FTC Issues Favorable Clinical Integration Advisory Opinion to Norman, Oklahoma PHO

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Since the passage of the Affordable Care Act (ACA), much attention has been paid to the antitrust treatment of Accountable Care Organizations, provider ventures contemplated by the ACA that the Federal Trade Commission and Department of Justice have said are, essentially, clinically integrated organizations. Nothing new, however, was said about clinical integration, the major provider initiative of the 2000s that could provide a basis for joint contracting with third-party payers without the sharing of financial risk. On February 13, 2013, the FTC staff issued a favorable Advisory Opinion to the Norman [Oklahoma] Physician Hospital Organization allowing a contemplated clinical integration program to move forward.

The Norman PHO was founded in 1994 between the Norman Regional Health System and physicians who hold a medical staff appointment or clinical privileges at the System’s hospitals. It currently has approximately 280 participating physicians. The PHO has previously used a messenger model when dealing with payers, but now intends to transition to a clinically integrated approach with the expectation that they would jointly contract with payers.

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Topics:  Advisory Opinions, Affordable Care Act, Clinical Integration, FTC, Joint Contracting, Norman Physician Association, Physician Hospital Organizations, Rule-of-Reason Analysis

Published In: Antitrust & Trade Regulation Updates, Business Organization Updates, Health Updates

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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