Scanning the Headlines: Clinical Integration

Updated on December 10, 2008

Links to full-text articles are provided where available.
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Morris L.  [Arrangement in which a hospital has agreed to share with four cardiology groups and one radiology group a percentage of the hospital’s cost savings arising from the physicians’ implementation over two years of a number of cost reduction measures in certain cardiac catheterization procedures]. OIG Advisory Opinion No. 08-21. U.S. Dept. of Health and Human Services, Office of the Inspector General, Dec. 8, 2008.

OIG opinions offer more kickback guidance.  Physician Compensation and Recruitment.  9(11):10, Nov. 2008.

Butler, M., and others.  Integration of Mental Health/Substance Abuse and Primary Care.  Rockville, MD:  Agency for Healthcare Research and Quality, Oct. 2008.

Taylor, M.  Experiments in payment.  H&HN.  Sept. 11, 2008.

CMS' 'stand in the shoes' revisions allay fears.  Modern Physician.  Sept. 8, 2008.  [free registration for viewing].

Grossman, J., and Cohen, G.  Despite Regulatory Changes, Hospitals Cautious in Helping Physicians Purchase Electronic Medical Records.  Washington:  Center for Studying Health System Change, Sept. 2008.

Gosfield, A.  Stark III: refinement not revolution (part 2).  Family Practice Management.  15(4):25-27, Aug. 29, 2008.  [free registration required].

Bakhtiari, E.  Under a microscope.  HealthLeaders Media.  Aug. 28, 2008.

Gosfield, A.  Stark III: refinement not revolution.  Family Practice Management.  15(3):25-28, Aug. 25, 2008.  [free registration required].

Barlow, K.  How to get past the physician gatekeeper.   Healthcare Marketing Advisor.   9(8):9-10, Aug. 2008.

Hospital-Physician Clinical Integration.  Chicago:  Center for Healthcare Governance, 2007.  (WX 203 H828 2007).

Babbo, T., Marren, J., and Deady, P. Clinical integration: a Physician and Hospital Strategy for Better Quality, Enhanced Competition, and Collection Contracting. Hogan Marren, Ltd., 2007. 

Berenson, R. Challenging the Status Quo in Chronic Disease Care: Seven Case Studies. California HealthCare Foundation, Sept. 2006.

Berenson, R. Challenging the Status Quo in Chronic Disease Care: Appendix With Detailed Case Studies. California HealthCare Foundation, Sept. 2006. 

Herwick, D., Nolan, T., and Whittington, J.  The triple aim: care, health, and cost.  Health Affairs.  27(3):759-769, 2008.

Bissegger, M. The Evanston initial decision: is there a future for patient flow analysis? Journal of Health Law.  39(1):143-59, Winter 2006.   

Blesch, G. Haven't we met before? Don't call it a merger--a spate of new joint operatingagreements may spark '90s deja vu, but it's different now, executives say. Modern Healthcare. 37(28):6-7, 16, July 16, 2007.

Blesch, G. Antitrust angst. Providers continue to seek clarity from feds on what types ofdeals and clinical affiliations would run afoul of the law. Modern Healthcare.  37(25):28-30, June 28, 2007.

Blesch, G.  CMS shines up its 'shoes':  stark revisions ease tensions on self-referrals.  Modern Healthcare.  38(34):17, Aug. 25, 2008.

Bohlmann RC. Hospital-owned medical practices. Some are integrated, others disconnected. MGMA Connexion.  7(6):35-7, July 2007.

Broccolo, B. Electronic Health Records Systems: From Vendor Contract Negotiation to Provider Practice Integration. American Health Lawyers Association, Feb. 2007.

Buchholz, S. What’s the risk in gain sharing.   Materials Management in Health Care.  1 4(8):43-4, Aug. 2005.  

Cameron, D.  Innovations in medical staff planning:  setting the stage for the future (cover story).  Healthcare Executive.  23(4):16-20, July/Aug. 2008.

Casalino, L. The Federal Trade Commission, clinical integration, and the organization of physician practice.  Journal of Health Politics, Policy and Law.  31(3):569-85, June 2006.

Cohn, K., Friedman, L., and Allyn, T.  The tectonic plates are shifting:  cultural change vs. mural dyslexia.  Frontiers of Health Services Management.  24(1):11-26, Fall 2007.

