The American Hospital Association last week asked federal rulemakers to better define antitrust laws in advance of an associationwide push to more closely partner hospitals with independent physician groups.
In meetings with the Federal Trade Commission and on Capitol Hill with Sen. Herbert Kohl (D-Wis.), the AHA has floated a guidance paper that details the benefitsand potential legal hurdlesinherent in so-called clinical integration practices, where hospitals and physicians work in lock step to better coordinate patient care and share resources but remain independent of each other.
William Petasnick, president and chief executive officer of 434-bed Froedtert Memorial Lutheran Hospital in Milwaukee and chairman-elect of the AHA, said that such partnerships are key to aligning quality and financial incentives that prepare us for the new world of pay-for-performance.
The paper explains that while some physicians have banded together into larger groups or were actually acquired by hospitals, other practicing doctors wish to remain in small and independent practices, yet work together in ways that enable them to reap many of the benefits of being in a hospital system.
But legal concerns over terms of agreements, exclusivity of the partnerships and more could work to hinderor squelch altogethersuch arrangements. Petasnick said the AHA has asked the FTC to be more prescriptive when it comes to defining what is and isnt a violation of antitrust statutes, which would then lead to more widespread adoption of clinical integration.
At least one antitrust lawyer, however, said that in general, the agency prefers to be less prescriptive. The lawyer, who spoke on the condition he not be identified, said that the FTC prefers to keep the rules on these types of partnerships fairly open because the law requires that the arrangements be analyzed under the rule of reason, which is a fact-specific inquiry thats hard to broadly regulate.
The FTC last weighed in on the issue in 2002, when it issued an opinion that said it would not immediately challenge a proposal from MedSouth, a Denver-based independent practice association, to partially integrate clinically and share quality data.
But the decision is too loose and leaves many important antitrust issues open to interpretation, Petasnick said.
In our own case, there is a relationship with physicians and a desire to work together, Petasnick said, referring to Froedtert. But because of concerns over rules that dictate the physician-hospital relationship, many independent doctors feel hamstrung to do so.
Larry Wellikson, CEO of the Society of Hospital Medicine, said that the partnerships can be a win-win, as long as its leads to better patient care. But Wellikson cautions that relationships between hospitals and physician groups havent always been so rosy.
Still, Wellikson said that the coordination of care would almost immediately improve under such integration policies. The sniff test is: Does this thing were doing lead to better care? Wellikson said. If it leads to better care, then Im going to go for it.