[Federal Register Volume 79, Number 36 (Monday, February 24, 2014)]
[Notices]
[Pages 10153-10156]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-03765]


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FEDERAL TRADE COMMISSION


Announcement of Public Workshop, ``Examining Health Care 
Competition''

AGENCY: Federal Trade Commission.

ACTION: Notice of public workshop and opportunity for comment.

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SUMMARY: The Federal Trade Commission (``FTC'' or ``Commission'') will 
hold a public workshop, ``Examining Health Care Competition,'' on March 
20-21, 2014, to study certain activities and trends that may affect 
competition in the evolving health care industry. The workshop will 
explore current developments related to professional regulations; 
innovations in health care delivery; advancements in health care 
technology; measuring and assessing health care quality; and price 
transparency for health care services. This notice poses a series of 
questions upon which the FTC seeks public comment. The Commission will 
consider these comments as it prepares for the workshop and may use 
them in a subsequent report or policy paper.

DATES: The workshop will be held on March 20-21, 2014, in the 
Conference Center of the FTC office building at 601 New Jersey Avenue 
NW., Washington, DC. For additional information, visit the workshop Web 
site at http://www.ftc.gov/news-events/events-calendar/2014/03/examining-health-care-competition. Prior to the workshop,

[[Page 10154]]

the Commission will publish an agenda and additional information on its 
Web site. To be considered for the workshop, comments in response to 
this notice must be submitted by March 10, 2014. In addition, any 
interested person may submit written comments in response to this 
notice and workshop discussions until April 30, 2014.

ADDRESSES: Interested parties may file a comment online or on paper by 
following the instructions in the SUPPLEMENTARY INFORMATION section 
below. Write ``Health Care Workshop, Project No. P131207'' on your 
comment and file your comment online at https://ftcpublic.commentworks.com/ftc/healthcareworkshop by following the 
instructions on the web-based form. If you prefer to file your comment 
on paper, mail or deliver your comment to the following address: 
Federal Trade Commission, Office of the Secretary, Room H-113 (Annex 
X), 600 Pennsylvania Avenue NW., Washington, DC 20580.

FOR FURTHER INFORMATION CONTACT: Patricia Schultheiss, Attorney 
Advisor, Office of Policy Planning, Federal Trade Commission, 600 
Pennsylvania Avenue NW., Washington, DC 20580, 202-326-2877, or Karen 
Goldman, Attorney Advisor, Office of Policy Planning, Federal Trade 
Commission, 600 Pennsylvania Avenue NW., Washington, DC 20580, 202-326-
2574, [email protected]. For more detailed 
information about the workshop, including an agenda, please visit the 
workshop Web site: http://www.ftc.gov/news-events/events-calendar/2014/03/examining-health-care-competition.

SUPPLEMENTARY INFORMATION: The Federal Trade Commission seeks to better 
understand the competitive dynamics of evolving health care product and 
service markets. Information obtained during this workshop will enrich 
the Commission's knowledge in this critical sector of the economy and 
thereby support the Commission's enforcement, advocacy, and consumer 
education efforts. The workshop will consider issues related to the 
professional regulation of health care practitioners; innovations in 
health care delivery; advancements in health care technology; 
developments in measuring and assessing health care quality; and recent 
efforts to make price information for health care services more 
transparent. The Commission may convene subsequent workshops in the 
near future to examine additional competition issues in the health care 
industry.

