Integrated Health in Limbo After U.S. District Court Decision

by Snell & Wilmer
Contact

In January, a U.S. District Court judge for the District of Idaho ordered St. Luke’s Health System Ltd. (St. Luke’s) to unwind a recent acquisition of a physician group because the deal violated federal and state antitrust laws. St. Luke’s claimed objective in acquiring Saltzer Medical Group (Saltzer) was to address the many problems—principally, the extraordinary cost of the fee-for-service reimbursement system—in the Nampa, Idaho healthcare market; however, the court found that the acquisition would ultimately lead to higher healthcare costs and a reduction in healthcare options.

The ruling represents the first time a federal court has struck down a hospital’s integrated health defense for antitrust reasons. In an integrated health system, primary care physicians and specialists work together to reduce waste by coordinating patients’ care so that nothing falls through the cracks. Oftentimes, integrated health is a central feature of accountable care organizations, which similarly aim to reduce the total cost of healthcare by assuming responsibility over the quality, effectiveness and efficiency of healthcare provided to patients.

The St. Luke’s acquisition specifically sought to enhance the ability of St. Luke’s to offer coordinated, patient-centered care; support physicians in an environment that rewards value of care rather than volume of care; and accept risk and accountability for patients’ outcomes. In doing so, St. Luke’s claimed that healthcare costs would decline and the quality of healthcare would improve, creating efficiencies that would far outweigh any anticompetitive effects. The court disagreed, however, stating that St. Luke’s did not present evidence of extraordinary efficiencies necessary to overcome the anticompetitive effects of market concentration.

The court based its decision on several anticompetitive indicators common in antitrust analysis. First, the court analyzed whether the acquisition would result in at least a small but significant, non-transitory increase in price and found that a price hike would not prompt consumers to travel to adjacent areas to take advantage of lower prices, thereby allowing St. Luke’s to profitably impose price increases in the market.

Next, the court analyzed the acquisition’s effect on market concentration. Compared to benchmark indices, the merger between St. Luke’s and Saltzer resulted in extreme market concentration by merging close substitutes, which reduced competition and consumers’ ability to choose between healthcare providers.

Finally, the court found that the acquisition would lead to a substantial increase in St. Luke’s bargaining power with health insurers and allow it to demand higher reimbursement rates, which would ultimately be passed on to consumers in the form of increased insurance premiums. What is more, the court determined that it was likely that St. Luke’s would exercise its enhanced bargaining power to charge more services at higher hospital billing rates, as opposed to physician group rates.

The district court’s decision puts similar integrated health acquisitions in jeopardy of also being struck down. Hospitals and physician groups will have to carefully navigate federal and state antitrust regulations to avoid a similar fate.

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.

© Snell & Wilmer | Attorney Advertising

Written by:

Snell & Wilmer
Contact
more
less

Snell & Wilmer on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Privacy Policy (Updated: October 8, 2015):
hide

JD Supra provides users with access to its legal industry publishing services (the "Service") through its website (the "Website") as well as through other sources. Our policies with regard to data collection and use of personal information of users of the Service, regardless of the manner in which users access the Service, and visitors to the Website are set forth in this statement ("Policy"). By using the Service, you signify your acceptance of this Policy.

Information Collection and Use by JD Supra

JD Supra collects users' names, companies, titles, e-mail address and industry. JD Supra also tracks the pages that users visit, logs IP addresses and aggregates non-personally identifiable user data and browser type. This data is gathered using cookies and other technologies.

The information and data collected is used to authenticate users and to send notifications relating to the Service, including email alerts to which users have subscribed; to manage the Service and Website, to improve the Service and to customize the user's experience. This information is also provided to the authors of the content to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

JD Supra does not sell, rent or otherwise provide your details to third parties, other than to the authors of the content on JD Supra.

If you prefer not to enable cookies, you may change your browser settings to disable cookies; however, please note that rejecting cookies while visiting the Website may result in certain parts of the Website not operating correctly or as efficiently as if cookies were allowed.

Email Choice/Opt-out

Users who opt in to receive emails may choose to no longer receive e-mail updates and newsletters by selecting the "opt-out of future email" option in the email they receive from JD Supra or in their JD Supra account management screen.

Security

JD Supra takes reasonable precautions to insure that user information is kept private. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. However, please note that no method of transmitting or storing data is completely secure and we cannot guarantee the security of user information. Unauthorized entry or use, hardware or software failure, and other factors may compromise the security of user information at any time.

If you have reason to believe that your interaction with us is no longer secure, you must immediately notify us of the problem by contacting us at info@jdsupra.com. In the unlikely event that we believe that the security of your user information in our possession or control may have been compromised, we may seek to notify you of that development and, if so, will endeavor to do so as promptly as practicable under the circumstances.

Sharing and Disclosure of Information JD Supra Collects

Except as otherwise described in this privacy statement, JD Supra will not disclose personal information to any third party unless we believe that disclosure is necessary to: (1) comply with applicable laws; (2) respond to governmental inquiries or requests; (3) comply with valid legal process; (4) protect the rights, privacy, safety or property of JD Supra, users of the Service, Website visitors or the public; (5) permit us to pursue available remedies or limit the damages that we may sustain; and (6) enforce our Terms & Conditions of Use.

In the event there is a change in the corporate structure of JD Supra such as, but not limited to, merger, consolidation, sale, liquidation or transfer of substantial assets, JD Supra may, in its sole discretion, transfer, sell or assign information collected on and through the Service to one or more affiliated or unaffiliated third parties.

Links to Other Websites

This Website and the Service may contain links to other websites. The operator of such other websites may collect information about you, including through cookies or other technologies. If you are using the Service through the Website and link to another site, you will leave the Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We shall have no responsibility or liability for your visitation to, and the data collection and use practices of, such other sites. This Policy applies solely to the information collected in connection with your use of this Website and does not apply to any practices conducted offline or in connection with any other websites.

Changes in Our Privacy Policy

We reserve the right to change this Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our privacy policy will become effective upon posting of the revised policy on the Website. By continuing to use the Service or Website following such changes, you will be deemed to have agreed to such changes. If you do not agree with the terms of this Policy, as it may be amended from time to time, in whole or part, please do not continue using the Service or the Website.

Contacting JD Supra

If you have any questions about this privacy statement, the practices of this site, your dealings with this Web site, or if you would like to change any of the information you have provided to us, please contact us at: info@jdsupra.com.

- hide
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.
Feedback? Tell us what you think of the new jdsupra.com!