Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program, FTC Matter No: V100017 #00111 

Submission Number:
00111 
Commenter:
James Langenfeld
Organization:
Navigant Economics
State:
Illinois
Initiative Name:
Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program, FTC Matter No: V100017

Please see attached for discussion, however, our basic conclusions are as follows: 1. The Policy Statement should clarify existing law. •Price fixing does not occur for CMS ACOs when government sets the rate. •Financial risk sharing (i.e., capitation) is sufficient to establish "rule of reason" analysis outside the context of the safety zones. 2. The concept of PSA allows for simple calculations of geographic market share, but need more clarifications to minimize investigations a minor overlaps and the importance of market expansion. 3. ACOs may need to utilize exclusive contracts with hospitals and physicians in order to develop pro-competitive product offerings, and therefore should not be given too much weight in evaluating the competitive effects of an otherwise pro-competitive ACO. 4. ACOs below the 50% mandatory review threshold and outside of the safety zone should be given guidance by the Statement, but not necessarily encouraged to request permissive review.