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July 25, 2012

Antitrust Guidelines in Health Care Markets—Reply

Author Affiliations

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

Author Affiliations: Division of Health Policy and Management, University of California, Berkeley (Drs Scheffler and Shortell) (shortell@berkeley.edu); and Project Hope, Lane Millwood, Virginia (Dr Wilensky).

JAMA. 2012;308(4):338-339. doi:10.1001/jama.2012.8163

In Reply: The key task in assessing collaborative activity among competitors under federal and state antitrust laws is to determine when that activity is likely to have (or is having) anticompetitive effects on the markets, such as price increases. While the law and the federal antitrust guidelines for Medicare Shared Savings Program ACOs properly recognize that certain conditions are particularly conducive to such anticompetitive effects, ultimately the law recognizes that collaborative activity may have both anticompetitive and procompetitive effects that need to be balanced to determine the net effect on consumer welfare. The Centers for Medicare & Medicaid Services itself has recognized that the important collaborative activity involved with Medicare Shared Savings Program ACOs may have at the same time both anticompetitive effects in the commercial insurer market and procompetitive effects in the Medicare market.