may refer you to an ear-nose-throat (ENT) doctor for specialized care. If your hearing loss is ongoing or permanent, they may also refer you to an audiologist near you for help with hearing aids and other treatments..