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R J Enders

Publications and source records attributed to R J Enders.

32 records · Page 2Linked to original sources

Understanding antitrust: focus on the relevant market.

The increase in the past five years of antitrust cases involving the healthcare industry has left few healthcare organizations untouched. Even if a provider has not been part of actual antitrust litigation or involved in a government investigation, the courts' antitrust decisions of the past several years have molded and will continue to affect competitive strategies and operational plans at all levels of the industry. Antitrust is becoming a necessary, if sometimes distasteful, fact of competitive life. In this first of a five-part series of articles on antitrust issues in health care, a framework for understanding the antitrust laws and the increasing number of antitrust suits brought by, against, and between providers is developed. Further articles will feature an expanded discussion of several topics including: antitrust guidelines on medical staff privileges for hospital decision makers; physician-hospital competition and antitrust considerations; provider antitrust suits against third-party payers; and a discussion of whether the antitrust risks in forming and operating preferred provider organizations has been overcome.

Economic Competition↗

Medical staff privileges: is antitrust a real issue for providers?

In recent years the number of antitrust suits brought by physicians against hospitals and other physicians because of denial, suspension, or revocation of staff privileges has increased dramatically. Therefore, it is important for hospitals to understand the various issues confronted by those involved in antitrust litigation and to develop guidelines for minimizing antitrust risks associated with staff privilege decisions.

Credentialing↗

Hospital-physician collaboration and competition: the antitrust connection.

Antitrust issues are surfacing in many kinds of relationships between physicians and hospitals. Although uncertainty still exists regarding the legality of many of these relationships, it is becoming increasingly clear that when a hospital and its medical staff attempt to improve their revenue position at the expense of other providers, the limits of their actions are constrained by antitrust laws. Also, when a hospital competes with physicians, several types of hospital-physician "understandings" could be challenged.

Economic Competition↗

Are PPOs a competitive force or antitrust risk?

The formation of PPOs is being encouraged as a procompetitive force in the healthcare marketplace. However, this encouragement is being cautioned with the prospect of possible antitrust violations. Although very few antitrust lawsuits have been filed, the risk still remains. PPOs are certainly a significant factor in today's healthcare field and eventually, more antitrust challenges will develop.

Economic Competition↗

Can provider antitrust suits against payers be successful?

In today's increasingly competitive healthcare marketplace, payers, not providers, are the driving force in the healthcare delivery system. Therefore, providers are feeling greater pressure to compete on price and other terms to become recommended providers for these payers. The question becomes: what, if any, antitrust claims does a provider have who is excluded from a payer's healthcare program, receives a lower rate of payment compared to other providers in a payer's program, or is disadvantaged by a payer's pricing decision?

Economic Competition↗