Electronic Health Records


Sebelius: Care coordination can easily turn into a monopoly

By Jennifer Bresnick

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius warned providers on Monday that coordination of care and consolidation of services can easily cross the line to a monopoly on healthcare, driving up prices and leaving patients with few options.  In a speech at the Harvard School of Public Health, Sebelius noted that the provisions of the Affordable Care Act (ACA) are in “constant tension” with antitrust laws.

As independent physicians increasingly join larger healthcare organizations in order to reduce the financial burden of EHR adoption and meaningful use, hospitals and other business partnerships are creating large conglomerates that may control a huge percentage of the healthcare options in any given location – and may control the pricing of services to an unacceptable degree.  “There is a tight balance between a coordinated care strategy and a monopoly,” Sebelius said, recommending that federal agencies should keep a close eye on such systems.  “Having that constant oversight is really appropriate,” she added.

“It’s great to know that the Secretary of Health and Human Services recognizes that it’s a real abiding tension between what the antitrust laws allow and where the ACA is really pushing hospitals to go,” commented Melinda Hatton, general counsel for the American Hospital Association (AHA).  The goals of the ACA include the adoption of expensive EHR and HIE technologies, the streamlining of patient care through reduced redundancies, better coordination, and the lowering of healthcare costs.

Hospitals feel that they need business partners to spread the costs around, but they risk rubbing up against anti-trust and anti-kickback laws designed to protect those consumers they’re trying to help.  The AHA has asked federal agencies to provide better guidance on how they can achieve their goals without running afoul of Federal Trade Commission statutes.

“I don’t see a fundamental tension between the goals of promoting efficiencies and promoting competition,” said Richard Feinstein, Director of the FTC’s Bureau of Competition. “There are many circumstances where integration, collaboration, and consolidation can be pro-competitive, but it depends on the circumstances of the market.”  That market is in a state of flux at the moment, as physicians are forced to sacrifice their clinical autonomy for the bottom line, which is making some independent practitioners abandon the field years before they had planned to retire and warn potential medical students away from the industry.

“The majority of new physician grads recently recruited here desire large group employment rather than private practice. Currently practicing physicians are prodded into ever larger groups to spread the pains of contract negotiation, quality reporting, EHR, ICD-10, and progressive governmental control of office practice via hold-backs, bundling, re-admissions denials, SGR, sequester, and mandated care,” lamented a physician responding anonymously to a recent poll. “Unable to find my own replacement, I contributed to the physician shortage by retiring from patient care. Likely others are doing likewise, retiring earlier than planned.”





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