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Clinical Integration, Market Consolidation, and Antitrust Enforcement

For a period of time, providers will be managing the difficult balance of being paid a mixture of fee-for-service and value-based payments.  Their ability to influence the pace of that change and stay balanced while investing for the future will determine their success.  Both change of control transactions and non-change of control transactions among providers are taking place in large numbers across the country.  The regulatory dialogue that has taken place around accountable care seeks to distinguish “good” collaboration from “bad” and relies heavily on clinical and financial integration as a basis for allowable transactions.  CMS’ definition of and requirements for ACOs align with the antitrust agencies’ historical thinking about clinical and financial integration, and, therefore the antitrust agencies have stated that they will accord rule of reason treatment to the commercial marketing activities of ACOs participating in the Medicare Shared Savings Program.  However, market share and market power concerns remain the subject of an ongoing national policy debate.

The articles and papers contained in this section are illustrative of and contribute to this important dialogue. Additional articles and papers are available in our Further Reading section.

  • Another Setback for State Regulatory Boards

    Federal Court Denies Texas Medical Board’s Motion to Dismiss Teladoc’s Antitrust Lawsuit

    Health Law Advisor Blog - January 8, 2016

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  • FTC Issues State Action Guidance for State Regulatory Boards

    On October 14, 2015, FTC issued guidance on how state regulatory boards can regulate their professions without running afoul of the antitrust laws.

    EBG Client Alert - December 3, 2015

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  • FTC Challenges Proposed Hospital Transaction in West Virginia

    Assurance of Voluntary Compliance with State’s Attorney General Is Insufficient to Stop Challenge

    EBG Client Alert - November 11, 2015

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  • FTC Issues First Statement of Enforcement Under Section 5 in 101 Years

    The Federal Trade Commission, by a 4-1 vote, approved a bipartisan “Statement of Enforcement Principles.” 

    EBG Client Alert - August 21, 2015

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  • Antitrust Enforcement Agencies Issue Joint Statement

    Encouraging Repeal of Virginia’s CON Program 

    Health Law Advisor Blog - March 15, 2016

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  • FTC and DOJ Hold Joint Workshop on Payment Models and Competition Within the Health Care Sector

    EBG Client Alert - April 14, 2015

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  • Competition In Health Care Markets

    Health Affairs Blog, Remarks by Julie Brill - January 22, 2015

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  • Illegal Premerger Coordination Leads to DOJ “Gun Jumping” – Enforcement Action and $5 Million Settlement

    EBG Client Alert - November 7, 2014
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  • FTC Wary of Mergers by Hospitals

    Written by Robert Pear - September 17, 2014
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  • The 125 Percent Solution: Fixing Variations In Health Care Prices

    Health Affairs Blog, Written by Jonathan Skinner, Elliott Fisher, and James Weinstein - August 26, 2014    
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  • States Side with FTC Against St. Luke’s Physician Deal

    Written by Beth Kutscher - August 22, 2014
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  • Considerations for ACOs in Consolidating Markets

    Remarks by Doug Hastings at the Fifth National Accountable Care Organization Summit - June 18, 2014
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  • How Much Market Power Do Hospitals Really Have?

    The Health Care Blog, Remarks by Jeff  Goldsmith - June 6, 2014
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  • Legal Perspectives on Trends in Capital Access

    Executive Interview by Jeni Williams, in HFM Magazine - June 2, 2014
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  • Competition Policy In Health Care Markets: Navigating The Enforcement And Policy Maze

    Written by Martin Gaynor - June 2014
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  • Getting The Product Right: How Competition Policy Can Improve Health Care Markets

    Written by William M. Sage - May 2014
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  • Seeking Lower Prices Where Providers Are Consolidated: An Examination Of Market And Policy Strategies

    Written by  Paul B. Ginsburg and L. Gregory Pawlson - May 2014
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  • Bending the Curve

    Person-Centered Health Care Reform: A Framework for Improving Care and Slowing Health Care Cost Growth - April 2013
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  • Further Reading

    Additional articles and papers from this section.

    Read More


EBG Advisors is affiliated with the law firm of Epstein Becker & Green, P.C., which has a health care and life sciences legal practice that is among the nation's largest.

NHA offers a broad range of specialized services for our clients, strategically focused on advocating and implementing public policy solutions for numerous sectors of the health care industry.