Clinical Integration in a Red Hot Antitrust Environment Clinical - - PDF document

Clinical Integration in a Red Hot Antitrust Environment

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Clinical Integration in a Red Hot Antitrust Environment

Horty, Springer & Mattern

A story of:

• Cost
• Quality
• Access

Idaho’s largest health system decided to acquire Idaho’s largest physician practice. What could go wrong? Lawsuits By

• Idaho Attorney General
• FTC
• Competitors

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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)

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Clinical Integration in a Red Hot Antitrust Environment

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Defenses:

• Doctors not employed; could quit

and work with competitors anytime

• No non-compete agreements
• No obligation to refer only to
• St. Luke’s

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JUDGE RULES ST. LUKE’S MUST GIVE UP SALTZER MEDICAL GROUP January 24, 2014

• 1. Would create too much power
• ver payers.
• 2. Would have 80% of PCPs in

Nampa.

• 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

Clinical Integration in a Red Hot Antitrust Environment

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Antitrust

In a Medical Staff Setting?

All “unassigned patients” to hospitalists? 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. …

Antitrust Laws

Assumption: Competition will yield lower prices, increased

• utput, and/or higher quality.

The antitrust laws protect competition, not competitors.

Clinical Integration in a Red Hot Antitrust Environment

4 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.

Sherman 1 (15 U.S.C. §1) Prohibits:

• Contract, combination or

conspiracy

• Unreasonable restraint of trade

Critical Element: Collective Behavior Per Se vs. Rule of Reason Per Se Violations

• Market allocation
• Price-fixing
• Group boycott

Clinical Integration in a Red Hot Antitrust Environment

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Result

1996 Guidelines: Clinical Integration Antitrust Enforcers Can:

• Enjoin arrangement
• Prosecute
• Sculpt

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

communication that does not require thinking!

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