One important question to ask about any health insurance merger is how will the deal will affect the local market.
It’s said that all politics is local and the same is true in health care. That’s why antitrust regulators will look closely at Anthem’s proposed acquisition of Cigna and Aetna’s proposed deal to buy Humana, which we covered earlier this month. Continue reading
Hospitals across the country are merging – both with other hospitals and with other health care entities such as clinics and rehab facilities. (Those are sometimes called, respectively, horizontal and vertical integration.)
The question is whether the consolidation is creating more efficiency in the health care system, as hospitals generally argue, or whether it’s creating big monopolistic health care entities that will have more clout in negotiating with insurers and thus will lead to higher, not lower, prices.
Antitrust/ mergers and acquisitions is a topic health reporters often shy away from. But it’s important and we need to pay more attention. To help you, we just posted a tip sheet, “Getting the facts on hospital mergers and acquisitions,” based on an email-interview with Barak Richman of Duke Law School, one of the foremost experts on health care antitrust law. In addition, here are a few additional resources on the topic and some recent coverage about the issue nationally and locally.
One of the most significant trends in health care over the past few years has been the merger of physician groups with hospitals. By acquiring physician groups, hospitals and health systems can develop accountable care organizations and gain a competitive advantage by requiring employed physicians to refer patients to them.
But last week a federal judge in Idaho ruled that St. Luke’s Health System in Boise had violated antitrust law by acquiring the 40-physician Saltzer Medical Group, in nearby Nampa, Idaho, in December 2012. At the time, Saltzer was the largest independent multispecialty group practice in the state. As result of the antitrust violation, the judge said the hospital had to unwind the acquisition.
Given that the Federal Trade Commission was a plaintiff in the case, the decision raises a question about whether the FTC will pursue antitrust cases in other cases when hospitals acquire physician groups. The decision on Friday by B. Lynn Winmill, chief judge of the U.S. District Court in Idaho, marked the first time a federal court had decided an FTC case against a hospital acquiring a physician practice, as Beth Kutscher explained in Modern Healthcare. Continue reading
News publishers in Idaho have asked the Ninth U.S. Circuit Court of Appeals in San Francisco to unseal pricing information that health insurers pay to hospitals and other providers in Idaho in an antitrust case stemming from a hospital system’s purchase of a physician group.
The publishers of the Idaho Statesman in Boise, the Idaho-Press Tribune in Nampa, and the Times-News in Twin Falls were joined by The Associated Press and the Idaho Press Club in the request to unseal the pricing data along with witness testimony and exhibits in the case, according to reports by Joe Carlson in Modern Healthcare and by Audrey Dutton in the Idaho Statesman.
The request was filed in November after U.S. District Court Judge B. Lynn Winmill failed to require lawyers to make compelling arguments for keeping the evidence sealed and keeping the courtroom closed at certain stages of the trial, Dutton reported.
Court documents (PDF) show that the pricing data was sealed before the trial began in September in Boise. Continue reading