Managed care competition and the antitrust laws. U.S. Healthcare, Inc. v. Healthsource, Inc.
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The occasional imposition of antitrust liability on medical staff members for actions involving peer review is not a sufficient reason to abandon medical staff participation in the peer review process. This article reviews some of the case law in which the applicability of the intracorporate conspiracy doctrine to medical staff peer review activity has been decided and explains why appropriate medical staff involvement in such activity does not raise the risk of antitrust liability.
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Hospital members of group purchasing organizations should ensure that their GPO's business practices do not restrain trade. Hospitals should monitor their GPO to minimize their antitrust exposure. GPOs and their hospital members should assess administrative fees, bundling arrangements, duration of contracts with suppliers, and product-breakthrough policies in relation to their impact on competition and product innovation. GPOs and their hospital members should closely monitor activities of federal and state antitrust agencies in light of the agencies' renewed antitrust concerns.
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As physicians explore areas of diversification and networking that can position them favorably for the changing health-care environment, their fear of running afoul of antitrust legislation handicaps them. A basic understanding of the intent of antitrust legislation and its application to healthcare is essential to physicians' strategic planning. This article traces the development of antitrust legislation and the regulatory agencies charged with its oversight. The authors review the first application of this legislation to the professions; distinguish per se violations from the rule-of-reason process; and summarize recent attempts by the Department of Justice and the Federal Trade Commission to provide useful guidance to healthcare providers in the market revolution.
This article describes the types of medical staff credentialing and peer review activities that invite the scrutiny of the Federal Trade Commission. To avoid antitrust problems, medical staffs and their members are advised to offer recommendations based on specific quality-of-care concerns. Antitrust problems will arise, however, if the medical staff or its members engage in collective activities that involve threats or coercion directed at the hospital's governing board or that are calculated solely to exclude an entire class of potential competitors.
Nonradiologist health care providers have enjoyed the privilege of film interpretation without the assistance of radiologists. However, encroachment on the radiologist's turf of radiological image interpretation by nonradiologist physicians and radiographer technicians is reminiscent of recent antitrust battles between anesthesiologists and nurse anesthetists. Numerous antitrust issues are relevant to radiology; however, the scope of this article is limited to antitrust issues most relevant to radiology turf battles. Such battles often raise antitrust issues of group boycotts, tying arrangements, and exclusive contracts.
Physicians now find it relevant to acquaint themselves with aspects of the law which heretofore were mainly of concern to the business world. One such area is antitrust, which is beginning to affect the practice of radiology. Three phases of the problem are discussed: exclusive privileges contracts; boycotts of nonphysician consultations (i.e., with chiropractors and cultists); and certificate of need requirements for acquisition of highly technical, sophisticated and expensive equipment.