In recent decades, hospitals have increasingly merged and acquired physician practices. “In the quest to create larger and more robust monopolies, some hospitals are using sham peer review to remove the last remnants of independent physicians practicing in hospitals,” writes Lawrence Huntoon, M.D., Ph.D., in the summer issue of the Journal of American Physicians and Surgeons.
“The creation of large hospital monopolies, with hospitals influencing the care provided by its employed physicians, has led to antitrust concerns,” Dr. Huntoon states.
Beginning with the antitrust case, Patrick v. Burget, which led to the passage of the Health Care Quality Improvement Act (HCQIA) of 1986, Dr. Huntoon reviews the effects of consolidation and HCQIA, as well as subsequent antitrust litigation.
HCQIA created virtually absolute immunity for hospitals conducting sham peer review, that is, reviews conducted in bad faith for reasons unrelated to improving patient care. Such a proceeding can ruin a physician’s career. While acknowledging that “a sanction by a peer review body can be a devastating blow to a physician, emotionally, financially, and professionally,” the American Medical Association (AMA) was skeptical about the existence or significance of sham peer review. However, the AMA apparently changed its view in 2012 and started offering limited information and advice to physicians about issues such as denial of due process.
Dr. Huntoon notes that “antitrust lawsuits are an option for physicians who have suffered harm as a result of anticompetitive conduct of hospitals.”
He concludes: “As patients continue to experience higher prices, higher insurance premiums, higher deductibles, higher co-pays, and poorer care as a result of the anticompetitive conduct of hospitals, Congress may face pressure to take action to halt the hospital monopoly juggernaut.”
The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.
Read Article: https://jpands.org/vol28no2/huntoon.pdf