Agenda for Joint
FTC/DOJ Hearings
on Health Care and Competition Law and Policy
March,
2003
Wednesday
March 26, 2003
Morning Session 9:15 am - 12:00 pm
Hospital
Round Table
- Lee B. Sacks, M.D., Advocate
Health Care
- Ralph
K. Andrew, New York Eye & Ear Infirmary
- David
Morehead, M.D., Ohio Health
- Robert J. (Mike) Ryan, MedStar
Health, Inc.
- James D. (Denny) Shelton,
Triad Hospitals, Inc.
Title:
Defining Product Markets for Hospitals
The definition of the product
market for hospitals has typically been at a high
level of generality, with the product defined
as "acute care inpatient hospital services"
or "anchor hospitals." Health care is
increasingly provided on an outpatient basis,
and general inpatient hospitals face competition
for the services they deliver from a range of
providers. What, if any, are the impacts of these
changes on the definition of a hospital product
market? What, if any, are the impacts of these
changes on competition for services provided by
hospitals? What developments have there been in
economic theory with regard to defining hospital
product markets? How do payors (including employers)
define product markets? How do patients and physicians
define product markets? What data are available
to assist in the formulation of an appropriate
product market?
- Seth
Sacher, [Document 2]
Charles River Associates
- Jack Zwanziger,
School of Public Health, University of Illinois,
Chicago
- Carol Beeler, Federated
Ambulatory Surgery Association
Wednesday
March 26, 2003
Afternoon Session 1:30 pm - 5:00 pm
Title:
Defining Geographic Markets for Hospitals
The definition of the geographic
market in hospital antitrust cases has been controversial.
In several high-profile hospital merger cases,
judges have rejected testimony from payors about
their limited ability to steer patients to lower-cost
providers in distant locations, and determined
that the geographic market was quite broad. In
most of these cases, the geographic market has
been defined through the use of Elzinga-Hogarty
patient flow criteria. Does the Elzinga-Hogarty
model represent the best current tool for defining
the relevant geographic market for hospital antitrust
cases? What are the weaknesses of this model?
What developments have there been in economic
theory with regard to defining hospital geographic
markets? What data are available to assist in
the formulation of an appropriate geographic market?
How do payors (including employers) define hospital
geographic markets? How do patients and physicians
define hospital geographic markets? Does the type
of illness and the nature of the recommended treatment
influence the size of the hospital geographic
market? What is known about the actual size of
geographic markets for hospital services?
- Margaret
Guerin-Calvert, Competition Policy Associates,
Inc.
- Gregory
Vistnes, [Document
2] [Document
3], Charles River Associates
- Barry C. Harris, Economists
Incorporated
- H.E. Frech, III, University
of California, Santa Barbara
- Gregory
Werden, Department of Justice, Antitrust
Division
Thursday
March 27, 2003
Morning Session 9:15 am - 12:15 pm
Title:
Single Specialty Hospitals
In recent years, single-specialty
hospitals have emerged in various locations in
the United States. Instead of offering a full-range
of inpatient services, these hospitals focus on
providing services relating to a single medical
specialty or cluster of specialties (typically
cardiology/cardiac surgery or orthopedic surgery).
What factors have driven this unbundling of inpatient
hospital services? What have been the effects
of this unbundling? Has quality of care been enhanced
as "focused factories" have emerged?
Have costs and access increased or decreased?
How has competition been affected for services
provided by both the general inpatient hospital
and the single-specialty hospital, and for services
provided only by the general inpatient hospital?
Is this development any different than the emergence
of specialized hospitals for children, rehabilitation,
and psychiatry? What actions have general inpatient
hospitals taken in response to the emergence of
competition from single-specialty hospitals? Do
any of these actions involve anti-competitive
conduct?
- Panel
- H.E. Frech, III, University
of California, Santa Barbara
- Dennis
Kelly, [Document
1], [Document
2], [Document
3], [Document
4], MedCath Corporation
- George
Lynn, representing American Hospital
Association
- Edward
Alexander, [Document
1], [Document
2], Surgical Alliance Corporation
- David
Morehead, M.D., Ohio Health
- John Rex-Waller,
National Surgical Hospitals
- Dan Muholland,
Horty, Springer & Mattern, P.C.
Thursday
March 27, 2003
Afternoon Session 2:00 pm - 5:00 pm
Title:
Contracting Practices
In recent years, some providers
have developed complex networks for the delivery
of health care services. These networks frequently
involve multiple geographic and product markets.
In several instances, there have been complaints
that such provider networks are requiring that
payors that wish to contract with a "desirable"
hospital in one product or geographic market,
must also contract with all other hospitals offered
by the network, and include all network hospitals
in their "most favored" tier for purposes
of co-payments and other financial incentives.
Payors allege that these contracts restrict their
ability to steer patients to lower-cost providers
in particular geographic markets. How prevalent
is such conduct? What does economic theory indicate
about the circumstances under which such conduct
is likely to emerge? When are such arrangements
likely to be pro-competitive and when are they
likely to be anti-competitive? Does traditional
antitrust analysis, including but not limited
to tying doctrine, adequately address the forms
of anti-competitive conduct likely to emerge?
Does the existence of such conduct have any implications
for merger review?
- Thomas R. McCarthy,
National Economic Research Associates, Inc.
- Margaret
Guerin-Calvert, Competition Policy Associates,
Inc.
- Bradley
C. Strunk, Centers for Studying Health
Systems Change
- Arthur
N. Lerner, Crowell and Moring
- Vincent
Scicchitano, Vytra Health Plan
- Harold N. Iselin, Couch
White, LLP
- Debra Holt, Federal Trade
Commission
Friday March
28, 2003
Morning Session 9:15 am - 12:30 pm
Title:
Issues in Litigating Hospital Mergers
Prior to 1994, the Federal Trade
Commission and the Department of Justice had considerable
success in challenging hospital mergers. During
the intervening eight years the Commission and
the Department lost seven successive cases challenging
hospital mergers. What explains this string of
losses? Do these cases suggest that courts have
become more skeptical of competition law and policy
as applied to health care? What, if any, are the
broader prospective implications of these losses?
What strategies should enforcement authorities
employ to ensure their efforts are targeted appropriately
in the future?
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