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ACO Market Consolidation and Antitrust Considerations: Current Issues, Implications and Considerations
While aggregation does not equal accountability, it is widely acknowledged that some size and scale is necessary for an Accountable Care Organization to succeed under changing reimbursement models. The organization needs to be of sufficient size to support comprehensive performance measurement, cost savings, and expenditure projections. It needs to be able to manage the continuum of care for a defined population, and it requires capital to make the infrastructure investments necessary to achieve integration, such as care redesign systems and information technology.

As a result, both change of control transactions and non-change of control transactions among providers are taking place in large numbers across the country, including for-profit/non-profit deals, and some private equity investment. The regulatory dialogue that has taken place around accountable care seeks to distinguish “good” collaboration from “bad” and relies heavily on clinical and financial integration as a basis for allowable transactions.

Market share and market power concerns remain the subject of an ongoing national policy debate. The Department of Justice and Federal Trade Commission have clearly stated that they will continue to protect competition in markets served by ACOs, will use CMS data, and will “vigorously monitor complaints.” Furthermore, merger enforcement is not affected by the ACO guidance – the FTC and DOJ will continue to enforce under the current merger guidelines, as evidenced by cases such as the FTC’s successful challenge of St. Luke’s Health System’s acquisition of Saltzer Medical Group.

Please join Epstein Becker Green's Mark Lutes and Patricia Wagner on Friday, October 3rd, 2014 at 1PM Eastern as they discuss current issues and considerations that stakeholders need to address regarding ACO consolidation and antitrust issues in the marketplace.  Click here for detailed information and to register or call 209.577.4888.
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