How True Clinical Integration Of Hospitals And Physicians Is Impacted By The Federal Trade Commission Policy Statements

The Federal Trade Commission(FTC) was created in 1914. It was created to ensure that there were no businesses that were anticompetitive; meaning that there wasn’t one company or business that was creating a monopoly. The FTC has three main goals; they are to protect consumers, maintain competition, and advance performance. They protect the consumers by preventing fraud and making sure businesses are fair in the marketplace. They maintain competition by preventing companies from merging together and creating a monopoly. Finally, they advance performance by advancing the FTC’s performance through organizational, personal, and management excellence. The FTC is very beneficial, and although not everybody knows about it, as a consumer it helps with the economy of every American. Throughout the years since it was created, there has been more laws added that help keep businesses

“An Integrated Physician Model is the result of a series of partnership between hospitals and physician develop overtime” (Harrison, 2016). Primarily, it is a joint venture that has become many joint ventures. In addition, all of this joint ventures are connected through congruent goals, and that is to provide different level of care to all the patients. Integrated physician model also organizing themselves to improve the cost and quality by operating under a clinical guideline. This could include acute care hospital, home care, nursing homes, affiliated medical group, primary care clinics, employed physician and any independent medical groups.

FTC (federal trade commission) and its importance- being a part of antitrust law, FTC was enacted in 1914 and works hard to prevent unfair methods of health care practices or deceptive acts which disrupts the commerce and make competition healthy by which consumers are benefited from better innovative low cost care(1). FTC guides the participants in health care market ranging

Established in 1914, the Federal Trade Commission (FTC), is responsible for ensuring customer protection and preventing monopolistic activities by businesses. As an independent government agency, “The FTC protects consumers by stopping unfair, deceptive and fraudulent practices in the marketplace” (“What We Do,” 2013). This is done by inspecting individuals or corporations that violate laws, promoting new regulations for companies to follow and informing consumers of their rights and responsibilities. Another aspect that the FTC controls is promotion of competition, as “it benefits consumers by keeping the prices low and the quality and choice of goods and services high” (“What We Do,” 2013). Monopolies have not been a part of the US economic

Analyze the technology necessary to meet the federal mandated requirements that will affect the merged healthcare organizations in the given scenario.

The PHO served as a vehicle through which competing hospitals and physicians could bargain collectively with health plans to obtain higher fees for themselves. The owner PHOs, member hospitals, and member physicians canceled contracts with payors and informed them that the PHO would be the sole entity through which they would enter into payor contracts. To contract with the PHO, payors allegedly have had to accept the fixed physician fee schedule and fixed discount of no more than 10 percent off hospital list prices.

Preferred provider organizations offer flexibility in benefit design and allow patients flexibility to choose from a list of in-network providers for their care. Care provided in-network typically is discounted with out of network services resulting in higher out of pocket expenses to the patient (Hirth, Grazier, Chernew and Okeke, 2007). Clinically integrated networks are a more recently developed managed care structure. In this model, independent practitioners form a virtual network as a means of increasing capacity for contracting with payers of healthcare whether commercial insurance or for self-insured organizations. Physicians recognize advantages to collaborative contracting and the increase in coordinating care of patients through the network (Kaplan and Guest, 2012). Commercial insurance companies are looking to clinically integrated networks as another mechanism to control the costs of healthcare delivery. Accountable care organizations, as with clinically integrated networks, are fairly recent phenomenon with similar but more formalized characteristics. An accountable care organization is a structured network of healthcare entities which have united and are responsible for the health of an identified population. The accountable care organization shares the risk of meeting the health needs of

The issue that the hospital faces when a patient necessitates emergent care and is a participant of a managed care organization is the potential of not receiving payment or not being in compliance with EMTALA (Fedor & Perez, 2001). Initially, many hospitals faced many unpaid claims by managed care entities because of their inability to contact the provider for authorization for care (Fedor & Perez, 2001). CMS advised hospitals to negotiate with managed care organizations with future contracts to include a provision for authorization after the patient has received stabilizing treatment with the purpose of remaining compliant with EMTALA (Fedor & Perez, 2001). By modifying contractual agreements between managed care organizations, the hospital can provide emergent care appropriately and ensure that claims are paid by managed

The FTC is a bipartisan federal agency with a unique dual mission to protect consumers and promote competition. For one hundred years, our collegial and consensus-driven agency has championed the interests of American consumers. As we begin our second century, the FTC is dedicated to advancing consumer interests while encouraging innovation and competition in our dynamic economy.

of gag clauses in contracts amongst the MCOs and their providers. These clauses limit providers

In the hope of better coordinating the care of patients, improving quality and lowering costs, the ACA provides incentives for physicians and hospitals to work together in several ways, such as Accountable Care Organizations (ACO’s) or establishing bundled payments for episodes of care (Martin Gaynor, 2012 ) which has spurred consolidation (Becker, Gamble, & Rosin, 2015). Additionally, compliance with various federal programs such as Meaningful Use requires a significant investment in technology which can be fiscally challenging for smaller provider groups; driving acquisitions of these smaller entities by larger health systems. Other reasons cited by hospital administrators in the pursuit of consolidation is to ensure a steady stream of physician referrals (NPR, 2010), and to create economies of scale and increased efficiencies, the fruits of which result in reduced costs and therefore cheaper care for patients (ProMarket Writers, 2016). However, what most hospital

Joining Managed Care Organizations will basically have a tremendous effects both on the patient volume, staffing and financial stability of my clinic in the sense that since MCOs integrates the payment as

In the case, Phycor was a physician practice management (PPM) firm that focused on providing cost saving services while increasing revenue. Their goals included better negotiation with contracts between physicians and HMO’s and PPO’s (Burns, Bradley, & Weiner, 2011).Some key facts included was that the company offered disease management services and demand management to over 3 million individuals, including those of managed care organizations (Focus on Phycor’s, Inc., 1995). At one point, the company inquired millions of dollars and was able to invest in several companies. “Phycor was undeterred, but wanted to take advantage of the market conditions to gain competitive advantage” (Burns, et. al., 2011, p. 316). By the end of the century, things

These acquisitions typically involve the purchase of the services of multiple physicians through employment contracts, as well as the practice’s physical building and equipment. For Example, Northwestern Memorial

The CMS’s conclusion here based In the preamble to our Phase II rulemaking, they concluded that a non-competition provision may not be placed on a recruited physician. 69 Fed. Reg. 16094, 16096-97 (Mar. 26, 2004] Phase III rulemaking that non-competition provisions should not be categorically prohibited from recruitment arrangements. They also stated: Upon review of the comments, however, they were persuaded that categorically prohibiting physician practices from imposing non-compete provisions may have the unintended effect of making it more difficult for hospitals to recruit physicians.