This policy lab conducted research on national health policy problems for the Medicare Payment Advisory Commission, or MedPAC. (MedPAC is an independent Congressional agency established by the Balanced Budget Act of 1997 to advise the U.S. Congress on issues affecting the Medicare program.) Students worked in teams with lawyers and PhD economists from MedPAC, resident and fellow physicians from Stanford Hospital, and other students from the University to expand the healthcare workforce by reforming states’ scope of practice regulation and to design antitrust policy to achieve the benefits of coordination and avoid the costs of consolidation.
In response to heightened demand for health services, which has resulted from the Affordable Care Act and other factors, the first project advised states on how they could expand the healthcare workforce by reforming the scope of medical practice regulation. Students analyzed possible changes to state practice regulations with the goal of expanding the scope of practice and specific tasks that non-physicians — such as nurse practitioners, physician assistants, and pharmacists — undertake to reduce the cost and/or improve the quality of care. The policy team researched incentives that the federal government could provide, either through Medicare or other means, to encourage states to optimize their scope of practice rules to reflect available new technologies.
The second project focused on designing antitrust policy to achieve the benefits of coordination and avoid the costs of consolidation. On one hand, closer links between physicians, hospitals, and other health care providers has the potential to reduce cost and improve quality by improving communication across care settings, avoiding wasteful duplication of effort, and reducing medical errors. On the other, consolidation may be used to exploit consumers by facilitating the exercise of health care providers’ market power. This tension has become especially important due to incentives in the Affordable Care Act that encourage doctors and hospitals to join together in Accountable Care Organizations. This project examined the following questions:
- How can the U.S. Department of Justice and Federal Trade Commission use existing federal antitrust law to allow welfare-improving coordination while prohibiting welfare-reducing consolidation in ways that minimize costs of enforcement, including the legal uncertainty facing providers?
- Can adoption of health-care-specific antitrust laws, such as those proposed or enacted in Massachusetts and California, effectively fill in the gaps in existing federal antitrust laws?
- What incentives might the federal government provide, through design of reimbursement policies in the Medicare program, to complement federal and state antitrust laws?
- White Paper: Designing Antitrust Policy to Achieve the Benefits of Coordination and Avoid the Costs of Consolidation
- Legal Memorandum
Working in teams with lawyers and PhD economists from MedPAC and physicians and fellows from Stanford Hospital, practicum students advised states on two topics: (1) how to reform the scope of practice regulations to expand the healthcare workforce to help meet the escalating public demand for healthcare, and (2) how to design antitrust policy to achieve the benefits of coordination and avoid the costs of consolidation.