FTC Commissioner Christine Wilson on Thursday said the agency this year will increase its scrutiny of the health care sector by challenging "every hospital merger" and cracking down on certificates of public advantage (COPAs), among other things.
Wilson made the comments during a speech at a Council for Affordable Health Coverage event.
FTC previously has expressed skepticism over hospital mergers' effects on competition in the market, as well as COPAs and their effects on care. Wilson on Thursday said FTC over the past 15 years has "successfully sued to block several problematic hospital mergers," and also has blocked some mergers involving physician practices.
In addition, FTC has been working on an ongoing project examining the effects of COPAs on health care access, innovation, prices, and quality. COPAs allow states to approve mergers that reduce market competition as long as the involved parties commit to make investments that benefit the public. However, FTC has claimed that states use the legal mechanisms "to immunize mergers and collaborations from antitrust scrutiny."
FTC to crack down on hospital mergers, COPAs in 2020
Wilson on Thursday said FTC will ramp up that scrutiny this year and look to "increase[e] competition in the [health care] sector, … pare back state policies that restrict entry into provider markets, reform insurance markets in ways that lower barriers to entry, and arm consumers with better information about their health care options."
For example, Wilson said FTC is "intent on challenging every hospital merger," noting that there are "a number in the pipeline." Wilson added that the agency also could review past hospital mergers to ensure they've achieved certain cost and quality metrics. She said, "We're conducting more retrospectives to make sure we're making the right calls [on mergers]."
Wilson also said FTC will work to abolish COPAs at the state level. "I believe abolishing [COPAs] at the state level will benefit consumers and FTC will continue to call out these laws," she said.
FTC also will work to repeal state Certificate of Need laws, Wilson said. Such laws establish requirements for states to approve a new provider's entry into a market or an existing provider's expansion in a market.
Further, FTC will push for increased flexibility in scope of practice laws, especially for mid-level providers such as nurse practitioners, Wilson said. According to Wilson, expanding nurses' practice authority could improve access to care, curb costs, and increase competition in the health care sector (Muchmore, Healthcare Dive, 1/17; Cirruzzo, Inside Health Policy, 1/16 [subscription required]; Wilson remarks, 1/16; National Conference of State Legislatures website, 12/1/19).