DoBias M. Clarify antitrust laws: AHA. Group discusses benefits of clinical integrationpractices.  Modern Healthcare.  37(17):12, Apr. 23, 2007.

Duffy, J., and Green, T. Hospital-Physician Clinical Integration.  Center for Healthcare Governance. 2007.

Dyke, M.  Hospital-physician integration and the role of nursing.  Voice of Nursing Leadership.  6(2):8-9, March 2008.

Enthoven, A., and Tollen L.  Competition in health care: it takes systems to pursue quality and efficiency. Health Affairs. Suppl. Web Exclusives:W5-420-33, Jul./Dec. 2005.

Evans, M. Higher standard. Ruling could make it tougher for antitrust plaintiffs. Modern Healthcare.  37(22):14-5, May 28, 2007.

Federal Trade Commission. Greater Rochester Independent Practice Association, Inc., Advisory Opinion. Sept. 17, 2007.  Related FTC Press Release, Sept. 21, 2007:

Federal Trade Commission. Follow-up to 2002 MedSouth, Inc. Staff Advisory Opinion, June 18, 2007.  Earlier MedSouth Advisory Opinion, Feb. 9, 2002.

Federal Trade Commission. FTC Staff Advisory Opinion Concerning Suburban Health Organization, Inc. Mar. 28, 2006.

Fera, W.  Using information technology to align physicians and hospitals.  Frontiers of Health Services Management.  24(1):27-30, Fall 2007.

Ferman, J. Gain sharing becomes more viable. Some of the traditional legal barriers to gain sharing arrangements are dissolving. Healthcare Executive.  20(4):38-9, Jul./Aug. 2005.

Gaynor M. Why don't courts treat hospitals like tanks for liquefied gases? Some reflections on health care antitrust enforcement.  Journal of Health Politics, Policy and Law.  31(3):497-510, June 2006.

Ginsburg, S.  Colocating Health Services: A Way to Improve Coordination of Children's Health Care?  New York:  The Commonwealth Fund, July 9, 2008.

Graham, J.  The Federal Trade Commission and physician practice.  Journal of Medical Practice Management .  20(5):259-62, Mar./Apr. 2005.

Greaney, T.  Antitrust and hospital mergers: does the nonprofit form affect competitive substance? Journal of Health Politics, Policy and Law .  31(3):511-29, June 2006.

Guterman, S., and Serber, M. Enhancing Value in Medicare: Demonstrations and Other Initiatives to Improve the Program.   New York:  The Commonwealth Fund, Jan. 2007.

Internal Revenue Service. Directive: Hospitals Providing Financial Assistance to Staff Physicians Involving Electronic Health Records. May 11, 2007.

Jain, S., and Roble, D.  Gainsharing in health care meeting the quality-of-care challenge.  Healthcare Financial Management.  62(3):72-78, Mar. 2008.

Jain, S., and Roble, D.  Gainsharing in health care meeting the quality-of-care challenge.  Healthcare Financial Management.  62(3):72-78, Mar. 2008.

Ketcham, J., and Furukawa, M.  Hospital-physician gainsharing in cardiology.  Health Affairs.  27(3):803-812, June 11, 2008.

Larson, S.  How to calm the "perfect storm".  Frontiers of Health Services Management.  24(1):35-40, Fall 2007.

Lazaroff. M. Developments in Antitrust Law in Healthcare Markets. Antitrust Review of the Americas 2008. Global Competition Review, 2007.

Leary, T. The Antitrust Implications of “Clilnical Integration:” An Analysis of FTC Staff’s Advisory Opinion to MedSouth.  Expanded version of speech to St. Louis University Health Law Symposium, Apr 12, 2002. 

Leary, T., and others. Guidance for Clinical Integration; Working Paper.  Hogan & Hartson, LLP for the American Hospital Association, Apr. 2007.

Lefko, L.  All Eyes on Physician-Hospital Arrangements.  HealthLeaders Media, Jan. 24, 2008. 

Marx, D. Jr.  Antitrust Fundamentals. American Health Lawyers Association, Nov. 2006. 

McIntire, T. Two recent opinions allow hospitals to assist independent physicians.
Physician Executive.  31(3):70-2, May/June, 2005. 

