Archive for February, 2013

Supreme Court Upholds FTC Disapproval of Hospital Merger

February 24, 2013 Leave a comment


From Akerman’s Health Law Rx Blog:


In a decision issued on February 19, 2013, the U.S. Supreme Court upheld the Federal Trade Commission’s efforts to prohibit a hospital merger which would substantially reduce competition.  Federal Trade Commission v. Phoebe Putney Health System, Inc. involved the acquisition by a public hospital in Georgia of the only other hospital in the county.  The FTC alleged that the transaction would substantially reduce competition in the market for acute care hospital services and sought to prohibit the transaction as being in violation of Federal antitrust laws.

The lower court dismissed the FTC’s claim, holding that, because the acquisition was effected pursuant to Georgia’s Hospital Authorities Law, the acquisition was immune from Federal antitrust law under the state action doctrine.  Under the state action doctrine, certain anti-competitive actions taken or authorized by state government or an agency of state government are immune from Federal antitrust prosecution.  The Georgia Hospital Authorities Law authorized political subdivisions of the state of Georgia to create hospital authorities as special purpose entities, with the power to acquire, lease and operate hospitals and other healthcare facilities.   The hospital system successfully argued in the lower court that the power to acquire hospitals granted to it by the Hospital Authorities Law immunized the acquisition of the competing hospital from Federal antitrust law under the state action doctrine.

The Supreme Court reversed the holding of the lower court, ruling that the state action doctrine protects anti-competitive behavior taken or authorized by state government only if the anti-competitive actions are undertaken pursuant to a “clearly articulated and affirmatively expressed” state policy to displace competition.  The Supreme Court found that, although the Georgia Hospital Authorities Law granted public hospital authorities the power to acquire hospitals, there was no evidence in the Law that the Georgia Legislature affirmatively contemplated granting hospital authorities the power to substantially reduce or displace competition for hospital services in a particular market.

From a healthcare policy perspective, the case demonstrates support for competition among providers as a positive value that should be protected, absent a very specific indication of state intent to limit competition.  From a more general jurisprudential perspective, the case is a surprising example of the Roberts Court, in a unanimous decision, limiting the authority of the states and supporting and expanding Federal antitrust powers.

Overcoming Obstacles to Better Health Care

February 24, 2013 Leave a comment

Transforming the American health care system could include offering safe harbor from malpractice suits for doctors who demonstrate high-quality care.  See on

Meaningful healthcare reform needs tort reform so that healthcare providers can spend less time (and less insurer’s money) on defensive medicine and more time (and arguably less insurer’s money) on preventive medicine and thereby achieve more accountable medicine.

Actually, Mr. Brill, Fixing Healthcare Is Kinda Simple | Wired Science |

February 24, 2013 Leave a comment

When you need health care, you enter not a market but a con game in which you’re first a guarantor and source of profit, and second a patient. Wired Science blogger David Dobbs explains why the government needs to step up.  See on

Patients have no clout in so-called market driven healthcare because of its fragmented delivery and billing systems.  Having insurance further mystifies the process and hides the information necessary to make market decisions. Something like a patients union is needed to equalize the playing field.  For now, Obamacare is all that patients have to give them some protection against the two Titans in healthcare who have all the market power.


Christensen, Flier and Vijayaraghavan: The Coming Failure of ‘Accountable Care’

February 24, 2013 Leave a comment

In The Wall Street Journal, Clayton Christensen, Jeffrey Flier and Vineeta Vijayaraghavan say that the Affordable Care Act’s updated versions of HMOs are based on flawed assumptions about doctor and patient behavior.  See on

Beware the nay sayers. ACOs and other accountable care measures can only succeed if there IS a change in physician behavior. Changing the way healthcare is done in this country is the basis (and only workable basis) for meaningful improvement in healthcare while controlling costs at the same time. No one ever thought it would be easy or quick.  

Primary care doctors becoming more involved in mental health care

February 24, 2013 Leave a comment

Don’t be surprised if your family doctor seems as interested in your brain as in your body. (RT @BeneficentGuild: Primary care doctors becoming more involved in mental health care – The Observer-Dispatch, Utica, N.Y.  See on

This is not a new situation.  The AMA reported on this trend in 2010, as resulting largely from increased focus on depressions and other mental health issues and the lack of psychiatrists for treatment.

Can we learn something from America – Accountable Care Organisations

February 24, 2013 Leave a comment

It has become de rigueur on the left to regard the US healthcare system as the very incarnation of evil and therefore a country from which nothing of value can be learned for improving our NHS.  This might be about to change. There is now growing interest in the notion of the ‘Accountable Care Organisation’ (ACO) – or as it is tending to be termed over here, the Accountable Integrated Care System.

The Accountable Care Organisation concept is gathering pace in the US following the 2010 Patient Protection and Affordable Care Act, which included a pilot programme to explore ACO structures and processes. Under the new law, an ACO would agree to manage all of the healthcare needs of a minimum of 5,000 Medicare beneficiaries for at least three years. The ACO can gain extra money through sharing savings (with Medicare) resulting from collaborative efforts to provide care cost-effectively. Stringent governance conditions must be met, along with transparency and quality performance – Medicare ACOs will report on 33 different quality metrics.

In his recent ‘Green Paper’ speech on future Labour Party health policy, Andy Burnham spoke of the need for  “one service co-ordinating all of one person’s needs“, with the district general hospital “evolving over time into an integrated care provider from home to hospital“. Indeed, he went on to say:

“If we look to the US the best providers are working on that highly integrated basis, co-ordinating physical, mental and social care from home to hospital. We have got to take the best of that approach and universalise it here.”   See on

From the Socialist Health Association of Scotland. I don’t want to think about the ramifications of having an important part of Obamacare endorsed by a socialist health organization. However, labels aside the ability to provide coordination of care in a private setting is a good thing, which is why ACOs are so critical to meaningful healthcare reform.


Your EHR needs a population health management system

February 24, 2013 Leave a comment

Office-based medical practice is changing fast. The government is providing incentives to those practices that use electronic prescribing and electronic records systems and will soon penalize those that don’t. Health reform will shortly deliver many newly insured patients to your office. A host of new patient care models aimed at making healthcare more team-based are emerging. Reimbursement tied to outcomes will demand a greater level of patient management and engagement in the care process.

Often, though, an EHR alone cannot provide the functionality necessary to manage a specific population of patients.

There are many reasons a practice may need to identify and proactively work with a defined group of patients. Primarily, it’s to insure they are receiving care according to the evidenced-based standards agreed upon by the practice.  See on

Many physicians are re-evaluating their first choice of EHR and are changing to others as they learn how they work and what is needed for their medical practices.  This is just one more instanceof making saure your EHR is robust enough to add new important components as the need develops.


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