Just watch us

FTC should al­low merg­ers that fur­ther re­form’s goals, with mon­i­tor­ing for ill ef­fects

Modern Healthcare - - Opinions Commentary -

The Fed­eral Trade Com­mis­sion’s an­titrust chal­lenge of ProMed­ica’s join­der agree­ment with St. Luke’s Hos­pi­tal in Maumee, Ohio, will have a neg­a­tive im­pact on health­care or­ga­ni­za­tions na­tion­wide as they eval­u­ate how best to pro­ceed with con­sol­i­da­tion and col­lab­o­ra­tion, in an era of un­cer­tainty and change in health­care. Just weeks af­ter the FTC was granted a pre­lim­i­nary in­junc­tion in the ProMed­ica legal ac­tion, the FTC filed a sim­i­lar ac­tion against an­other health­care or­ga­ni­za­tion in Al­bany, Ga.

We’re at the dawn of a new day in how health­care is to be de­liv­ered in this coun­try. Reg­u­la­tory agen­cies such as the FTC would bet­ter serve the coun­try’s cit­i­zens by keep­ing pace and adapt­ing to re­flect the new health­care en­vi­ron­ment. In­stead, the agency has de­vel­oped a short and swift an­swer of “no” to many of us who are at­tempt­ing to de­velop a model that bet­ter meets the needs of this new day— pre­fer­ring that health­care or­ga­ni­za­tions spend po­ten­tially hun­dreds of mil­lions of dol­lars un­nec­es­sar­ily on bricks and mor­tar that could other­wise be used to meet the health­care needs in their com­mu­ni­ties. With so much at stake, “no” should not be an op­tion.

Health­care or­ga­ni­za­tions in mid­sized com­mu­ni­ties the size of Toledo, Ohio, where there are fewer com­peti­tors, will likely be­gin to re­sist po­ten­tial col­lab­o­ra­tion or merg­ers—no mat­ter how ben­e­fi­cial it would be to the com­mu­nity— be­cause a merger of two com­peti­tors in com­mu­ni­ties of this size will be vir­tu­ally cer­tain to cre­ate a “pre­sump­tively un­law­ful” vi­o­la­tion— ac­cord­ing to the FTC. Add to this the very chal­leng­ing stan­dards that the merg­ing en­ti­ties would need to meet to re­but the FTC’s claims, and the im­pact on fu­ture hos­pi­tal and health sys­tem merg­ers could be sti­fling.

Col­lab­o­ra­tion is key—to­day and to­mor­row. At a re­cent an­nual meet­ing of the Amer­i­can Hos­pi­tal As­so­ci­a­tion, Dr. Don­ald Ber­wick, CMS ad­min­is­tra­tor, stated that Phase I of the Pa­tient Pro­tec­tion and Affordable Care Act re­lated to the moral chal­lenge of cre­at­ing a cov­er­age mech­a­nism to en­sure Amer­i­cans can re­ceive health in­surance. He added that this con­nec­tion alone can­not re­solve the health­care is­sues in this coun­try.

We agree with Ber­wick that col­lab­o­ra­tion, in­no­va­tion and part­ner­ship are cru­cial to achiev­ing the long-term sus­tain­abil­ity of the three fun­da­men­tal aims of the CMS as it

The FTC should al­low the col­lab­o­ra­tion with St. Luke’s to pro­ceed with reg­u­la­tory over­sight.

en­ters phase II: Bet­ter health, bet­ter care and lower cost through im­prove­ment.

We are ex­pe­ri­enc­ing—and will con­tinue to ex­pe­ri­ence—rad­i­cal change in health­care. At the cen­ter of that change is col­lab­o­ra­tion among health­care or­ga­ni­za­tions and clin­i­cal in­te­gra­tion. Clin­i­cal in­te­gra­tion is the key to en­sur­ing that pa­tients re­ceive the best care, at the right time, in the right lo­ca­tion from all of their providers. And that re­quires in­tense col­lab­o­ra­tion and part­ner­ships among hos­pi­tals, doc­tors, nurses and other care­givers. Un­for­tu­nately, the re­cent ag­gres­sive ac­tions by the FTC will dull any ap­petite by health­care or­ga­ni­za­tions to work to­gether for fear of a heavy­handed re­ac­tion to any po­ten­tial merger.

