Health Care thoughts: Policy Confusion
by Tom aka Rusty Rustbelt
Health Care: Policy Confusion
The Obama administrative, and especially the Department of Health and Human Services, is pushing the notion of accountable care organizations (ACOs) and similar innovative integration strategies to improve the cost-benefit ratio of health care services. This is integral to PPACA (“Obamacare.”)
ACOs and other integrated provider networks are to provide 1) better coordination of care and 2) lower cost, perhaps through a bundled payment system. The exact form of these organizations is still evolving.
http://en.wikipedia.org/wiki/Accountable_care_organization
The Federal Trade Commission appears to be preparing to hammer physicians and hospitals under the assumption ACOs and the like are anti-competitive. This is consistent with pre-PPACA enforcement policies. Reports and lawyer gossip say there is a tug-of-war between the two agencies, with the Justice Department being more sympathetic to the integration.
To be fair, the FTC is supposed to enforce the laws on the books, perhaps we need some clarification from Congress?
A little clarity would speed the integration and further the intent of PPACA, IMHO.
Well, the PPACA is every bit as much a statute on the books as the statutes under which the FTC operates. I assume though that the PPACA doesn’t specifically provide for ACOs, and that, instead, that’s something that HHS is trying to put into that agency’s regulations under the PPACA.
I don’t understand from your brief description of ACOs why it would matter that ACOs reduce competition if they succeed in improving the cost-benefit ratio of health care services. After all, isn’t that a key purpose of the PPACA AND of the FTC’s regulations (anti-trust law) promoting competition?
Or am I missing something obvious?
Well, the PPACA is every bit as much a statute on the books as the statutes under which the FTC operates. I assume though that the PPACA doesn’t specifically provide for ACOs, and that, instead, that’s something that HHS is trying to put into that agency’s regulations under the PPACA.
I don’t understand from your brief description of ACOs why it would matter that ACOs reduce competition if they succeed in improving the cost-benefit ratio of health care services. After all, isn’t that a key purpose of the PPACA AND of the FTC’s regulations (and anti-trust law) promoting competition?
Or am I missing something obvious?
Well, the PPACA is every bit as much a statute on the books as the statutes under which the FTC operates. I assume though that the PPACA doesn’t specifically provide for ACOs, and that, instead, that’s something that HHS is trying to put into that agency’s regulations under the PPACA.
I don’t understand from your brief description of ACOs why it would matter that ACOs reduce competition if they succeed in improving the cost-benefit ratio of health care services. After all, isn’t that a key purpose of the PPACA AND of the FTC’s regulations promoting competition?
Well, the PPACA is every bit as much a statute on the books as the statutes under which the FTC operates. I assume, though, that the PPACA doesn’t specifically provide for ACOs, and that, instead, that’s something that HHS is trying to put into that agency’s regulations under the PPACA.
I don’t understand from your brief description of ACOs why it would matter that ACOs reduce competition if they succeed in improving the cost-benefit ratio of health care services. After all, isn’t that a key purpose of the PPACA AND of the FTC’s regulations promoting competition?
Well, the PPACA is every bit as much a statute on the books as the statutes under which the FTC operates. I assume, though, that the PPACA doesn’t specifically provide for ACOs, and that, instead, that’s something that HHS is trying to put into that agency’s regulations under the PPACA.
I don’t understand from your brief description of ACOs why it would matter that ACOs reduce competition if they succeed in improving the cost-benefit ratio of health care services. After all, isn’t that a key purpose of the PPACA AND of the FTC’s regulations promoting competition?
Or am I missing something obvious?
PPACA does not specifically excuse ACOs from anti-competitive statutes and regulations.
So there are conflicting statutes, or at least statutes that are not in sync.
The act of integrating entities, depending on market share in a given area, could be seen as anti-competitive.
There’s a comma missing between “competition” and “if” in the sentence in my post that reads: “I don’t understand from your brief description of ACOs why it would matter that ACOs reduce competition if they succeed in improving the cost-benefit ratio of health care services.” What I was trying to say is that as long as the ACOs do improve the cost-benefit ratio of health care services, why should it matter that competition is reduced?
But you’re right, of course, that as long as the PPACA doesn’t exempt the ACO from statutes and regulations—especially antitrust statutes—that limit the integrating of entities, it matters as a matter of law, if not as a matter of economics. Which was your point.