Office of the Inspector General, U.S. Department of Health and Human Services.  Advisory opinion on arrangement for a medical center sharing with physician groups a percentage of the medical center’s cost savings arising from the physicians’ implementation of cost reduction measures. OIG Advisory Opinion No. 08-09, July 31, 2008.

Office of the Inspector General, U.S. Department of Health and Human Services.  OIG Advisory Opinion No. 08-10, Aug. 19, 2008.

Office of the Inspector General, U.S. Department of Health and Human Services.  Contractual Joint Ventures, Apr. 2003.

Perry, M.  A local solution for hospital-physician relationships.  Frontiers of Health Services Management.  24(1):31-34, Fall 2007.

Petasnick, W.  Hospital-physician relationships:  imperative for clinical enterprise collaboration.  Frontiers of Health Services Management.  24(1):3-10, Fall 2007.

Physician-hospital affiliation/integration models.  Healthcare Executive.  23(4):21, July/Aug. 2008.

Reiboldt, M.  Find Strength in Numbers.  HealthLeaders Media.   Apr. 24, 2008.

Reinertsen, J., and others.  Engaging Physicians in a Shared Quality Agenda - Free.  Cambridge, MA:  Institute for Healthcare Improvement, 2007.

Report on the National Steering Committee.  Chicago:  Health Research and Educational Trust, Sept. 2006.

Romano, M. Integration demonstration. The CMS' latest pay-for-performance initiative willtest the power of integrated delivery systems to alter doc practice patterns. Modern Healthcare.  35(44):6-7, 16, Oct. 31, 2005.

Rosch, J. Clinical Integration in Antitrust: Prospects for the Future. Remarks of Commissioner, Federal Trade Commission to Americah Health Lawyers Association, American Bar Association Antitrust Secion and Health Law Section at 2007 Antitrust in Health Care, Sept. 17, 2007. 

Runy, L. A collaborative approach to quality and cost control. Hospitals and Health Networks Most Wired Online.  May 29, 2007. 

Saver, R. Squandering the gain: gainsharing and the continuing dilemma of physician financial incentives.
Northwestern University Law Review. 98(1):145-238, Fall 2003.

Schryver DL. The re-emergence of the IDS practice model. Cost-driven and community-focused. MGMA Connexion.  5(5):44-6, 48, May/June, 2005.  1. Erratum in: MGMA Connexion.  5(8):2, Sept. 2005. 

Sheridan, S., and others.  Disclosure through our eyes.  Journal of Patient Safety.  4(1):18-26, Mar. 2008.

Shields, M., Sacks, L., and Patel, P.  Clinical integration provides the key to quality improvement: structure for change.  American Journal of Medical Quality.  23(3):161, 2008.

Slonim, A., and others.  Recommendations for integration of chronic disease programs: are your programs linked?  Preventing Chrnoic Disease.  4(2):serial online, Apr. 2007.

Snapshot. Uncoordinated Care: A Survey of Physician and Patient Experience. California HealthCare Foundation. 2007. 

Solomon, M.Regional health information organizations: a vehicle for transforming health care delivery? Journal of Medical Systems.  31(1):35-47, Feb. 2007. 

Sorrel, A.  Doctor-hospital network gets rare FTC approval to integrate. American Medical News, Oct. 15, 2007.

Sorrel, A.  FTC lets grop continue clinical integration plan.  American Medical News, Feb. 5, 2007. 

Taylor, M.  Advice and Consent from the FTC.  Hospitals and Health Networks.  81(1):40, Jan. 2008. 

Taylor, M. Antitrust watchdog. FTC Chairman Majoras says healthcare remains an importantpriority for her agency.  Modern Healthcare.  36(26):28-30., June 26, 2006.

Taylor, M. Behind the FTC's lawsuit. Payers pointed finger at Evanston Northwestern. Modern Healthcare.  36(1):14-6, Jan. 2, 2006.

Taylor, M.  Changing the balance. In ordering Evanston Northwestern to divest a hospital, theFTC could give insurers more power in negotiating with providers.  Modern Healthcare.  35(43):6-7, 16, Oct. 24, 2005.

Taylor, M. Competitive duel. FTC lawyer says Evanston deal caused 'sea change'.  Modern Healthcare.  35(7):8-9, Feb. 14, 2005.