Professional Regulation of Health Care Providers

    The Commission has long been interested in the competitive 
implications of professional regulation in health care.\1\ The 
Commission seeks to inform itself of new developments and refine its 
understanding of the ways in which professional regulations governing 
the scope of practice for health care providers may affect competition.
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    \1\ See, e.g., FTC & U.S. Dep't of Justice (``DOJ''), Improving 
Health Care: A Dose Of Competition (2004), available at http://www.ftc.gov/reports/healthcare/040723healthcarerpt.pdf; FTC Staff 
Comment Before the Massachusetts House of Representatives Regarding 
House Bill 6 (H.2009) Concerning Supervisory Requirements for Nurse 
Practitioners and Nurse Anesthetists (Jan. 2014), available at 
http://www.ftc.gov/sites/default/files/documents/advocacy_documents/ftc-staff-comment-massachusetts-house-representatives-regarding-house-bill-6-h.2009-concerning-supervisory-requirements-nurse-practitioners-nurse-anesthetists/140123massachusettnursesletter.pdf; Letter from FTC Staff to Hon. 
Timothy Burns, Louisiana Legislature (May l, 2009) (regarding 
proposed restrictions on mobile dentistry), available at http://www.ftc.gov/policy/policy-actions/advocacy-filings/2009/05/ftc-staff-comment-louisiana-house-representatives-0; FTC Staff Comment 
Before the Kentucky Cabinet for Health and Family Services 
Concerning Regarding Proposed Rule to Regulate Limited Service 
Clinics (Jan. 2010), available at http://www.ftc.gov/os/2010/02/100202kycomment.pdf.
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    Professional regulations may protect patient safety, improve 
quality of care, and provide useful information to consumers who are 
choosing among health care providers. Greater competition may result 
when regulatory changes expand the number of health care providers or 
services available to consumers by increasing the use of advanced 
practice nurses, dental therapists, and other qualified non-physician 
or non-dentist professionals. Such increased competition may provide 
consumers with benefits such as lower prices and improved access to 
health care services. Some regulations may, however, unnecessarily 
restrict the ability of non-physician health care professionals to 
practice to the full extent of their training, imposing costly 
limitations on professional services without well-founded consumer 
safety justifications or other consumer benefits to offset those costs. 
Such overly restrictive professional regulations are likely to suppress 
beneficial competition by non-physician health care providers and may 
prevent institutional providers (such as hospitals) from developing 
innovative health care delivery models that rely more heavily on non-
physician providers to provide efficient, safe care. While all patients 
may be affected by reduced competition from non-physician health care 
professionals, the impact may be particularly severe for vulnerable and 
underserved patient populations.
    In the workshop, the Commission intends to study developments in 
the regulation of health care professionals, including accreditation, 
credentialing, licensure, and supervision/cooperation requirements. The 
Commission also intends to examine scope of practice issues in emerging 
health care professions, such as dental therapy and care coordination.
    The Commission invites public comment on questions relevant to this 
topic, including:
     What recent developments have occurred in the regulation 
of health care professionals, particularly with respect to 
accreditation, credentialing, licensure, and supervision/cooperation 
requirements?
     What are the consequences of such regulations? To what 
extent are these regulations necessary to protect consumers or serve 
other important state interests? How do they affect the supply of 
services, patient safety, costs, care coordination, and quality of 
care?
     Is there evidence that quality of care is improved when 
professional regulations are narrowly tailored to protect patient 
safety while facilitating greater deployment of non-physician or non-
dentist health care professionals?
     Do professional regulations affect staffing decisions at 
health care facilities? If so, how?
     To what extent might professional regulations 
unnecessarily restrict the scope of practice of non-physician or non-
dentist health care professionals?
     What is the relationship between professional regulations 
and competition? Would changes to professional regulations enhance 
competition among health care providers? If so, what changes would be 
desirable?
     What is the relationship between professional regulations 
and access to care, especially for vulnerable and underserved patient 
populations?
     To what extent do professional regulations vary by state? 
Does state-by-state variation affect patient health, health care 
spending, or other important measures?
     How do current regulations concerning licensure and 
credentialing affect the ability of health care professionals to 
relocate or practice in more than one geographic area, particularly 
across state lines?
     Would greater state-to-state licensure portability improve 
competition? What issues would increased licensure portability raise?

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     How do professional regulations affect reimbursement for 
health care services? Do professional regulations lead to reimbursement 
policies that reduce incentives for health care competition?
     What is the relationship between accreditation of 
education programs and professional regulation? To what extent do 
accreditation standards affect competition? Would changes to 
accreditation standards enhance competition among health care 
providers? If so, what changes would be desirable?
     Are there other factors that should be considered when 
analyzing the competitive implications of professional regulation in 
health care?

