Healthcare Reform and Antitrust Enforcement: Provider Consolidation Encouraged, Scrutinized
Jane Willis, Melissa Davenport, Ryan McManus, Jul 17, 2012
The Patient Protection and Affordable Care Act ("ACA") withstood constitutional challenge in June 2012 and will define the shape of the U.S. healthcare system for years to come. Provisions within the ACA address the dual policy goals of controlling healthcare costs and ensuring high quality care, and often do so through incentivizing providers to work together and share the responsibility for delivering high-quality care (and the risk for failing to do so). Through provisions encouraging the creation of accountable care organizations ("ACOs") and other measures that reward providers who demonstrate quality and efficiency, providers are encouraged to achieve scale and ensure a continuum of care. However, this activity may confront a number of potential existing roadblocks, not the least of which is antitrust concern about market power and related price-fixing issues. This article will address this tension, and discuss how organizations looking to consolidate may proceed.