In this new health­care en­vi­ron­ment, achiev­ing greater de­grees of clin­i­cal in­te­gra­tion is crit­i­cal to achiev­ing bet­ter pa­tient out­comes. It does that by de­liv­er­ing higher qual­ity care, and by mak­ing the med­i­cal sys­tem less ex­pen­sive, more efficient and eas­ier to nav­i­gate for pa­tients and providers.

Hos­pi­tals in com­mu­ni­ties across the coun­try are try­ing to cre­ate these types of part­ner­ships. But out­dated reg­u­la­tory bar­ri­ers, in­clud­ing con­fus­ing and sti­fling an­titrust poli­cies that fail to rec­og­nize the chang­ing com­pet­i­tive dy­namic in the mar­ket for health­care ser­vices, stand in the way.

It is not log­i­cal for the gov­ern­ment to ex­pect health­care or­ga­ni­za­tions to achieve rad­i­cal change with­out re­mov­ing bar­ri­ers. Achiev­ing the CMS’ fun­da­men­tal aims of bet- ter health, bet­ter care and lower costs will re­quire in­no­va­tive ap­proaches. Out­dated reg­u­la­tory bar­ri­ers are in­con­sis­tent with cur­rent and fu­ture de­mands in health­care—and could re­sult in or­ga­ni­za­tions need­ing to re­duce ser­vices. It is im­per­a­tive that reg­u­la­tory agen­cies such as the FTC seek new and in­no­va­tive ap­proaches that al­low new ideas to move for­ward with nec­es­sary con­straints.

There are so­lu­tions. For ex­am­ple, Christine Var­ney, as­sis­tant at­tor­ney gen­eral of the an­titrust divi­sion for the U.S. Jus­tice Depart­ment, has ac­knowl­edged the po­ten­tial for a new ap­proach to eval­u­at­ing merg­ers. This ap­proach would not be an un­equiv­o­cal “yes” or “no” to a merger, but a will­ing­ness to com­pro­mise and al­low an or­ga­ni­za­tion to part­ner in the best in­ter­ests of the com­mu­nity, with con­straints against cer­tain ef­fects with reg­u­la­tory over­sight in the courts.

With this idea in mind, ProMed­ica be­lieves the FTC should con­sider a com­mu­nity com­mit­ment agree­ment that will al­low the join­der with St. Luke’s to con­tinue with ap­pro­pri­ate safe­guards and reg­u­la­tory over­sight. This ap­proach would en­able the com­bined or­ga­ni­za­tions to in­te­grate in ways that will achieve the CMS goals while still pro­tect­ing the pub­lic in­ter­est. It is an ap­proach that could serve as a model for other com­mu­ni­ties na­tion­wide and de­serves strong con­sid­er­a­tion ver­sus sti­fling op­po­si­tion.

There are many ben­e­fits for the com­mu­nity from col­lab­o­ra­tion be­tween or­ga­ni­za­tions such as ProMed­ica and St. Luke’s, yet the FTC con­tin­ues to use out­dated stan­dards that no longer ap­ply in this next gen­er­a­tion of health­care. The re­sult of its legal ac­tion fore­casts a chill­ing fu­ture for col­lab­o­ra­tion in the na­tional health­care com­mu­nity. On the other hand, a will­ing­ness by the FTC to take a new ap­proach in how it eval­u­ates merg­ers could go a long way to achiev­ing that new, brighter day in health­care.

Randy Oos­tra is pres­i­dent and CEO of ProMed­ica, Toledo, Ohio.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.