Innovations in Health Care Delivery

    Several new models for health care delivery, including retail 
clinics and telemedicine, have emerged in recent years, spurring 
additional competition in the provision of health care services. These 
models may offer significant cost savings while maintaining, or even 
improving, quality of care. These models may also increase the supply 
of health care services, which may expand consumer access to care. The 
Commission seeks to better understand the potential benefits of these 
new health care delivery models.
    The Commission invites public comment on questions relevant to this 
topic, including:
     What are the prevalent and emerging forms of health care 
delivery?
     To what extent are health care services being delivered in 
new formats and locations, such as retail clinics? What trends are 
projected in the future?
     What are the competitive implications of the increased use 
of retail clinics on the supply of services, cost, quality, and access 
to care?
     To what extent is telemedicine being used today? What new 
developments are occurring in telemedicine? What role is telemedicine 
projected to play in the future?
     What are the competitive implications of the increased use 
of telemedicine on the supply of services, cost, quality, and access to 
care? Does the increased use of telemedicine raise any patient safety 
concerns?
     Are there regulatory or commercial barriers that may 
restrict the use of retail clinics, telemedicine, or other new models 
of health care delivery? If so, are there any valid justifications to 
support such restrictions?
     How do professional regulations affect telemedicine or 
other innovations in delivering health care services or expertise 
across geographic areas or jurisdictional boundaries, especially in 
rural or underserved areas?
     What, if any, changes in government regulations would 
facilitate the emergence of new health care delivery models, enhance 
competition among health care providers, and encourage additional 
innovation?
     What are the competitive implications of recent 
legislative proposals to expand or facilitate telemedicine across state 
lines?
     How are new health care delivery models reimbursed for 
providing services?
     Do regulations governing retail clinics, telemedicine, and 
other new models of health care delivery affect reimbursement? Could 
these regulations be modified in ways that would improve reimbursement 
for services provided under new models, better align incentives to 
implement new models, or otherwise promote innovation?
     Are there other factors that should be considered when 
analyzing the competitive implications of retail clinics, telemedicine, 
and other new models of health care delivery?

Advancements in Health Care Technology

    Recent advancements in health care technology may have competitive 
implications. The Commission seeks to better understand developments in 
electronic health records, health data exchanges, and technology 
platforms for health care payers and providers, including the current 
state of competition among hardware and software platforms. In 
addition, the workshop will examine certain new consumer-oriented 
health technologies, such as mobile medical applications and personal 
medical records technologies, that may improve patient engagement and 
quality of care. The Commission invites public comment on questions 
relevant to this topic, including:
     What is the current state of competition in health 
information technology markets serving institutional providers, health 
care professionals, patients, and payers?
     Do innovators in health information technology face 
barriers to entry? If so, are these barriers significant impediments to 
competition? How might these barriers be reduced?
     What new and established technologies have been most 
important to the development and deployment of telemedicine or 
``telehealth''?
     What policies could further technical innovation conducive 
to effective and efficient telemedicine?
     To what extent are information technology vendors and 
health care providers sharing patient health information? Are there 
significant impediments to the useful flow of patient health 
information to improve health care coordination and quality?
     Do recent health care technology advancements raise 
standard-setting, network effects, or interoperability issues?
     What has been the impact of health information technology 
advancements and policies on physicians and other caregivers? What has 
been the impact on patients?
     Does the adoption of particular health care technologies 
lead to increased switching costs and customer lock-in issues?
     Are there other factors that should be considered when 
analyzing the competitive implications of emerging health care 
technologies?

Measuring and Assessing Quality of Health Care

    In the workshop, the Commission intends to examine recent 
developments in the measurement and assessment of health care quality. 
In particular, the Commission will consider whether, and to what 
extent, information related to quality of care affects competition and 
informs health care choices by patients, providers, employers, payers, 
and other health care decision-makers.
    The Commission invites public comment on questions relevant to this 
topic, including:
     How is health care quality measured and evaluated, and for 
what purposes? Are these current measures effective?
     Have there been any recent innovations in quality 
measurement?
     What challenges are encountered when measuring quality? Do 
these challenges differ depending on whether process or structure 
measures are used, versus outcome measures?
     To what extent is quality assessment shifting away from 
process and structure measures, and towards outcome measures?
     How, and to what extent, do quality measures account for 
higher-risk patient populations, so that providers are neither 
penalized for treating sicker patients nor rewarded for selectively 
treating healthier patients? Can risk adjustment be improved?
     How is quality information shared with various health care 
decision-makers, including patients, providers, employers, and payers? 
Are there better ways to convey such information?
     Does available quality information empower patients, 
providers, and other

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health care decision-makers to choose more cost-effective and better 
care?
     Does available quality information facilitate improved 
care coordination?
     Are there ways to improve quality information so that it 
is more useful to patients, providers, and other health care decision-
makers?
     Is a standard measure likely to emerge that would allow 
patients, providers, and other health care decision-makers to 
effectively compare providers based on quality?
     Are there other factors that should be considered when 
analyzing the competitive implications of quality measurement and 
assessment?

