A proposal to create a network of thirteen licensed ambulance and ambulette service providers ("members") to offer scheduled, non-emergency ambulance and ambulette services throughout northeast and southcentral Ohio does not appear to raise antitrust concerns, according to staff of the Federal Trade Commission in response to the written request of Ohio Ambulance Network, Inc., (“OAN”) for a staff advisory opinion. OAN is a for-profit corporation incorporated under Ohio law for the purpose of operating an ambulance services network.
Ambulance and ambulette services involve the provision of transportation services to persons who may require medical assistance during transport, such as persons traveling to or between hospitals, physicians offices, treatment clinics, or other health facilities. Ambulance services are provided to persons who potentially may require basic or advanced life support services during transit. Ambulette services are provided to non-ambulatory persons (e.g., those confined to a wheelchair) who do not require ambulance services.
Ambulance or ambulette services will be provided by OAN members in accordance with the terms of network participating agreements and of contracts with purchasers. OAN intends to administer network contracts by coordinating the scheduling and dispatch of members, centralizing billing and payment functions, and facilitating any necessary communication between a purchaser and a participating provider relating to patient grievances or other non-price related concerns. In addition, OAN will identify potential purchasers and actively market the network. Members will be free to join other networks or to contract with purchasers independently.
OAN members will not agree among themselves on the terms of their dealings with payers or negotiate collectively with respect to price, utilization, or quality assurance terms. Instead, OAN intends to hire an independent contractor to act as a "messenger," conveying information, offers, and counteroffers between potential purchasers, such as HMOs and large employers, and each member provider. Each member will decide independently, without knowledge of the views or intentions of the messenger or other OAN members, whether to accept, reject, or propose a counteroffer to, terms proposed by potential purchasers. OAN intends to ensure that network members do not share competitively sensitive information.
According to the staff’s advisory opinion, signed by Robert F. Leibenluft, Assistant Director for Healthcare at the FTC, the proposed network does not appear to involve horizontal agreements on price-related terms. As is discussed in Statement 9 of the Health Care Statements, use of the messenger model to avoid a horizontal agreement on price terms can avoid concerns about price-fixing among the members through the network, the staff letter said. According to the staff letter, the network proposed by OAN appears unlikely to create or facilitate exchanges of price or price-related information, or collective agreements on price or price-related terms, among members. Moreover, OAN does not propose to agree on other terms of dealing with payers.
NOTE: This letter sets out the views of the staff of the FTC's Bureau of Competition, as authorized by the Commission's Rules of Practice. It has not been reviewed or approved by the Commission. As the Commission's rules explain, the staff's advice is rendered "without prejudice to the right of the Commission later to rescind the advice and, where appropriate, to commence an enforcement proceeding."
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