Changing FTC regulations shouldn’t be a problem as long as Obama’s reelected. But I doubt that Congress would change the antitrust statutes in order to allow ACOs. The Republicans wouldn’t allow it. Which in a way is interesting, because it wasn’t very long ago that a big part of the Republican legal agenda was to undermine antitrust law.
There’s a comma missing between “competition” and “if” in the sentence in my post that reads: “I don’t understand from your brief description of ACOs why it would matter that ACOs reduce competition if they succeed in improving the cost-benefit ratio of health care services.” What I was trying to say is that as long as the ACOs do improve the cost-benefit ratio of health care services, why should it matter that competition is reduced?
But you’re right, of course, that as long as the PPACA doesn’t exempt the ACOs from statutes and regulations—especially antitrust statutes—that limit the integrating of entities, it matters as a matter of law, if not as a matter of economics. Which was your point.
Changing FTC regulations shouldn’t be a problem as long as Obama’s reelected. But I doubt that Congress would change the antitrust statutes in order to allow ACOs. The Republicans wouldn’t allow it. Which in a way is interesting, because it wasn’t very long ago that a big part of the Republican legal agenda was to undermine antitrust law.
There’s a comma missing between “competition” and “if” in the sentence in my post that reads: “I don’t understand from your brief description of ACOs why it would matter that ACOs reduce competition if they succeed in improving the cost-benefit ratio of health care services.” What I was trying to say is that as long as the ACOs do improve the cost-benefit ratio of health care services, why should it matter that competition is reduced?
But you’re right, of course, that as long as the PPACA doesn’t exempt the ACOs from antitrust statutes and FTC regulations—especially antitrust statutes—that limit the integrating of entities, it matters as a matter of law, if not as a matter of economics. Which was your point.
Changing FTC regulations shouldn’t be a problem as long as Obama’s reelected. But I doubt that Congress would change the antitrust statutes in order to allow ACOs. The Republicans wouldn’t allow it. Which in a way is interesting, because it wasn’t very long ago that a big part of the Republican legal agenda was to undermine antitrust law.
There’s a comma missing between “competition” and “if” in the sentence in my post that reads: “I don’t understand from your brief description of ACOs why it would matter that ACOs reduce competition if they succeed in improving the cost-benefit ratio of health care services.” What I was trying to say is that as long as the ACOs do improve the cost-benefit ratio of health care services, why should it matter that competition is reduced?
But you’re right, of course, that as long as the PPACA doesn’t exempt the ACOs from the antitrust statutes and FTC regulations—especially antitrust statutes—that limit the integrating of entities, it matters as a matter of law, if not as a matter of economics. Which was your point.
Changing FTC regulations shouldn’t be a problem as long as Obama’s reelected. But I doubt that Congress would change the antitrust statutes in order to allow ACOs. The Republicans wouldn’t allow it. Which in a way is interesting, because it wasn’t very long ago that a big part of the Republican legal agenda was to undermine antitrust law.
“perhaps we need some clarification from Congress?”
I wish for a Pony too.
Rusty, Your comments and posts on health care are appreciated. Good to hear from someone in the front line trenches taking incoming. Keep up the good work.
Thanks.
from Modern Healthcare today
Lawmakers urge FTC, Justice to monitor ACOs
Eight Democratic senators urged the Justice Department and the Federal Trade Commission to jointly regulate accountable care organizations, a payment model under development by Medicare and in the private market. “Background in all relevant industries—including the hospital, provider and payer arenas—is essential,” according to the letter, which noted the two agencies have historically shared healthcare antitrust enforcement. “The model of shared jurisdiction has served healthcare consumers well for decades.”
In October, FTC Chairman Jon Leibowitz said the two enforcement agencies had plans to create a “safe harbor” for accountable care networks, loosely defined as groups of providers that manage care and are eligible for financial bonuses based on quality and cost control. An FTC spokesman said no date has been set for the release of ACO guidance.
If a Republican wins the White House in 2012, those regulations could be rescinded before the main parts of the Act even take effect. Then again, if a Republican wins the White House in 2012, the entire Act could be repealed, depending on the makeup of the Senate and whether enough Dems go along.
I expect, though, that by 2012, the PPACA will have popular support.