An article in The New England Journal of Medicine examines whether current proposals in the U.S. health care system may unintentionally be at odds with promoting competition in health care markets. In particular, the authors opine that efforts to promote integrated, coordinated care can generate incentives for provider consolidation that may reduce competition — citing the ACO initiative as an example. ACO’s may take the form of vertical integration — hospitals acquiring physician groups; or horizontal integation — the merger of two hospitals. This, the authors, Katherine Baicker and Helen Levy, argue reduces competition (which is why there is scrutiny from FTC, they note, and from CMS). With respect to EHRs, specifically, the authors caution that “the use of electronic health records, can in theory promote both competition and coordination, but only if they are implemented well.” They then use as an example interoperable health IT, which could lock patients in to their current providers or provider networks.
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As noted in earlier posts, some commentators also worry that only the biggest health care entities will benefit from integrated IT systems, which are supposed to seemlessly and safely share patient data among and between providers or health care payors.