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Judge hands FTC defeat in efforts to block big Ill. merger

U.S. District Judge Jorge Alonso’s refusal  this week to block a merger between Advocate Health Care and NorthShore University HealthSystem, both in the Chicago area,  dealt a hard blow to the Federal Trade Commission’s efforts to rein in consolidation of hospitals. The decision could quickly encourage systems to merge, which could lead to considerably higher healthcare costs as the new entities wield more market power and thus are better able to negotiate with insurers.

It was unclear that the FTC would appeal.

In another  similar big case, a federal judge in Pennsylvania refused to stop t a merger between Penn State Hershey (Pa.) Medical Center and PinnacleHealth System in Harrisburg — a decision that the FTC is appealing.

The judge in that case said: “Our determination reflects the healthcare world as it is, and not as the FTC wishes it to be. We find it no small irony that the same federal government under which the FTC operates has created a climate {of cooperation among providers} that virtually compels institutions to seek alliances such as the hospitals intended here.”




FTC will continue to fight big Penn. merger

The Federal Trade Commission will continue fighting to stop a merger between Penn State Milton S. Hershey (Pa.) Medical Center and Harrisburg-based PinnacleHealth System despite a federal judge’s ruling that would, in effect, probably let the merger proceed, say a couple of experts, Modern Healthcare reports.

“This case goes contrary to FTC advocacy and success in other cases, so I’m sure they don’t want this to stick,”  Thomas Greaney, a former assistant chief in charge of healthcare antitrust enforcement at the Justice Department, and now co-director of the Center for Health Law Studies at St. Louis University School of Law, told the publication. “I just think this opinion standing on the books is not a good one for them.”

Jeff Miles, an antitrust expert at law firm Ober Kaler, noted the agency’s concerns with the methodologies  used to define the geographic market of the hospitals that the  judge used in rejecting the FTC’s arguments against the merger.



Judge refuses to block big Pennsylvania merger


The slightly quaint Polyclinic Medical Center, in Harrisburg, Pa., part of Pinnacle Health.

U.S. District Judge John Jones III judge  has refused to temporarily block  the merger  of Penn State Hershey Medical Center and PinnacleHealth System, in a rare defeat for the Federal Trade Commission’s drive against many hospital mergers.

As Modern Healthcare has noted: “Hospitals and insurers across the country have been watching the Pennsylvania case and several others as mergers continue to proliferate. The loss comes as the FTC pursues an injunction in a hospital merger case in the Chicago area between Advocate HealthCare and NorthShore University HealthSystem. ”

“Judge  Jones rejected the FTC’s request for a preliminary injunction to stop the merger between Penn State Hershey, a 508-bed, not-for-profit health system in Dauphin County, and PinnacleHealth System, a not-for-profit, three-campus system with 607 beds, also in Dauphin County. He also slammed the FTC in his opinion for its opposition to such mergers in the current healthcare environment.

“He wrote that the FTC too narrowly defined the systems’ geographic market because the agency didn’t account for the distances many of their patients travel to reach the hospitals. He also wrote that the FTC did not include enough hospitals in its definition of the market.

He found it “compelling” that the hospitals have already worked with central Pennsylvania’s two largest insurers, CBC and Highmark, to ensure that their rates wouldn’t increase following a merger. Of course, who knows what would actually happen with those rates.

Feds keep trying to lower hospital-merger wave



The Federal Trade Commission plans to block the combination of two large Illinois hospital groups,  showing that the FTC and other agencies are  increasingly concerned about the ability of very big health systems to dramatically raise prices through their domination of their markets.

Recent studies that have shown the ability and indeed enthusiasm of big hospital systems for raising  prices much more than smaller systems or freestanding hospitals have added fuel to the regulatory fire.

The FTC said  that the  proposed merger of Advocate Health Care, Illinois’s state’s largest health system, and NorthShore University HealthSystem, could create a 16-hospital behemoth that would dominate the  affluent North Shore area of Chicago.

Deborah L. Feinstein, director of the agency’s Bureau of Competition, asserted that the proposed merger would probably significantly increase the combined system’s bargaining power with health-insurance plans, “which in turn will harm consumers by bringing about higher prices and lower quality.”
The hospital groups say they plan to fight the government’s move, citing the effects of the Affordable Care Act in encouraging  coordinating services and technology.

Besides the Illinois case, the FTC just in the past three weeks has moved halt the merger of two hospitals in West Virginia and joined with Pennsylvania authorities to try to stop an agreement between Penn State Hershey Medical Center and PinnacleHealth System.

