In a rare move approving joint contracting by independent physicians, the Federal Trade Commission staff said it would not recommend an antitrust challenge against a plan for clinical integration proposed by TriState Health Partners, a physician-hospital organization involving 300-bed Washington County Health System, Hagerstown, Md.
In a 37-page advisory opinion, the FTC staff concludes that TriState’s plans for integration have the potential to achieve higher quality and more cost-effective care, providing a comprehensive program of care management that fosters collaboration among physicians. The joint contracting is necessary and subordinate to the broader effort, the government’s key antitrust test for such programs, which the FTC more commonly concludes amount to illegal price fixing.
The opinion notes, however, that TriState’s 212 physicians make up a substantial majority of physicians in the area. Even though TriState physicians would be free to contract individually with insurance companies, the inability of payers to assemble provider networks with individual TriState physicians “would at least raise serious questions requiring further investigation and clarification.”
Similarly, the plan calls for the hospital, the only acute-care facility in Washington County, to contract with payers independently of the TriState network, but the FTC would become concerned if TriState was used strategically to squeeze competition for its services, such as outpatient procedures provided by some physicians in the market.
