An appellate court on July 8 revived an antitrust lawsuit against IU Health that alleges the Indianapolis-based health system engaged in anti-competitive behavior that decreased standards of care in the region.
1. IU Health won a motion to dismiss the suit in November after a federal judge found the geographic markets outlined by Ricardo Vazquez, MD, the surgeon-plaintiff in the lawsuit, did not reflect the "commercial realities of the industry," according to Bloomberg.
2. Dr. Vazquez, an independent vascular surgeon in Bloomington, Ill., alleges IU Health restricted referral patterns to specialists within its network after acquiring almost all the primary care physicians in Southern Indiana. "IU Health charges more for patients to see these unfamiliar vascular surgeons — raising prices to consumers and payers — patients receive lower quality care, and patients cannot receive certain vascular surgery services all together from the IU Health vascular surgeons."
3. The lawsuit also alleges IU Health employs 75 percent of vascular surgeons and 97 percent of primary care physicians in Bloomington and over 80 percent of primary care physicians in the wider region and can direct where surgeries are performed. IU Health's alleged "monopoly" over primary care services in the region forces patients to see physicians in its network and sacrifices patients' continuity of care, according to the complaint.
4. Dr. Vasquez said he previously had privileges at Bloomington Hospital, part of IU Health, but also took cases to Indiana Specialty Surgery Center, which competes directly with an IU Health-affiliated ASC. He alleges Bloomington Hospital improperly revoked his privileges because he took cases outside the health system's network and opened an office-based lab instead of using IU Health's outpatient vascular services.
5. IU Health stopped credentialing Dr. Vasquez as a participating provider within the IU Health Plan and transferred or referred his former patients to IU Health's Methodist Hospital in Indianapolis, which increased the cost of care and reduced quality, according to the complaint. Prices are higher at Methodist than Bloomington and the additional time it takes to transfer patients from the local facility to Indianapolis could be life-threatening, the lawsuit said.
6. The lawsuit seeks to break up IU Health's monopoly over primary care services and prevent the system from enforcing an internal referral policy that prevents its primary care physicians from referring to vascular surgeons outside its network.