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PubMedDate not supplied

Critical issues in hospital antitrust law.

Antitrust litigation involving hospitals is common. This paper describes recent developments and underlying issues in antitrust law with respect to hospital-hospital relations, hospital-physician relations, and hospital-payer relations. A key unanswered question in each of these areas is how government regulation and public purchasing affect competitive markets for hospital services.

Antitrust Laws↗
PubMed1995

Antitrust law applicable to managed care contracting.

Antitrust laws cannot be ignored by physicians on the basis that they are not fair, are too complicated or make no sense. The Justice Department and the FTC view independent practitioners as competitors. As such, organized actions by physicians relative to managed care contracting are carefully scrutinized for antitrust violations. A basic understanding of the antitrust laws is therefore essential.

Antitrust Laws↗
PubMedDate not supplied

Government policies on a collision course. Health cost containment and the antitrust laws.

The Sherman Act, passed in 1890, was initially enacted to break up the huge "trusts" of that era, writes Donald Mooney, but it has been used more frequently as a weapon in the government's war to slow mounting health care costs. In this era of mergers, acquisitions and joint ventures, groups need to be readily aware of the laws regarding antitrust.

Antitrust Laws↗
PubMed1995

Impact of antitrust laws on physician networking and rural communities.

After reviewing the history of antitrust legislation and established zones of safety for providers and the application of antitrust laws to the healthcare industry in two earlier installments, the authors explore the consequences of the vigorous application of antitrust laws to physician networking, with an emphasis on rural communities. They review common exemptions to antitrust laws that maintain the uneven distribution of power in the evolving healthcare market. Acknowledging the tenuous ground that providers hold in the struggle for control of the healthcare industry, the authors argue for greater consideration of the unique circumstances and barriers that tend to prohibit the formation of strong, physician-sponsored, integrated healthcare networks. The authors have tested the climate for relief from the antitrust enforcement agencies in Washington, DC, and have found no easing of antitrust legislation forthcoming. However, following the resolution of several antitrust cases in recent months, barriers to physician-led organizations appear to be lessening. The authors close with a review of several strategies to minimize the risk of antitrust challenges.

Antitrust Laws↗
PubMedDate not supplied

Are you violating antitrust laws?

A hospital enters into an exclusive contract for staffing of its emergency room. Physicians band together into a managed care organization. Another hospital enters into an exclusive contract for anesthesiology services. Yet another agrees to refer patients exclusively to a vendor of durable medical equipment. These and similar arrangements, increasingly common in the health care industry, have one thing in common: They have been challenged repeatedly as antitrust violations. The providers have won some of these lawsuits and lost others. Short of avoiding all exclusive contracts, how can you avoid such a lawsuit, or at least improve your chance of winning it? This article outlines the antitrust principles that apply to exclusive contracts and joint ventures between health care providers. Its purpose is to alert you to situations that may implicate the antitrust laws. Because antitrust law is complex and turns on the specific facts of each situation, you should consult with your legal counsel whenever antitrust questions arise.

Antitrust Laws↗
PubMed1981

Applying antitrust law to medical credentialing.

This Article analyzes the possible antitrust liability of medical credentialing programs by dividing their potentially anticompetitive acts into three categories: (1) communicative behavior--for example, credentialing agencies' promulgation of standards--designed primarily to influence government decision making; (2) communicative behavior designed to influence private decision makers, such as consumers, hospitals, and training programs; and (3) noncommunicative behavior--for example, an agreement by the credentialing agency and others to boycott a group of professionals--that might be used to exclude competitors from various fields of medical care. The author argues that the first amendment of the U.S. Constitution, together with the related Noerr-Pennington doctrine, should exempt from antitrust law any credentialing standard that has been adopted for a good-faith purpose and is at least arguably reasonable. On the other hand, the author also argues that antitrust law should condemn any "sham" standard that in fact is designed to eliminate or to punish competitors, and any other noncommunicative behavior by credentialing agencies for the same purpose.

Accreditation↗
PubMedDate not supplied

Judge Posner's RFP: antitrust law and managed care.

The emergence of a competitive market in health care portends an increasingly important role for antitrust law. Managed care is even more difficult than fee-for-service practice to analyze in the quantitative, economic terms required by modern principles of antitrust law. This paper examines a recent court decision authored by a prominent judge and antitrust scholar: Blue Cross and Blue Shield United of Wisconsin v. Marshfield Clinic. The purpose of the paper is not to describe the law as it is or as it should be, but to illustrate the assumptions and gaps in understanding that can occur when courts are asked to evaluate this complex and rapidly changing industry without the benefit of sound empirical research.

Antitrust Laws↗
PubMed1985

How antitrust laws are changing the health care industry.

The new competitive environment and the recent application of antitrust laws to the health care industry are changing the way in which hospitals do business. This article explores the applicability of antitrust laws to health care, common practices which may be considered in violation of those laws, and offers a solution to the problem in the form of an antitrust compliance monitoring program.

Economic Competition↗
PubMed2003

The National Resident Matching Program and antitrust law.

In May 2002, a group of physicians filed a class action lawsuit alleging that the National Resident Matching Program (NRMP) violates antitrust laws. The plaintiffs contend that NRMP practices have stabilized lower-than-competitive wages and imposed exhausting working conditions on residents. They also maintain that NRMP procedures virtually force applicants for house officer positions to forfeit their right to negotiate for better wages and conditions. The plaintiffs also allege that the defendants have collectively fostered anticompetitive accreditation standards through the Accreditation Council for Graduate Medical Education. Jung v Association of American Medical Colleges could present antitrust law with some difficult challenges. Although the matching program on its face appears to limit competition in a manner that previous cases have found illegal, it operates in the context of important professional activities (medical education and quality improvement) that may generate some judicial deference. At this early stage, no confident prediction can be made about the outcome of the case if it goes to trial; however, the plaintiffs appear to have a plausible case under existing antitrust doctrine, and lengthy litigation is possible. Given the important questions that the litigation will not address, such as the potential costs of a finding of illegality to the government and other payers, and the impact of such a finding on the health care system as a whole, a legislative solution seems highly desirable.

Antitrust Laws↗
PubMed1995

The application of antitrust laws to the healthcare industry.

The move toward managed care initiatives and multiprovider networks has intensified in recent years in response to escalating healthcare costs and increasing market dominance by the insurance industry. As a consequence, the antitrust laws have played a significant role in defining the limits of physician cooperation. An understanding of the application of antitrust laws to evolving healthcare delivery systems and a knowledge of the specific areas where providers must exercise caution are essential to physicians' strategic planning. This article looks at the major areas of innovation emerging in the healthcare delivery market and details some of the most important guidelines for safeguarding physician collaborations. The authors compare the ability of physicians and insurers to organize integrated care systems and question the continued protection of the insurance industry under the McCarran-Ferguson Act.

Antitrust Laws↗
PubMed1985

The emerging relevance of antitrust laws to the delivery of health care.

Until relatively recently, antitrust enforcement in the delivery of health care was virtually non-existent. Not even 15 years ago, many legal observers might have concluded that the professional services of medical care providers were exempted from the federal antitrust laws altogether; or that many providers were engaged in local activities beyond the reach of federal interstate commerce jurisdiction. Even 10 years ago, many providers were arguing that collective agreements among potential competitors were not only sound public policy, but also that such concerted activities were actively encouraged by various federal laws. Today, however, the enforcement of the federal antitrust is an integral part of the complicated legal environment of American health care delivery.

Delivery of Health Care↗