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On the defense

AHA says most mergers aren't anti-competitive


By Beth Kutscher
Posted: June 8, 2013 - 12:01 am ET
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With the healthcare reform law casting intense scrutiny on costs and what drives them, the American Hospital Association wants to deflect the notion that hospital consolidation is a significant factor.

Last week, the AHA came out with an analysis of six years of hospital mergers and acquisitions. A declining number of them, the report concluded, involve overlapping markets.

The volley comes as the industry awaits an appeals court ruling on the Federal Trade Commission's bid to unwind a hospital deal in Ohio between ProMedica and St. Luke's Hospital that antitrust enforcers predict will lead to higher prices.

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The AHA analysis looked at 316 transactions involving 551 hospitals between 2007 and 2012. The proportion of mergers with an overlap in at least one metropolitan statistical area (MSA) decreased to 32% last year from 60% in 2007, according to the report.

When the two parties were operating in the same market, almost 90% were in MSAs with at least five competitors, the report concluded. And when there were five or fewer competitors—the situation with 20 deals—most of the transactions involved a small hospital in a small community.

Those hospitals were likely to be in serious financial straits and “there were clearly tangible benefits that accrued to the community,” said Richard Pollack, AHA executive vice president. The acquired hospitals—without scale or access to capital—were at risk for closure, he said.

Nearly all hospital mergers and acquisitions undergo antitrust review, and the vast majority are approved, the AHA pointed out in the report. But the government is looking closely at these deals and has challenged four since 2011.

Kenneth Field, a former FTC lawyer who now focuses on antitrust at Jones Day, noted that even when there are multiple players in the market, regulators will focus on the extent of direct competition between the two merging parties. The FTC, he said, is especially interested in how much leverage the merging parties will have with payers.

In the ProMedica case, the FTC seized upon comments that the CEO of St. Luke's Hospital in the Toledo suburb of Maumee made to his board of directors in 2009: that joining ProMedica would have “the greatest potential for higher hospital rates.”

America's Health Insurance Plans has argued repeatedly that consolidation gives providers greater leverage with payers and leads to higher costs for patients. It reiterated that position in a court filing in the ProMedica case and in a blog post last week.

Pollack countered that price growth has reached a historic low and argued that hospitals have only so much control over prices because many years of consolidation among insurers means a single payer now controls a lion's share of the commercial market in many regions.

Follow Beth Kutscher on Twitter: @MHbkutscher


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