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T H Brock

Publications and source records attributed to T H Brock.

11 recordsLinked to original sources
PubMed2000

Partial integration raises antitrust concerns.

Recently, providers have begun to explore a new model of integrated delivery system, the partially integrated IDS. Typically, a partially integrated IDS is a joint venture, owned by a core group of providers that maintains complete financial and operational independence outside the joint venture. The IDS contracts with other providers to furnish services that the part-owners do not furnish. A partially integrated IDS raises antitrust concerns because the participating providers may be seen as competitors banding together to set prices jointly for healthcare services. Therefore, to minimize their antitrust exposure, providers that are considering this model should be careful to structure the IDS in accordance with the relevant Federal antitrust laws (i.e., Section 1 of the Sherman Act), taking into account the Federal antitrust agencies' various guidelines and enforcement policies.

Antitrust Laws↗
PubMed1999

Minimizing antitrust exposure in a virtual merger.

As an alternative to complete mergers or joint ventures, hospitals recently have begun to explore virtual mergers, in which the parties are able to retain some managerial and financial independence while coordinating their mutual operations to financial advantage. Because virtual mergers are a recent phenomenon and can be structured in various ways, the antitrust risks associated with such transactions are unclear. A state antitrust challenge brought against an East Coast virtual merger and informal guidance by Federal antitrust attorneys suggest that the antitrust agencies will be inclined to challenge a virtual merger if the parties to the transaction retain too much independent decision-making authority. Hospitals that are considering a virtual merger therefore would do well to structure the transaction to combine governance and administration, financial assets, operations, and medical staffs as much as possible, while still allowing each party to the transaction to retain the independent decision-making authority each feels is necessary.

Antitrust Laws↗
PubMed1998

Medicare+Choice creates opportunities for PSOs.

The Medicare + Choice program, a feature of the Balanced Budget Act of 1997, has far-reaching implications for healthcare providers, and for provider-sponsored organizations (PSOs), in particular. Under Medicare + Choice, PSOs will be able to contract with Medicare if they meet certain conditions. Most significantly, the PSO must be established, operated, and majority-owned by healthcare providers that directly furnish a substantial portion of the covered services. PSOs and other participants in the Medicare + Choice program will receive aggregate annual payments based on geographic location and demographic characteristics of enrollees. Medicare + Choice provider participants should understand the details of how these payments will be calculated. For instance, geographically based payments will gradually be modified to reflect a more uniform payment rate nationally. In addition, participants in Medicare + Choice will need to meet state solvency requirements or apply to HCFA for a three-year waiver of those requirements to participate in the program. The best time to form a PSO may be in the next three years, before HCFA's authority to grant such waivers expires.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1998

New HCFA regulations clarify PSO requirements.

In March and April of 1998, HCFA promulgated regulations regarding various requirements for provider-sponsored organizations (PSOs). These regulations define what constitutes an affiliated provider to a PSO, identify what percentage of services must be provided directly to beneficiaries by PSO affiliated providers, define what constitutes provider ownership in a PSO, and set minimum capitalization and liquidity standards for PSOs.

Budgets↗
PubMed1997

Protecting payment levels under Medicare risk-based contracting.

More than 3.4 million Medicare beneficiaries are enrolled in risk-based HMOs, and the enrollment rate is expected to double in the next five to seven years. In addition, the Balanced Budget Act of 1997 has directed HCFA to contract with other plans, including PPOs, provider service organizations, and traditional insurance companies. HCFA's payment determinations, therefore, will have an increasing impact on HMOs and other insurers in the future. The Medicare Act requires that HCFA's payment to a plan under a risk-based contract reflect the adjusted average per capita cost of the services typically furnished to Medicare patients in the geographic area. HCFA, however, sometimes errs in calculating this payment, resulting in underpayment to HMOs. In many instances, the errors occur because HCFA calculates payments by using a Medicare enrollee's Social Security mailing address rather than the geographic area serviced by the HMO. To avoid underpayment, risk-based HMOs should monitor Medicare payments for HCFA and challenge payment rates they feel are inadequate.

Capitation Fee↗
PubMedDate not supplied

Antitrust--pre-merger compliance.

On September 15, the U.S. Department of Justice and the Federal Trade Commission issued joint antitrust guidelines to enhance health care industry understanding of antitrust enforcement policy in six topic areas. The guidelines represent a statement of federal antitrust enforcement policy. The guidelines do not change existing law and are not binding on private antitrust litigants or the courts. According to the guidelines, the agencies will not challenge a merger between two general acute-care hospitals where one of the hospitals (1) has an average of fewer than 100 licensed beds over the three most recent years, (2) has an average daily inpatient census of fewer than 40 patients over the three most recent years and (3) is more than five years old. With regard to hospital mergers that fall outside of the safety zone, traditional antitrust merger analysis will apply.

Antitrust Laws↗