Stop their expansion? Hell, shrink them.

Just five weeks after its plans to merge with a big suburban hospital were rebuffed, the state’s most powerful health system is moving to complete an acquisition of a smaller doctors group that will strengthen its foothold in the Eastern Massachusetts medical market.

The move by Partners HealthCare to take over Harbor Medical Associates, a practice of about 70 physicians on the South Shore, immediately drew fire from Attorney General Maura Healey.

Adding Harbor Medical to its physician network — already 6,000 strong — will allow Partners to raise the prices those doctors charge. The state Health Policy Commission, which tracks medical spending, has said Partners’ acquisition of Harbor Medical would permanently raise prices by more than 41 percent a year, adding $8 million to annual spending.

But that's not all it would do. The acquisition would also cement in the referrals of those doctors to PHS hospitals, which are also priced well above average. So not only would local MD visits become more expensive: Follow-up secondary and tertiary care would also.

The AG and the story miss out on a key element of this scenario, the compliance of the major insurer in the state, Blue Cross Blue Shield of MA.  Had not BCBS agreed to a contract term that allowed PHS to expand its base of physicians, those doctors would not have been able to have been offered higher rates in the first place.  They might then have chosen to become affiliated with another network or to have remained independent.  (Why do I only mention BCBS?  Because it is, by far, the dominant insurer in the state–with more subscribers than all the others combined–and the other small companies are forced to follow its lead on such issues.)  Why is there no investigation by the AG into BCBS contracting practices?

I wonder, too, why the AG and the newspaper do not expand on the implications of such statements as this.

“Harbor Medical’s chief executive, Dr. Peter A. Grape, and Brigham and Women’s Hospital’s president, Dr. Elizabeth G. Nabel, added in a joint statement that the deal will give South Shore patients better access to specialists at Brigham.”

This is a prima facie admission of discrimination on the part of this Harvard teaching hospital:  You get better access to us only if you are referred by a PHS doctor.

And is likely also an admission that the Epic EHR being installed by PHS also is being used in a discriminatory fashion:  You only get interoperability between your local doctor's and the hospital's electronic health record if both entities are part of the PHS system?

It's time for the AG to take PHS to task for continuing exploitation of its existing market power, to pursue anti-trust measures to shrink the system down, in addition to opposing its expansion.  It's time for the AG to insist on true interoperability of EHRs in the state–on which hundreds of millions of dollars in government-supported investments are being made–to allow full choice by patients and referring physicians.  It's time for the newspaper, too, to point out the inherent inconsistencies in the PHS statements and actions: Report on the existing use of market power, not only increments to it.  A good first step would be to check out that PHS billion dollar Epic EHR system and see how costly it will be for a non-PHS physician group or hospital to exchange patient medical records.