суббота, 6 октября 2012 г.

Hospital claims Premier is stifling competition ; Physician-owned center claims large health system put pressure on insurers. - Dayton Daily News (Dayton, OH)

DAYTON -- A small, physician-owned hospital claims in federalcourt that southwest Ohio's largest health system has colludedillegally to drive competition from the Dayton market.

The Medical Center at Eliza-beth Place, located in the former St.Elizabeth's Hospital, filed the antitrust lawsuit against PremierHealth Partners.

'The lawsuit seeks to remove the illegal barriers erected by thedefendants and return the playing field to level-set,' Alex Rintoul,the Medical Center's CEO, said Friday.

Insurers listed in the complaint represent more than 70 percentof insured people in the Dayton area, the complaint states.

The complaint claims that Premier and other defendants --Catholic Health Initiatives, MedAmerica Health Systems Corporation,Atrium Health System, Samaritan Health Partners and UVMC -- colludedby 'coercing, compelling or co-opting commercial health insurers ormanaged care providers' to cut off access to the medical center fortheir networks.

Anthem, UnitedHealthcare, Private Healthcare Systems, Humana,Cigna and Medical Mutual of Ohio are listed in the complaint but arenot defendants in the lawsuit.

In addition to pressuring insurers, the complaint states, thedefendants threatened punitive financial consequences againstphysicians who affiliated with the hospital and offered payments todoctors who agreed not to work with the center.

'We strongly deny the allegations that were made in the lawsuit,and we'll be defending against that,' said Diane Ewing, vicepresident of marketing and communications for Premier HealthPartners. She said she was speaking on behalf of all of thedefendants.

Antitrust lawsuits are not uncommon, and physician-ownedhospitals have taken aim at larger hospitals in other markets, saidHarry Gerla, a former U.S. Securities and Exchange attorney whoteaches antitrust law at the University of Dayton School of Law. Butprivate entities who file those lawsuits lose more than 97 percentof the time, he said.

'In general plaintiffs are heavy, heavy underdogs,' Gerla said.'They've got a tough task. I'm not saying they can't do it.'

Premier is a nonprofit corporation formed in 1995 that existsbecause of a joint operating agreement involving the otherdefendants:

- Catholic Health Initiatives is a Colorado-based nonprofitcorporation and the sole corporate member of Samaritan HealthPartners, the parent company of Good Samaritan Hospital.

- MedAmerica, an Ohio nonprofit, operates Miami Valley Hospitaland some subsidiaries.

- Atrium, an Ohio nonprofit, was previously known as Middle-townRegional Health System and operates the Atrium Medical Center inMiddletown.

- UVMC, an Ohio nonprofit, controls and operates Upper ValleyMedical Center in Troy.

Spokespeople for some of the insurers stated that those companiesdon't comment on pending litigation.

'We are unaware of the lawsuit between the Medical Center atElizabeth Place and Premier and are unaware of the allegations inthat lawsuit,' said Kim Ash-ley, public relations director forAnthem. 'I can tell you the Medical Center at Elizabeth Place iscurrently contracted with Anthem and has been for several years.'

In 2010, Rintoul and Dr. John Fleishman, chairman of MCEP'sboard, told the Dayton Daily News that less generous contracts withAnthem and UnitedHealthcare have hurt financial performance, revenuegrowth and profit margins.

The Medical Center at Eliza-beth Place is a for-profit companyand opened in 2006 inside the former St. Elizabeth's Hospital withfour operating suites. It has 26 beds and the space to expand to atleast 50, the complaint states. The effects of Premier's actionsforced the center to sell an ownership interest to Kettering HealthNetwork, the only other hospital system in the Dayton area, in 2009,the complaint states. Kettering Health Network is not a defendant inthe lawsuit.

The complaint, filed Jan. 30, states that under the jointoperating agreement, the defendants are owned, controlled andoperated independently, and 'Premier has stated that the JOA is nota merger of assets, but a consolidation of revenue streams.'

The complaint also quotes an unnamed Premier vice president assaying that specialty hospitals should be precluded in most cases,and physician-owned speciality hospitals are 'particularly damaging'because they 'attract away an important segment of an existinghospital's specialists,' resulting in revenue declines.

The medical center claims that Dayton Heart Hospital was a victimof the conspiracy, and that 'Premier brazenly acknowledged that theHospital Defendants exerted their market power to convince managed-care plan providers not to do business with Dayton Heart.'