SLIDE 1
Clinical Integration in a Red Hot Antitrust Environment
1
Clinical Integration in a Red Hot Antitrust Environment
Horty, Springer & Mattern
A story of:
- Cost
- Quality
- Access
Clinical Integration in a Red Hot Antitrust Environment Horty, - - PDF document
Clinical Integration in a Red Hot Antitrust Environment Horty, - - PDF document
Clinical Integration in a Red Hot Antitrust Environment Clinical Integration in a Red Hot Antitrust Environment Horty, Springer & Mattern A story of: Cost Quality Access 1 Clinical Integration in a Red Hot Antitrust Environment
SLIDE 2
SLIDE 3
Clinical Integration in a Red Hot Antitrust Environment
3
Lawsuits By
- Idaho Attorney General
- FTC
- Competitors
5
Charges:
- High rates for ancillary services
due to its size
- Encourages PCPs (60% of market)
to direct patients to St. Luke’s
- Threat to monopolize (though
competitors are also giants)
6
SLIDE 4
Clinical Integration in a Red Hot Antitrust Environment
4
Defenses:
- Doctors not employed; could quit
and work with competitors anytime
- No non-compete agreements
- No obligation to refer only to
- St. Luke’s
7
JUDGE RULES ST. LUKE’S MUST GIVE UP SALTZER MEDICAL GROUP January 24, 2014
SLIDE 5
Clinical Integration in a Red Hot Antitrust Environment
5
- 1. Would create too much power
- ver payers.
- 2. Would have 80% of PCPs in
Nampa.
SLIDE 6
Clinical Integration in a Red Hot Antitrust Environment
6
- 3. Judge commented on how
expensive health care is, despite its failure to match that with high quality.
Summer 2014 Appeal to 9th Circuit Advances
SLIDE 7
Clinical Integration in a Red Hot Antitrust Environment
7
Antitrust
In a Medical Staff Setting?
All “unassigned patients” to hospitalists?
SLIDE 8
Clinical Integration in a Red Hot Antitrust Environment
8
PMG must refer internally?
All hospitalists must meet:
- Daily/early rounds
- See patient within 45 minutes of
arrival
- CPOE Rules
- Discharges by 11:00 a.m. …
SLIDE 9
Clinical Integration in a Red Hot Antitrust Environment
9
Antitrust Laws
Assumption: Competition will yield lower prices, increased
- utput, and/or higher quality.
The antitrust laws protect competition, not competitors.
SLIDE 10
Clinical Integration in a Red Hot Antitrust Environment
10
Just because it makes good business sense doesn’t mean it’s legal. Just because government policy promotes integration doesn’t mean you’re allowed to do it.
SLIDE 11
Clinical Integration in a Red Hot Antitrust Environment
11
Sherman 1 (15 U.S.C. §1) Prohibits:
- Contract, combination or
conspiracy
- Unreasonable restraint of trade
Critical Element: Collective Behavior
SLIDE 12
Clinical Integration in a Red Hot Antitrust Environment
12
Per Se vs. Rule of Reason Per Se Violations
- Market allocation
- Price-fixing
- Group boycott
SLIDE 13
Clinical Integration in a Red Hot Antitrust Environment
13
Result
1996 Guidelines: Clinical Integration Antitrust Enforcers Can:
- Enjoin arrangement
- Prosecute
- Sculpt
SLIDE 14
Clinical Integration in a Red Hot Antitrust Environment
14
Commonwealth v. Partners Healthcare System The Rodin of Antitrust Enforcement Tips for Heading Off Legal Issues
- Develop Rationale: Cost, Quality, Access
- Do not meet with competition without
counsel
- Engage timely government, payers
- Remember, loose lips invite/extend
litigation
- Ban email or any other indelible