“We were moving along with the project and got to a time it was time to try it with live data,” said David Hopkins, director of quality measurement at the Pacific Business Group on Health. “At that point the hospitals' attorneys said, ‘You can't do that—it's a violation of antitrust.' ”
The coalition then sought an opinion from the Justice Department. In a letter issued today, Assistant Attorney General Christine Varney writes that the lack of access to raw data by participating hospitals and insurers makes it unlikely the effort would lead to collusion on prices. More likely, she writes, the transparency would enhance competition by allowing payers and employers to make more informed decisions about hospital services.
Under the proposal, an outside consultant would collect what each of 330 hospitals was paid the previous year in insurance reimbursement and patient contributions for five payers, accounting for nearly 70% of the state's HMO and PPO enrollment. The data would be crunched to produce cost and efficiency indexes.