AHIP wants closer scrutiny of ACO arrangements

Commercial insurers say the proposed antitrust regulations for accountable care organizations don't go far enough in subjecting healthcare providers to market-competition reviews, given the significant risks that more cooperation among providers will lead to higher prices and lower quality of care.

In contrast to critics from hospitals who say the proposed rules are overly onerous, the insurance industry trade group America's Health Insurance Plans submitted a 22-page comment letter (PDF) to federal regulators saying the rules could create loopholes in which hospitals and physician groups could escape scrutiny.

Two attorneys for AHIP wrote that the formation of ACOs would likely lead to further market consolidation among healthcare providers, even though academic studies have shown that larger healthcare systems command market power that allows them to charge higher prices and removes incentives to improve patient care.

AHIP's comments came in response to draft antitrust regulations jointly published by the Justice Department and the Federal Trade Commission, which propose, among other ideas, to subject ACOs to mandatory antitrust review if they include 50% of more the market. The rules also propose that ACOs with less than 30% market share be considered in a “safety zone” and exempt from such scrutiny.