See case page: Sidibe v. Sutter Health   On August 24, the 9th Circuit Court of Appeals heard oral arguments in the appeal of the federal class action Sidibe v. Sutter Health. A jury verdict in March 2022 in the Northern District Court of California had cleared the hospital giant of anticompetitive allegations that were initially filed over a decade ago. The alleged practices were also at issue in the case filed in state court by a labor union that was later joined by the attorney general, UEBT v. Sutter Health. …

After much debate fueled by disagreement over California’s $31.5 billion deficit, lawmakers and Governor Newsom have finalized the state’s 2023-2024 budget. The final budget bill outlines a $310 billion spending plan that includes $248.1 billion for Health and Human Services programs,[1] up from $245.69 billion in the May Revision.[2] Stakeholders can breathe a sigh of relief: core health programs will not face budget cuts, and California’s commitment to health care generally, and Medi-Cal in particular, remains strong. Consistent with the proposed budget in the May Revision, California continues to move …

Our roundup of studies and reports for this month focuses on healthcare costs and consolidation, including a paper written by The Source teama examining state action to regulate healthcare mergers and acquisitions. We also share two studies relating to impacts of consolidation and acquisition; one compares post-surgery outcomes in high and low concentration markets, and the other takes a broad view of costs and quality at acquired hospitals. Next, a systemic review analyzes trends and impacts of private equity acquisition and a study compares hospital prices paid between Medicare Advantage …

In a new research paper published in Frontiers in Public Health Volume 11, The Source’s Alex Montague, Robin Davison, Katie Gudiksen, and Jaime King examine the use of conditional approvals by state officials on hospital and health system mergers, acquisitions, and other consolidating transactions. While federal antitrust enforcers play an important role in overseeing large mergers, acquisitions, and other consolidating transactions of major healthcare providers, state oversight over healthcare markets is essential to slow consolidation more broadly and address market failures across the country. One method states have used to address …

As private equity (PE) investment in healthcare draws scrutiny from advocates and regulators, one lawsuit has been in the spotlight as a potentially important precedent-setter, particularly regarding its corporate practice of medicine (CPOM) claims: American Academy of Emergency Medicine Physician Group (AAEM-PG) v. Envision Healthcare. The Independent Emergency Physicians Consortium called this case a “momentous event” that could signal an inflection point in the increasing corporatization of medicine.[1] However, proceedings have been on pause since May 2023, when the defendant filed for bankruptcy, and it is unclear if and when …

This month’s roundup of studies and reports highlights growing consolidation in health care as well as increasing costs of care. One report predicts higher medical costs in 2024—a trend that continued from the last two years. Another report highlights that policy efforts to reduce facility fees charged by hospitals are a potential avenue for controlling costs. Global capitation, in particular one value-based model utilized in Maryland, may help reduce the cost of specialty care delivery. Meanwhile, trends in the size of physician practices and recent M&A activity are indicators of …

On July 19, the Federal Trade Commission (FTC) and Department of Justice (DOJ) jointly released updated draft guidelines for their antitrust review of mergers and acquisitions. The new proposed guidelines were established following public comments solicited from the past 18 months and aim to better evaluate business and competition in the modern economy and current market realities. The draft guidelines provide 13 principles the agencies will use in determining whether a transaction is anticompetitive and take into consideration increasing concern over new forms of consolidation including vertical mergers, cross-market mergers, …

On June 27, the Federal Trade Commission (FTC), joined by the Department of Justice (DOJ), announced its proposal to amend pre-merger reporting rules that implement the Hart-Scott-Rodino (HSR) Act of 1976. The new rules would require entities seeking to merge to provide more information and details on their transaction. This latest move by the federal antitrust enforcement agencies is consistent with ongoing efforts to promote competition in the U.S. and may act to slow down consolidation trends in the healthcare industry.   What is the Existing Reporting Process The original …

Summer is here, and we hope you can enjoy some vacation time. Whether you’re at work or on the beach, our July roundup brings you the highlights of recent healthcare pricing and competition studies and reports. First, we share several articles that discuss the potential for anticompetitive impacts from consolidation through collaborative agreements and cross-market mergers, two types of lesser-examined transactions that more easily escape regulatory scrutiny. Next, we share an American Hospital Association fact sheet that spotlights insurer policies and acquisitions as under recognized contributors to the changing landscape …

In the past month, newly released publications have chronicled how partnerships, alternative payment models, and insurer market power affect competition and consolidation. Separately, researchers examined Affordable Care Act developments in terms of its impact on coverage and costs of health care. Moreover, as more and more price data are made publicly available, researchers studied how that data is presented, utilized, and what is reveals.   Competition and Consolidation Since 2005, over 190 rural hospitals have closed across the US, and today, 600 more (the nearly one third that remain) are …