Competing in the Marketplace
How physicians may increase their value in the health care market through medical practice integration
"Competing in the marketplace" is designed to help physicians in all practice sizes determine the level of integration that makes the most sense for their practice. Now in its third edition, this resource can help physicians, legislators, attorneys and others identify many of the benefits and limitations of several potential integration arrangements.
Gain legal perspective: Sharpen your understanding of the landscape and options
The reasons physicians consider practice integration are varied. Some may want to create the collaborative environment needed to make significant quality and cost-effectiveness improvements, or to develop economies of scale and raise capital sufficient to implement health information technology. Others may be looking for an opportunity to take advantage of participating in performance-based reimbursement programs and to lawfully bargain collectively with payers. "Competing in the marketplace" can help you understand these and other topics associated with a rapidly changing market and regulatory environment that encourages practice integration.
Physician integration efforts sometimes raise antitrust issues. This resource identifies the relevant antitrust concerns when physicians seek to jointly negotiate fees and describes the current state of the law on the subject. Most essentially, "Competing in the marketplace" points out possible antitrust pitfalls and describes generally the types of arrangements that are currently acceptable under the antitrust laws.
Read the full resource or scan an outline of the chapters below.
The primary motive should be to bring to market a competitive product through which physicians can respond to changes in health care delivery and payment that physician could not otherwise produce by acting independently. Physicians in solo or small group practice may think it is prohibitively expensive and time consuming to integrate. This is not necessarily true—there are a number of lawful integrative collaboration options available that offer flexibility. In many cases physicians will be able to: (1) remain in their local practice settings; (2) oversee many day-to-day practice operations; (3) be rewarded based on individual productivity; and (4) continue working with the same primary care physicians and specialists.
Learn more about the reasons to integrate, and examples of integration, in Part I (A), beginning on page 5.
"Competing in the marketplace" is composed of three parts:
- Part I, beginning on page 5, discusses physician practice mergers and merger models.
- Part II, beginning on page 8, examines financial and clinical collaborative models through which physicians may integrate their separate practices.
- Part III, beginning on page 12, contains an analysis of the antitrust issues implicated when physicians use a joint venture or competitor collaboration to negotiate fee-related terms with health insurers and other purchasers of physician services.
The decision as to whether and how to integrate should be based on an assessment of the relevant market, the capabilities and compatibility of the participants, and the business prospects of the combined entity.
Before integrating, physicians should consider the following factors that will enhance a physician's ability to succeed:
- Collaboration with an integrated network of primary care physicians, specialists and appropriate allied health personnel
- Ability to access, coordinate, or develop data that demonstrate competitive costs and outcomes
- Retention of organizational flexibility to modify incentives and to respond to regulatory, technical and practice pattern changes
- Commitment to motivating and supporting the best clinical practices
- Having strong management that can negotiate and analyze managed care contracts
Learn more about the necessity of strategic and business planning, and access related checklists, in Part I (C), beginning on page 7.
The merger model means the consolidation of separate physician practices into one medical group in which participating physicians have a complete unity of interest. The merged firm controls all of the resources of the combined practices such that none of the participating physicians compete with one another.
Learn more about the flexibility this model can offer, general requirements for fully integrated physician practice mergers in Part II, beginning on page 8.
Under collaborative integration models, independent physicians pool resources to engage in a common endeavor and the physicians are actual or potential competitors without merging their practices.
Learn more about the two types of collaborative integration models—financial and clinical integration—and potential antitrust issues in Part III, beginning on page 12.