Accountable care and integration: a challenge for credentialing and risk management.

Healthcare reform efforts have resulted in expanded creation of integrated organizations such as accountable care organizations. These ACOs, however, create additional risk management issues for organizations in terms of antitrust compliance, fraud and abuse, and medical liability issues. While much has been written on the formation of such organizations, the postformation risks have not been explored adequately.

Can preventing diversion of profitable patients justify hospitals' economic credentialing under the antitrust laws?

Investments by physicians in specialty hospitals, ambulatory surgery centers, and other competing facilities have caused many full-service acute care hospitals a great deal of concern. These full-service hospitals believe they are at a disadvantage in competing against such centers because physician-investors allegedly can "pre-select" profitable patients. Full-service hospitals have reacted in a variety of ways, including adopting economic credentialing policies.