| The skinny
The Department of Justice has sued both OhioHealth and NewYork-Presbyterian Hospital this year. The lawsuits claim these providers have forced payers to contract with their entire health systems, rather than allowing them to pick and choose individual facilities. The Justice Department argues that these “all-or-nothing” contracting tactics block payers from steering patients to lower-cost providers. OhioHealth and NewYork-Presbyterian are cooperating with the reviews of their managed care agreements, but they both maintain that their contracting practices are lawful and benefit patients by ensuring broad access to care. Experts — including an antitrust lawyer, healthcare economist, frontline physician and patient advocate — agree with the Justice Department. They believe that these types of contracting practices do drive up healthcare costs and squeeze independent doctors, as well as leave patients with fewer choices. Sending a message
The lawsuits against OhioHealth and NewYork Presbyterian signify a shift in the nation’s healthcare antitrust enforcement. Historically, the focus has been on hospital mergers, but these two cases are scrutinizing contracting behavior. Attorney Cory Talbot, a partner at Holland & Hart, said the lawsuits are “designed to send a message” and are likely to push health systems to rethink or abandon their all-or-nothing tactics in negotiations. Another expert — Katie Keith, founding director at Georgetown University’s Center for Health Policy and the Law at the O'Neill Institute — agreed, saying that hospitals using these tactics “should be on notice that this might not be a sustainable strategy under this Department of Justice.” A growing affordability crisis
Dr. David Eagle, a hematologist-oncologist at New York Cancer & Blood Specialists, described a before-and-after scenario from his oncology practice. It involved the same doctor, same location and same care. Before joining a large health system, the doctor’s patients typically paid $50 to $70 per visit — but after the practice was acquired, those same visits often came with $300 copays and additional facility fees. Despite receiving care from the same doctor in the same location, some patients could no longer afford to return and were forced to seek care elsewhere or go without.
These cost pressures ultimately land on patients navigating an increasingly restricted and confusing insurance landscape, pointed out Caitlin Donovan, senior director of the Patient Advocate Foundation. She thinks all-or-nothing contracting adds another layer to an already constrained system and is glad that the Justice Department’s lawsuits are targeting one piece of a broader affordability problem. — By Katie Adams |
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