Antitrust and IDNs (integrated delivery networks): how far can we go?

Since the 1970s, the outcomes in antitrust actions against healthcare facilities have become significantly more predictable. But there are still differences of opinion among healthcare providers and antitrust enforcers as to how far antitrust enforcement activities should go. Antitrust enforcement involves a determination of reasonable and unreasonable activities, rather than the application of clear rules. This can lead to confusion over what is legal and may inhibit providers from engaging in collaborative efforts. Intent is very important in antitrust matters. A cooperative venture's effect on the consumer is the primary factor in the enforcers' consideration of whether it is reasonable. Thus well-planned and appropriate healthcare ventures will succeed in most places. Congress has been considering the antitrust implications of healthcare reform. To date, however, there is no consensus on what antitrust laws need changing, if any, or whether new definitions or exemptions could address the problem. Integrated delivery networks (IDNs), the central feature of many healthcare reform proposals, could raise many classic antitrust concerns. Antitrust enforcers' interest in these arrangements will vary according to their effect on competition. Any attempts to establish IDNs will need to also ensure clear language exists regarding the reach of antitrust laws.