In this issue: Healthcare is not only a contentious antitrust issue, but a highly confusing one; we focus here on clinical integration. Christi Braun looks at the challenge of promoting cost-effective health care while controlling joint contracting; Heather Cooper gives some cautionary advice to physicians looking to join forces; Ashley Fischer & David Marx, Jr. […]

Antitrust Implications of Clinically-Integrated Managed Care Contracting Networks and Accountable Care Organizations

Ashley Fischer, David Marx, Oct 11, 2010 The Patient Protection and Affordable Care Act (“PPACA”) established various mechanisms to make healthcare providers more accountable for both the cost and quality of the services they provide. One of these mechanisms is the establishment of a new class of Medicare provider-the Accountable Care Organization (“ACO”). An ACO […]

An Opportunity for Reform of the U.K. Competition Regime

Antonio Bavasso, Simon Pritchard, Oct 11, 2010 The Government’s spending review provides an opportunity to look strategically at possible reforms in U.K. competition law enforcement. The reforms that modernized the U.K. regime of competition enforcement with the 1998 Competition Act and the 2002 Enterprise Act have largely been successful. The United Kingdom is now seen […]

Are Clinically Integrated Physician Networks Candy-Coated Cartels?

Gregory Pelnar, Oct 11, 2010 Are “clinically integrated” physician networks that jointly contract with third-party payors such as Blue Cross little more than “candy-coated” cartels? If the answer is not necessarily, then how can one distinguish the good (i.e., those that raise consumer welfare) from the bad (i.e., those that do not)? While the Antitrust […]

The Interplay Between Competition and Clinical Integration: Why the Antitrust Agencies Care About Medical Care Delivery Styles

Gregory Vistnes, Oct 11, 2010 The Affordable Care Act provides for the formation of Accountable Care Organizations (“ACOs”). These ACOs will be composed of health care providers (hospitals and physicians) that will work together to manage and coordinate care for Medicare beneficiaries. Through this coordination of care-sometimes referred to as clinical integration-Medicare hopes that ACOs […]

Clinical Integration: Linchpin of Real Reform

Melinda Hatton, Oct 11, 2010 During the year-long debate over health care reform, removing barriers to clinical integration received far less attention than it should have. It was preempted by debate over more voluble issues like single payer options, individual mandates, and filling donut holes. Now that attention has turned to making health reform-officially, the […]

Federal Courts and Enforcers Diagnose Physician Practice Associations with Risk of Conspiracy Liability: Degree of Integration is Crucial to Challenges to Medical Network Price Agreements

Heather Cooper, Oct 11, 2010 Thanks to a recent federal district court decision, physicians and medical staff have more reason to think twice about price and other arrangements adopted by the practice associations and clinics to which they belong. Last Spring, the United States District Court for the Eastern District of California held that a […]

Clinical Integration: The Balancing of Competition and Health Care Policies

Christi Braun, Oct 11, 2010 The reason that clinical integration is a topic on which the Federal Trade Commission (“FTC”) and the Department of Justice Antitrust Division (“DOJ”) have written and spoken extensively is that providers who develop and operate clinical integration networks do so with the intent to jointly sell their services to health […]