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Will ACOs Face Tough Antitrust Scrutiny?

Posted on August 2, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

For some reason, I’ve always been interested in antitrust regulation, not just in the healthcare industry but across the board.

To me, there’s something fascinating about how federal agencies define markets, figure out what constitutes an unfair level of market dominance and decide which deals are out of bounds. For someone who’s not a lawyer, perhaps that’s a strange sort of geeking out to do, but there you have it.

Obviously, given how complex industry relationships are, healthcare relationships are fraught with antitrust issues to ponder. Lately, I’ve begun thinking about how antitrust regulators will look at large ACOs. And I’ve concluded that ACOs will be on the radar of the FTC and U.S. Department of Justice very soon, if they aren’t already.

On their face, ACOs try to dominate markets, so there’s plenty of potential for them to tip the scales too far in their favor for regulators to ignore. Their business model involves both vertical and horizontal integration, either of which could be seen as giving participants too much power.

Please take the following as a guide from an amateur who follows antitrust issues. Again, IANAL, but my understanding is as follows:

  • Vertical integration in healthcare glues together related entities that serve each other directly, such as health plans, hospitals, physician groups and skilled nursing facilities.
  • Horizontal integration connects mutually interested service providers, including competitors such as rival hospitals.

Even without being a legal whiz, it’s easy to understand why either of these ACO models might lead to (what the feds would see as) a machine that squeezes out uninvolved parties. The fact that these providers may share a single EMR could makes matters worse, as it makes the case that the parties can hoard data which binds patients to their network.

Regardless, it just makes sense that if a health plan builds an ACO network, cherry picking what it sees as the best providers, it’s unlikely that excluded providers will enjoy the same reimbursement health plan partners get. The excluded parties just won’t have as much clout.

Yes, it’s already the case that bigger providers may get either higher reimbursement or higher patient volume from insurers, but ACO business models could intensify the problem.

Meanwhile, if a bunch of competing hospitals or physician practices in a market decide to work together, it seems pretty unlikely that others could enter the market, expand their business or develop new service lines that compete with the ACO. Eventually, many patients would be forced to work with ACO providers. Their health plan will only pay for this market-dominant conglomerate.

Of course, these issues are probably being kicked around in legal circles. I’m equally confident that the ACOs, which can afford high-ticket legal advice, have looked at these concerns as well. But to my knowledge these questions aren’t popping up in the trade press, which suggests to me that they’re not a hot topic in non-legal circles.

Please note that I’m not taking a position here on whether antitrust regulation is fair or appropriate here. I’m just pointing out that if you’re part of an ACO, you may be more vulnerable to antitrust suits than you thought. Any entity which has the power to crush competition and set prices is a potential target.

Virtual Reality (VR) and Augmented Reality (AR) – #HITsm Chat Topic

Posted on June 13, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 6/16 at Noon ET (9 AM PT). This week’s chat will be hosted by Danielle Siarri (@innonurse) on the topic of “Virtual Reality (VR) and Augmented Reality (AR).”

As technology continues to evolve, the clinicians’ skill set will need to continue to keep up with the health tech evolution. Virtual reality actually stimulates our senses together in order to create the illusion of reality. Augmented reality (AR) is a blend of virtual reality (VR) and real life. AR users are able to interact with virtual contents in the real world and to distinguish between the two. A new term Mixed Reality is a hybrid reality that merges real and virtual worlds to produce new environments /visualizations where physical/digital objects co-exist then interact in real time. Currently VR and AR are being used to simulate and support medical and nursing training as well therapy for patients for anxiety and pain control.

Clinical practitioners are using VR prior to surgery instead of sedation. In Sweden, pharmacist are using VR for pain control. At a California hospital VR is being used for children with terminal cancer to “transport” them during long hospital and facilitate end of life care. Physiologist are using VR for agoraphobia and treating Post-Traumatic Stress Disorder (PTSD) to expose patients mentally without physically putting them in challenging environment.

Join us for the #HITsm chat for the topics of VR/AR in healthcare technology.

This Week’s Topics
T1: What are some ways you have seen VR/AR used to improve the patient’s experience? #HITsm

T2: What are some uses of Mix Reality that could be applied to clinical education? #HITsm

T3: What are implications of using 360 videos and VR with patients with limited mobility? #HITsm

T4: What are some of the future implication of AR, VR, MR in healthcare technology and why? #HITsm

T5: What are the barriers to implementing and widespread adoption of VR/AR into practice? #HITsm

Bonus: What efforts are in place to improve the divide in education and digital health literacy with VR/AR? #HITsm

Upcoming #HITsm Chat Schedule
6/23 – Clinical Intelligence
Hosted by Megan Janas (@TextraHealth)

6/30 – EHR Optimization
Hosted by Max Stroud (@MMaxwellStroud), Justin Campbell (@tjustincampbell), and Julie Champagne (@JulieEChampagne)

We look forward to learning from the #HITsm community! As always let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

Health System & Health Plan Innovation, Change & Growth During Uncertain Times – #HITsm Chat Topic

Posted on June 7, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 6/9 at Noon ET (9 AM PT). This week’s chat will be hosted by @HCExecGroup, @_GWConnect and @_GuideWell as part of #AHIPInstitute on the topic of “Health System & Health Plan Innovation, Change & Growth During Uncertain Times.”

Major forces of change – including consumerism, value-based care, risk-sharing between health systems, providers and payers, the need to address health equity, and new market entrants – have ‘invaded’ healthcare in the United States over the past decade. Moreover, the Affordable Care Act, ongoing regulatory pressures and uncertainty resulting from healthcare reform efforts have further amplified the need for health systems, health plans, hospitals and healthcare providers to evaluate new business models and diversify their business; all while devising innovative ways to stay relevant and competitive in their markets as they improve health outcomes, lower costs & improve equity for all.

This chat will explore topics related to innovation and factors impacting how healthcare organizations change and grow during this uncertain time. Join us Friday, 6/9 at Noon ET (9 AM PT) for a lively discussion.

This Week’s Topics
T1: What specific ‘areas of opportunity’ must health plans/systems address to improve health outcomes, lower costs & improve equity? #HITsm

T2: What must health systems & health plans focus on over next 8 to 18 months regardless of health reform outcome? #HITsm

T3: Who’s most likely to disrupt healthcare: insiders or outsiders? And what barriers do each face – right now or in near future? #HITsm

T4: What technologies will do the most to move healthcare supply-side toward improving outcomes, lowering costs & enhancing equity? #HITsm

T5: Incentives drive innovation. How can they be aligned to meaningfully support innovation that improves outcomes & lowers costs? #HITsm

Bonus: What are examples of innovative healthcare programs, processes, people and organizations – U.S.-based or elsewhere? #HITsm

Upcoming #HITsm Chat Schedule
6/16 – Virtual Reality (VR) and Augmented Reality (AR)
Hosted by Danielle Siarri (@innonurse)

6/23 – Clinical Intelligence
Hosted by Megan Janas (@TextraHealth)

6/30 – EHR Optimization
Hosted by Max Stroud (@MMaxwellStroud), Justin Campbell (@tjustincampbell), and Julie Champagne (@JulieEChampagne)

We look forward to learning from the #HITsm community! As always let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.