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July 25, 2012

Antitrust Guidelines in Health Care Markets

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliation: America's Health Insurance Plans, Washington, DC (

JAMA. 2012;308(4):338-339. doi:10.1001/jama.2012.8157

To the Editor: The Viewpoint on accountable care organizations (ACOs) and antitrust1 suggested that while the focus on the antitrust issues related to ACOs may have diminished with the release of the final rules from the Centers for Medicare & Medicaid Services, the significance of the issues will only continue to grow as the Medicare Shared Savings Program moves toward full-scale implementation. The article, however, made a subtle but important mistake in characterizing the guidelines from the Department of Justice and the Federal Trade Commission2 published as a companion to the Medicare Shared Savings Program. The authors twice identify a “balance” between market power and integration efficiencies as the goal of the antitrust guidelines. The concept of balance misstates the vital role of competition policy and antitrust enforcement in the program.

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