Antitrust rules affect mergers

June 3, 2005

My three-doctor cardiology practice is considering a merger with one of the three other cardiology groups in our community. Would this violate antitrust rules?

Q: My three-doctor cardiology practice is considering a merger with one of the three other cardiology groups in our community. Would this violate antitrust rules?

A: Probably not, if it's a true merger-meaning the two groups would become one corporate entity, and all members would share financial risk and bill under the same group identification number. But if you're talking about an IPA or some other sort of physician network, you need to examine guidelines issued by the Department of Justice and Federal Trade Commission.

For instance, your network could violate antitrust rules if it holds an exclusive contract with your local hospital or managed care plan, and the total number of physicians in the group exceeds 20 percent of the cardiologists working in your community. Even if the network doesn't hold an exclusive contract, the setup could violate antitrust rules if the number of physicians in the group exceeds 30 percent of the community's cardiologists. Ask a healthcare attorney to review the specifics of your case. The key issue is the degree to which your arrangement may limit the ability of other provider networks or health plans to compete in the market.