The New York Times reported that James H. Skogsbergh, Advocate’s chief executive, defended the merger plan as “good for consumers and very pro-competitive.”  asserting that because the hospitals’ market was dominated by a major insurer, — Blue Cross Blue Shield —  the systems were “price takers, not price setters.”


FTC opposes big Pennsylvania system merger


The Federal Trade Commission  seeks  to block Penn State Hershey Medical Center’s proposed merger with PinnacleHealth System, asserting that the new central Pennsylvania  entity would raise prices and lower healthcare quality in the area.

“The proposed merger would eliminate the significant competition between these hospitals {hospital systems} resulting in higher prices and diminished quality,” said Debbie Feinstein, director of the FTC’s Bureau of Competition.

PinnacleHealth and Penn State Hershey responded by saying:

“We are extremely disappointed that the FTC does not share the enthusiasm of the many employers, community leaders, private physicians, commercial insurance providers and others who have recognized the benefits of our integration and demonstrated their broad support for it.”

The systems have asserted that the proposed merger would create “the depth of services and scale” needed to manage population health at the lowest possible cost.

But  hospital mergers have tended to be associated with higher prices in their regions as a result of less competition.

The FTC’s decision displays its continuing skepticism and frequent opposition to  hospital mergers, especially since 2007.

Deals that would give systems more than 40 percent of the market share  in their regions tend to ignite the agency’s opposition.

Fee-for-value leader Dr. Beauregard joins CMG


George Beauregard, D.O., has joined Cambridge Management Group (CMG) as a senior adviser. Dr. Beauregard has been a leader in moving hospitals and physicians into the new world of fee-for-value care.

He has 20 years of experience in private practice in internal medicine and vast experience with pay for performance; performance- and risk-based contracts involving commercial and Medicare payers; EMR/HIT implementation, and Accountable Care Organization and Bundled Payment development.

In his recent role as senior vice president and chief clinical officer for the PinnacleHealth System, based in Harrisburg, Pa., he worked closely with the clinical and administrative leadership to help PinnacleHealth achieve enterprise- wide success in successful CMS Accountable Care and Bundled Payment initiatives; quality and performance improvement; clinical integration, and HIT optimization. This helped lead CMS to welcome RiverHealth ACO, of which PinnacleHealth is a founding member, into the 2014 Medicare Shared Savings Program.

Prior to joining PinnacleHealth, in September 2012, Dr. Beauregard was president and chief medical officer of Southcoast Physicians Network, in Massachusetts.  His leadership helped gain Southcoast admission into the 2013 Medicare Shared Savings Program.

Before that, he was co-founder, in 1996, of Primary Care LLC, the largest independent community-based primary-care-physician network in eastern Massachusetts. Dr. Beauregard guided a merger of that entity with Tufts Medical Center in 2005 to form the New England Quality Care Alliance (NEQCA), where he then served as chairman of the board for four years. He also was trustee of Tufts Medical Center Physicians Organization Inc.

George Beauregard is a graduate of the University of New England College of Osteopathic Medicine. He has been awarded Diplomate Certificates by the American Board of Internal Medicine and the National Board of Osteopathic Medical Examiners.


PinnacleHealth’s program to get physicians to listen more


With  vivid examples, Nirmal Joshi, M.D., chief medical officer for Pinnacle Health System, based in Harrisburg, Pa., discusses in a New York Times piece the necessity of  intense, if sometimes brief, two-way communication between physicians and patients.

Dr. Joshi notes that  the Joint Commission  has found that ”communication failure (rather than a provider’s lack of technical skill) was at the root of over 70 percent of serious adverse health outcomes in hospitals.”

”{O}ne survey found, two out of every three patients are discharged from the hospital without even knowing their diagnosis. Another study discovered that in over 60 percent of cases, patients misunderstood directions after a visit to their doctor’s office. And on average, physicians wait just 18 seconds before interrupting patients’ narratives of their symptoms.”

Dr. J0shi describes started a program  that he and his colleagues started to improve doctors’ communication with their patients at Pinnacle.

They developed a physician-training program, which, he writes in The Times, ”involved mock patient interviews and assessment from {an} actor role-playing the patient. Over 250 physicians were trained using this technique. We also arranged for a ‘physician coach’ to sit in on real patient interviews and provide feedback.”

 And it helped a lot, as his op-ed explains.

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