The Source Blog

The TakeAway On March 25, 2015, a federal district court in Illinois denied dominant provider OSF Healthcare System’s motion for judgment on the pleadings (reviewed under same standard as a motion to dismiss) in an antitrust suit filed against OSF by rival Methodist Health Services Corporation. The upshot of the opinion is that the court allowed Methodist to proceed with a product market definition that includes medical services sold to commercial health insurers, but expressly excludes the same services sold to government payers. This case importantly varies from some recent precedent …

The FTC appears to be on a roll. On February 25, 2015, the U.S. Supreme Court affirmed the Fourth Circuit’s upholding of the Commission’s administrative ruling that the North Carolina State Board of Dental Examiners (“Board”) had illegally restrained trade under the FTC Act by forcing nondentists to cease offering teeth whitening services in that state. The underlying facts were that nondentists had been offering teeth whitening services for lower prices than were licensed dentists. In response to complaints from dentists, the Board took action to exclude nondentists from the …

Last month, a three-judge Ninth Circuit panel in Portland heard arguments in the appeal of Saint Alphonsus Medical Center, et al v. St. Luke’s Health System, LTD, et al. Watch the video of the hearing. The Ninth Circuit In the arguments, counsel for the appellants focused on the benefits that the acquisition, which was stayed pending appeal, would bring to the community. Jack Beirig of Sidley Austin, who argued the case for St. Luke’s, opened by claiming that the district court had not considered the deals’ potential benefits, and assertion contested by the panel, …

The political fight over Proposition 45 is getting heated as we close in on election day in California. The measure, which would give the Insurance Commissioner greater oversight of health insurance rate increases, was in the spotlight on Wednesday when California Insurance Commissioner Dave Jones publicly criticized health plan Anthem Blue Cross’ rate increase for 120,000 policy holders of small business coverage as “excessive.” Pro-Prop 45 advocates used the Commissioner’s statement as an example of why greater oversight is needed, while opponents claimed the remarks only highlighted the danger of making insurance rates …

The National Academy for Social Insurance and Catalyst for Payment Reform have released a new report entitled “State Policies on Provider Market Power,” that examines common threads among states’ laws in addressing healthcare competition. The Source collaborated with CPR on the underlying research for this important report.

The Overview Last month, a California appeals court struck a blow to hospitals’ charging the rates included in their chargemasters in non-contract situations. Children’s Hospital of California sued Blue Cross of California, demanding that the insurer pay the full chargemaster rates for services rendered outside of a contract. Blue Cross claimed that, under California regulations governing claims settlements, it only owed the Hospital the reasonable value of the services, which it calculated as rate paid by the government. In 2012 the lower court in Madera County agreed with the Hospital …

The Source has been following Sidibe v. Sutter Health, a putative class action filed in federal court in San Francisco in September 2012, wondering whether it would affect the way hospitals contract with health plans in California and elsewhere. The plaintiffs in the case alleged that Sutter used provisions in its contracts with health plans to create healthcare monopolies and charge above-market prices, which were passed on by the plans to consumers. Seven months after the case was refiled for the second time, on Friday, June 20, the federal district …

The Source scans a number of the nation’s major newspapers and other online publications to bring you the most relevant media coverage of issues related to healthcare cost and competition. You can find the news you are looking for in a variety of ways: find the most recent news articles by looking at the home page. Or, go directly to the News page to find more articles in chronological order. If you prefer to search by issue, head to the Key Issues page to find news related to healthcare costs, healthcare markets, price …

As the “laboratories of democracy,” the states play a major role in creating new laws and shaping public policy on important issues, including those related to healthcare costs and competition.  Our Legislation/Regulation page provides various ways to research and track recent happenings in the legislative and regulatory arena. Our state-by-state map displays new regulatory and legislative developments, and these developments can be further explored by viewing the documents below the map, which are organized by topic, including by specific type of statute. Also, The Source Blog will take you through …

In this inaugural Academic Articles and Reports Roundup, we highlight some of the most relevant academic articles and reports on healthcare cost and competition published since January 2014. Going forward, we will publish a Roundup each month to highlight the “must read” articles and reports from that month. The Academic Articles and Reports pages on the site also have links to relevant articles and reports dating back to January 2013.  Academic Articles   In this issue of the Academic Roundup, we first highlight two health services research articles and one …