January 22, 2020

Our take: FTC wants to crack down on hospital mergers in 2020

Daily Briefing

    Editor’s note: This story originally referenced a quote reported by Inside Health Policy that FTC Commissioner Christine Wilson had said FTC is “intent on challenging every hospital merger and we have a number in the pipeline." Inside Health Policy has issued a correction and now reports that Wilson said, “I do believe we are intent on challenging every hospital merger that's going to produce anti-competitive effects, and we have a number in the pipeline." The story has been updated below.

    FTC Commissioner Christine Wilson on Thursday said the agency this year will increase its scrutiny of the health care sector by cracking down on hospital mergers and 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, according to Inside Health Policy, Wilson said FTC is "intent on challenging every hospital merger that's going to produce anti-competitive effects," 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).

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