Sebelius acknowledges tension between care coordination, antitrust laws

The Affordable Care Act's emphasis on coordinating and integrating healthcare can conflict with government antitrust efforts, U.S. Department of Health & Human Services Secretary Kathleen Sebelius said Monday.

"There is a tight balance between a coordinated care strategy and a monopoly," Sebelius said in comments at the Harvard School of Public Health, reported Reuters, a co-sponsor of the event.

That pressure is especially acute in smaller communities, where consolidation among limited numbers of providers can "astronomically" increase prices, she said, according to Reuters. Constant federal oversight of antitrust behavior "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 Affordable Care Act is really pushing hospitals to go," Melinda Hatton, general counsel for the American Hospital Association, told Reuters.

In fact, the tension between gaining efficiencies through provider collaboration and controlling prices in a less competitive healthcare market was the subject of a General Accounting Office report issued last month at the request of Congress.

GAO found healthcare stakeholders disagreed on the effectiveness of antitrust guidance as it related to provider collaboration in three main areas: clinical integration, exclusive collaborative arrangements, and the size and scope of collaborative arrangements considered exempt from antitrust scrutiny, known as safety zones.

Meanwhile, the Federal Trade Commission continues pursuing antitrust actions against healthcare mergers it deems anticompetitive and likely to increase healthcare prices. Last month, for example, the FTC sued to prevent Idaho's largest hospital group from acquiring the state's largest physician group.

To learn more:
- read the Reuters article
- here's the GAO report (.pdf)

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