health care (creative english)

Question

CASE STUDY: ANTI-TRUST

"Nomo Booker a forty-five-year-old executive wakes up before sunrise every Friday to meet eight other colleagues before work. For the past twelve years they have been playing basketball at a local park.

This morning was a game. Driving the lane for the winning basket, Nomo was fouled and landed badly on his left leg.

Following the game, Nomo called Dr. Jones, his primary care physician. Dr. Jones was a solo family practitioner until last year when he joined Withering Physicians Group PPG is the area's largest physician group and is affiliated with the area's largest hospital, Withering Hospital, through the Withering System.

Dr. Jones initially wanted to remain independent, but decreasing insurance reimbursements and increasing costs made the change unavoidable. He now no longer competes with physicians in the group; he collaborates with them. Because PPG negotiates with insurers as a single entity, the FTC is investigating whether PPG's formation violates the antitrust laws.

After examining Nomo, Dr. Jones refers him to orthopedic surgeon Dr. Taylor at Withering Sports Medicine Group, another affiliated entity within the Withering System. Dr. Holtz refers Nomo for an MRI at Withering Radiology Center. Since the Withering System acquired Withering Radiology, its share of the radiology market has skyrocketed. Competing independent radiologists are up in arms, complaining about the lack of referrals and Withering Radiology's practice offering insurers discounts in exchange for being designated the exclusive in-network radiology center. Withering Radiology calls this price competition; in its suit, the DOJ calls this abuse of dominance.

Unfortunately, the MRI confirmed that Nomo tore the ligaments in his knee. A week later, Dr. Henry performs reconstruction surgery on Nomo at Withering Hospital. Last year, Withering merged with its nearest competitor, Oakridge Hospital, a small, antiquated, and financially-troubled hospital.

Following the merger, Withering closed part of Oakridge's campus, consolidating non-emergency surgeries at the newer Withering campus. The cost savings were substantial, but the FTC filed a post-closing challenge, contending that insurers were left without a viable alternative. At trial, the insurers testified in the FTC's favor because Withering reimbursement rates are higher than Oakridge's.

Forty-five days later, Nomo received a bill from Withering Hospital. After being told that his insurance company does not cover overnight stays for knee surgery, he learned that his insurer reduced coverage last year after the area's dominant insurance company, Indigo Cross inserted a most favored nation's provision in its contract with the Withering System.

This caused Withering to raise rates for Nomo's insurer, resulting in the insurer's decision to reduce coverage. Indigo Cross calls this price competition; in its suit, the DOJ calls this abuse of market power.

Six months later, Nomo is back on the basketball court. He is now better and wiser. After spending hours on the phone with his insurer, he eventually gives up and pays the bill. At benefits renewal time, he switches to another PPO plan" (BNA, 2015, pp.1-2)

The midterm analysis is to be broken down into the following steps.

1. Identify the most important facts surrounding the case.

2. Identify the key issue or issues

3. Specify alternative courses of action

4. Evaluate each course of action

5. Recommend the best course of action

Writing Requirements:

5-7 page paper in APA format, for citations and references

Use the APA template located in the Student Resource Center to complete the assignment.

Each team member submits the team assignment

Project Team Member Peer Evaluation Form (Peer Evaluation Form)

Grading Criteria:

This assignment will be graded using the UOTP Writing Rubric displayed below

Answer 1

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