The Federal Trade Commission (FTC) has published a notice explaining how it may go about applying antitrust rules to the new Medicare accountable care organizations (ACOs).
The FTC, which has developed the notice together with the antitrust division of the U.S. Justice Department, says it and the Justice Department will apply a “rule of reason” when financial or clinical integration arrangements appear to be good for the overall level of competition, rather than bad.
Arrangements that are acceptable in the Medicare ACO program will also be acceptable in the commercial ACO market, officials say.
An ACO is supposed to be a vehicle for paying teams of health care providers to provide and manage care for whole patients, instead of paying for care one service at a time.
Section 3022 of the Patient Protection and Affordable Care Act (PPACA) requires Medicare to set up a Medicare Shared Savings Program that will promote use of Medicare ACOs starting in 2012.
Commercial insurers have been experimenting with their own ACO programs, and some policymakers say the Medicare ACO program may encourage expansion of the commercial ACO efforts.
Medical societies have argued that health insurer concentration helps insurers dominate physicians in an unfair way.
Health insurers traditionally have said that they need substantial market clout to bargain
for reasonable prices from physicians and hospitals. They have expressed concerns that poorly structured ACO programs could lead to higher health care prices rather than lower prices.