ACOs bring together rivals

Anti-trust agencies still skeptical of accountable care
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With the newly announced accountable care organizations this month, ACOs are bringing together rival hospitals. With those partnerships, however, also come fears of a healthcare monopoly.

The U.S. Department of Health & Human Services announced 106 new ACOs, bringing the total to more than 250 since the 2010 Affordable Care Act passed. Among them is OneCare Vermont Accountable Care Organization, the nation's first statewide accountable care organization, the Associated Press reported. CareOne, which covers Vermont and New Hampshire, said on Friday that 42,000 of Vermont's 118,000 Medicare beneficiaries will receive care from the new entity.

"This is the first time that we've been able to arrange for so many hospitals, physicians and community-based healthcare services throughout the state to work together," Fletcher Allen Health Care President and CEO John Brumsted told the AP.

Although executives from Fletcher Allen Health Care and the Dartmouth Hitchcock Medical Center--two past rivals in the academic medical center market--touted the benefits of coordinated care for chronic condition patients, lawmakers raised eyebrows. They questioned whether it would create a healthcare monopoly in the area. Brumsted and John Butterly, Dartmouth's executive medical director, pointed out they are nonprofits.

Vermont's statewide ACO isn't the first that has brought together competing hospitals into one accountable care entity. Health Partners and Allina Hospitals and Clinics aligned in Minnesota to save $6 million.

Although encouraged by the ACA, ACOs are subject to review by federal anti-trust agencies that still worry collaboration teeters on anti-competiveness.

The Department of Justice and the Federal Trade Commission apply a "rule-of-reason" analysis to ACOs, in which the agencies conduct a cost-benefit analysis in weighing the anti-competitive effects of the ACO with the benefits of the ACO.

"ACOs could grow so large in some areas that they will have a monopoly on the healthcare system," Enterprise Counsel Group, a law firm in Irvine, Calif., wrote in a statement Thursday. "If any two companies work together to coordinate pricing or share confidential information, anti-trust concerns develop."

For more information:
- read the AP article
-  here's the ECG statement

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