Price Transparency of Health Care Services

    Payers, employer groups, and health care systems are engaged in 
efforts to make price information (often combined with quality 
information) more transparent to patients, providers, employers, 
payers, and other health care decision-makers. Price transparency may 
be used as a means to control costs while maintaining quality in the 
provision of health care services. A potential benefit of price 
transparency is that it may enhance competition among health care 
providers or between different, potentially substitutable, treatments, 
thereby leading to reduced prices for health care services and a more 
efficient allocation of health care resources. Some forms of price 
transparency may, however, facilitate price coordination among health 
care providers, thereby dampening competition. The Commission seeks to 
better understand the competitive implications of price transparency 
for health care services.
    The Commission invites public comment on questions relevant to this 
topic, including:
     What types of benefit designs (e.g., co-insurance, high-
deductible health plans, reference pricing) utilize price transparency 
as a means to control costs while maintaining quality? What degree of 
transparency is necessary to achieve each type of benefit design?
     To what extent might price transparency enhance 
competition among health care providers or between different 
treatments?
     To what extent might price transparency facilitate price 
coordination among health care providers and thereby undermine the 
potential benefits of competition?
     Are there ways to focus the use of price transparency so 
that it enhances competition without resulting in negative 
consequences?
     What is the relationship between transparency of price and 
quality information? Is price information more meaningful to patients, 
providers, and other health care decision-makers when combined with 
quality information? Do pricing data alone provide sufficient 
information to enable meaningful health care decisions?
     Are there other factors that should be considered when 
analyzing the competitive implications of price transparency in the 
health care industry?

Request for Comment

    You can file a comment online or on paper. To be considered for the 
workshop, comments in response to this notice must be submitted by 
March 10, 2014. In addition, any interested person may submit written 
comments in response to this notice and workshop discussions until 
April 30, 2014. Write ``Health Care Workshop, Project No. P131207'' on 
your comment. Your comment--including your name and state--will be 
placed on the public record of this proceeding, including on the 
publicly accessible FTC Web site, at http://www.ftc.gov/os/publiccomments.shtm. As a matter of discretion, the Commission tries to 
remove individuals' home contact information from comments before 
placing them on the Commission Web site.
    Because your comment will be made public, you are solely 
responsible for making sure that your comment does not include any 
sensitive personal information, like anyone's Social Security number, 
date of birth, driver's license number or other state identification 
number or foreign country equivalent, passport number, financial 
account number, or credit or debit card number. You are also solely 
responsible for making sure that your comment does not include any 
sensitive health information, like medical records or other 
individually identifiable health information. In addition, do not 
include any ``[t]rade secret or any commercial or financial information 
which . . . is privileged or confidential,'' as discussed in Section 
6(f) of the FTC Act, 15 U.S.C. 46(f), and FTC Rule 4.10(a)(2), 16 CFR 
4.10(a)(2). In particular, do not include competitively sensitive 
information such as costs, sales statistics, inventories, formulas, 
patterns, devices, manufacturing processes, or customer names.
    If you want the Commission to give your comment confidential 
treatment, you must file it in paper form, with a request for 
confidential treatment, and you have to follow the procedure explained 
in FTC Rule 4.9(c), 16 CFR 4.9(c). Your comment will be kept 
confidential only if the FTC General Counsel, in his or her sole 
discretion, grants your request in accordance with the law and the 
public interest.
    Postal mail addressed to the Commission is subject to delay due to 
heightened security screening. As a result, we encourage you to submit 
your comments online. To make sure that the Commission considers your 
online comment, you must file it at https://ftcpublic.commentworks.com/ftc/healthcareworkshop by following the instructions on the web-based 
form. If this Notice appears at http://www.regulations.gov/#!home, you 
also may file a comment through that Web site.
    If you file your comment on paper, write ``Health Care Workshop, 
Project No. P131207'' on your comment and on the envelope, and mail or 
deliver it to the following address: Federal Trade Commission, Office 
of the Secretary, Room H-113 (Annex X), 600 Pennsylvania Avenue NW., 
Washington, DC 20580. If possible, submit your paper comment to the 
Commission by courier or overnight service.
    Visit the Commission Web site at http://www.ftc.gov to read this 
Notice and the news release describing it. The FTC Act and other laws 
that the Commission administers permit the collection of public 
comments to consider and use in this proceeding as appropriate. The 
Commission will consider all timely and responsive public comments that 
it receives on or before April 30, 2014. You can find more information, 
including routine uses permitted by the Privacy Act, in the 
Commission's privacy policy, at http://www.ftc.gov/ftc/privacy.htm.

    By direction of the Commission.
Donald S. Clark,
Secretary.
[FR Doc. 2014-03765 Filed 2-21-14; 8:45 am]
BILLING CODE 6750-01-P