Taylor, M. FTC hears Illinois merger case.  Modern Healthcare.  36(21):14, May 22, 2006.

Taylor, M. Pulling it together. Annual IHN 100 ranking shows continuing move toward enhancedintegration. Modern Healthcare.  36(6):28-31, Feb. 6, 2006.

Taylor, M. High stakes in Evanston case. If FTC loses, hospital merger enforcement may lag. Modern Healthcare.  35(27):12, July 11, 2005.

Taylor, M. Legal issues. Will FTC decision in Illinois impact hospital mergers nationally?  Hospitals and Health Networks.  81(9):28, Sept. 2007.

Taylor, M. Merger issues linger. Modern Healthcare.  35(4):7, Jan. 24, 2005.

Taylor, M. Responding to an antitrust investigation. When the FTC calls, be sure to get anexperienced lawyer, cooperate fully and don't be afraid to settle.  Modern Healthcare.  34(45):S3, Nov. 8, 2004.

Taylor, M. Revival of the fittest. PHOs have dropped in number, but many are still goingstrong despite antitrust scrutiny--and there's even renewed interest. Modern Healthcare.  36(26):24-6, June 26, 2006.

Taylor, M. Splitting headaches. FTC judge's ruling could have far-ranging impact.  Modern Healthcare.  35(46):17-8, Nov. 14, 2005.

Taylor, M. Working through the frustrations of clinical integration.  Hospitals and Health Networks.  82(1):34-40, Jan. 2008. 

The Board of Directors for America’s Health Insurance Plans (AHIP) has released core principles that support using the patient-centered medical home approach to enable more personalized and coordinated care. The patient-centered medical home model replaces episodic care with a long-term relationship between patient and physician. The new AHIP model focuses on:

  • Practice redesign so care is delivered to meet a patient’s needs and wants;
  • Clear criteria for patient participation;
  • Adoption of health IT that enables evidence-based integrated care;
  • Accountability;
  • Engaging, informing, and empowering consumers to improve behavior;
  • Structuring payment to align with measurable improvements; and
  • Piloting reformed payment models or practice redesign.

(AHIP Board of Directors Releases Principles on Patient-Centered Medical Home, AHIP Press release, June 25. 2008)

Thaldorf, C., and Liberman, A.  Integration of health care organizations: using the power strategies of horizontal and vertical integration in public and private health systems. Health Care Manager.  26(2):116-27, Apr./June 2007. 

Tollen, L.  Physician Organization in Relation to Quality and Efficiency of Care: A Synthesis of Recent Literature.  New York:  The Commonwealth Fund, Apr. 17, 2008.

Trisolini, M. and others. The Medicare Physician Group Practice Demonstration: Lessons Learned on Improving Quality and Efficiency in Health Care.  New York:  The Commonwealth Fund, Feb. 2008.

Trisolini, M. and others. Medicare Physician Ggroup Practices: Innovations in Quality and Efficiency. New York:  The Commonwealth Fund, Dec. 2006.

Tynan, A., and Draper, D.  Getting What We Pay For: Innovations Lacking in Provider Payment Reform for Chronic Disease Care.   Washington:  Center for Studying Health System Change,  June 2008.

U.S. Department of Justice and Federal Trade Commission.  Improving Health Care: a Dose of Competition. July 2004.

Vuletich, M. New IDS models share the same challenges.  MGMA Connexion.  5(5):47-8, May/June 2005. 

Warden, J. and Woodward K. Creating a sustainable physician strategy.  Healthcare Financial Management.  62(1):62-68, Jan. 2008.

Weil, A. Public administration barriers to expanding integrated models.  Health Affairs .  20(6):173-4, Nov./Dec. 2001.

Whitham, J., and Bernstein, S. Bonding with physicians: hospitals and IT donations. Trustee.  60(10):29-30, Nov./Dec. 2007.

Wilensky, G., Wolter, N., and Fischer, M. Gain sharing: a good concept getting a bad name?   Health Affairs.  26(1):w58-67, Jan./Feb. 2007.

Woolf, H., and others.  Putting it together: finding success in behavior change through integration of services. Annals of Family Medicine.  Suppl. 2:S20-7, July/Aug. 3, 2005.