The performance audit—requested by Senate Finance Committee Chairman Max Baucus (D-Mont.) and seven other Democratic senators—examined the current state of federal antitrust policy to determine whether policies were harming providers' efforts to collaborate and reduce fragmentation in the delivery system.
First, the report said some experts and stakeholders wanted more clarity on defining ways that clinical integration can be used to demonstrate pre-competitive effects that can offset potential anti-competitive effects of a collaboration.
Second, the report found that experts inside and outside the healthcare provide industry were divided on whether the Federal Trade Commission and the Justice Department, which enforce the antitrust laws, should allow greater use of exclusive collaborative arrangements. Such arrangements can either improve competition or limit it, depending on the market, the report said.
And finally, the GAO found that experts disagreed on whether regulators ought to expand the 1996-era “safety zones” for collaborative arrangements between providers that are exempt from antitrust analysis.
“One of these groups stated that it was necessary to include a broad range of clinically integrated providers—including hospitals, primary-care physicians and specialists—to develop a collaborative arrangement that was effective at reducing costs and improving quality,” the study said, citing a comment from an unidentified industry stakeholder group. “However, this group noted that providers were reluctant to develop such arrangements because of the lack of a safety zone for clinically integrated or multi-provider arrangements.”
On each of the issues identified by the GAO as being controversial, the auditors said the federal regulators reported that their policies were already well-defined and broad enough to meet the market's current demands.