Haven't we met before? Don't call it a merger--a spate of new joint operating agreements may spark '90s deja vu, but it's different now, executives say.

While a legal ruling in 2000 put a damper on joint operating agreements, hospital officials are again testing the waters. Systems or hospitals in Georgia, Maine, New York and Wisconsin are all looking at some kind of cooperation. "There are a lot more conversations occurring again between organizations, between health systems," says William Petasnick, left. "Some of this is a reflection of times changing again."

[Effects of minimum volume regulations on the provision of health care services in cardiology]. / Auswirkung von Mindestmengen auf die stationären Versorgungsstrukturen der Kardiologie.

In order to improve the quality of medical care, minimum volumes for services were set. Hospitals are only permitted to continue to provide these services and settle accounts with the health insurance companies if they are able to achieve these minimum annual volumes. This study is based on service data of the year 2002 from 88 neighboring hospitals of the hospital association Cologne, Bonn and region. In the study, the influence of these regulations on the provision of health care services in cardiology were examined. The cases were grouped according to the different examined services, followed by an analysis of the number of cases for each hospital in comparison to four fictitious minimum quantity models. When the hospital's volume remained below the minimum quantity, these cases were assigned to the nearest hospital still able to provide the service. For the services coronary angiography, PTCA, AICD implantation, EPS and ablation, only marginal case redistributions were determined. Depending on the minimum quantity, service concentrations are only expected for pacemaker implantations. Due to the increasing service concentration as a consequence of the DRG-payment system, a bureaucratic regulation of minimum volumes has become superfluous for most cardiological services. Instead of minimum volume regulations, recommendation of minimum volumes should be made in cardiological guidelines.

An empirical investigation of for-profit and tax-exempt nonprofit hospitals engaged in joint ventures.

Joint ventures between nonprofit and for-profit hospitals offer opportunities for collaboration to increase efficiency. These transactions have attracted the attention of the Internal Revenue Service, which may threaten tax-exempt status. This article analyzes inherent financial characteristics of nonprofit hospitals that joint venture with for-profit hospitals and those that choose not to joint venture.

Minimizing antitrust exposure in a virtual merger.

As an alternative to complete mergers or joint ventures, hospitals recently have begun to explore virtual mergers, in which the parties are able to retain some managerial and financial independence while coordinating their mutual operations to financial advantage. Because virtual mergers are a recent phenomenon and can be structured in various ways, the antitrust risks associated with such transactions are unclear. A state antitrust challenge brought against an East Coast virtual merger and informal guidance by Federal antitrust attorneys suggest that the antitrust agencies will be inclined to challenge a virtual merger if the parties to the transaction retain too much independent decision-making authority. Hospitals that are considering a virtual merger therefore would do well to structure the transaction to combine governance and administration, financial assets, operations, and medical staffs as much as possible, while still allowing each party to the transaction to retain the independent decision-making authority each feels is necessary.