Cascade Health Solutions v. PeaceHealth

502 F.3d 895, 2007 U.S. App. LEXIS 21075, 2007 WL 2473229
Court of Appeals for the Ninth Circuit·Decided September 4, 2007·No. 05-35627, 05-35640, 05-36153, 05-36202·Published·Cited by 3 cases

Opinion

GOULD, Circuit Judge:

McKenzie-Willamette Hospital (“McKenzie”) filed a complaint in the district court against PeaceHealth asserting seven claims for relief. Five of the claims arose under the federal antitrust laws: monopolization, attempted monopolization, conspiracy to monopolize, tying, and exclusive dealing. The other two claims arose under Oregon state law: price discrimination and intentional interference with prospective economic advantage.

Before trial, the district court granted summary judgment in favor of Peace-Health on McKenzie’s tying claim. After a two-and-a-half-week trial, the jury rendered a verdict in favor of PeaceHealth on McKenzie’s claims of monopolization, conspiracy to monopolize, and exclusive dealing. However, the jury found in favor of McKenzie on McKenzie’s claims of attempted monopolization, price discrimination, and tortious interference. The jury awarded McKenzie $5.4 million in damages, which the district court trebled for a final award of $16.2 million. The district court also awarded McKenzie $1,583,185.57 in attorneys’ fees, costs, and expenses.

We vacate the jury’s verdict in favor of McKenzie on the attempted monopolization, price discrimination, and tortious interference claims, and we vacate the district court’s summary judgment in favor of PeaceHealth on the tying claim. We also vacate the district court’s award of attorneys’ fees, costs, and expenses. We remand for further proceedings.

I

A

McKenzie and PeaceHealth are the only two providers of hospital care in Lane County, Oregon. The jury found and, for the purposes of this appeal, the parties do not dispute, that the relevant market in *902 this case is the market for primary and secondary acute care hospital services in Lane County. Primary and secondary acute care hospital services are common medical services like setting a broken bone and performing a tonsillectomy. Some hospitals also provide what the parties call “tertiary care,” which includes more complex services like invasive cardiovascular surgery and intensive neonatal care.

In Lane County, PeaceHealth operates three hospitals while McKenzie operates one. McKenzie’s sole endeavor is McKenzie-Willamette Hospital, a 114-bed hospital that offers primary and secondary acute care in Springfield, Oregon. McKenzie does not provide tertiary care. In the time period leading up to and including this litigation, McKenzie had been suffering financial losses, and, as a result, merged with Triad Hospitals, Inc. 1 so that it could add tertiary services to its menu of care.

The largest of PeaceHealth’s three facilities is Sacred Heart Hospital, a 432-bed operation that offers primary, secondary, and tertiary care in Eugene, Oregon. PeaceHealth also operates Peace Harbor Hospital, a 21-bed hospital in Florence, Oregon and Cottage Grove Hospital, an 11-bed hospital in Cottage Grove, Oregon. In Lane County, PeaceHealth has a 90% market share of tertiary neonatal services, a 93% market share of tertiary cardiovascular services, and a roughly 75% market share of primary and secondary care services.

To understand the antitrust issues in this case, it is necessary to appreciate the structure of the market in which this case arises. The market for hospital services and medical care is complex. However, based on the record, there appear to be three major participants in the market for hospital services: hospitals, insurers, and patients. Hospitals, like those operated by PeaceHealth and McKenzie, provide services to patients and sell services to insurers. Insurers are usually commercial health insurance companies that seek to buy medical services from hospitals on the best terms possible. The insurers in turn sell insurance services to patients and employers. Patients buy health insurance from insurers (often through their employers) and sometimes buy services from hospitals.

In the transaction between a hospital that sells care services and an insurer that buys care services, the price agreed upon is often referred to as a “reimbursement rate.” For example, in a hospital-insurer contract, the agreed upon price might be “a 90% reimbursement rate.” A 90% reimbursement rate price means that, when the insurer must purchase services from the hospital, the insurer gets a 10% discount off the hospital’s regular price, also called the charge master or list price. It follows that hospitals prefer high reimbursement rates and insurers prefer low reimbursement rates, as each group pursues its own economic interest.

B

Before trial, the district court granted summary judgment to PeaceHealth on McKenzie’s tying claim, concluding that McKenzie had not presented any evidence that PeaceHealth “coerced” insurers into purchasing primary and secondary services from it in order for the insurers to obtain tertiary services. The district court let the remainder of McKenzie’s claims proceed to trial before a jury. On McKenzie’s monopolization and attempted monopolization claims, McKenzie’s primary theo *903 ry was that PeaeeHealth engaged in anticompetitive conduct by offering insurers “bundled” or “package” discounts. McKenzie asserted that Peace-Health offered insurers discounts of 35% to 40% on tertiary services if the insurers made PeaeeHealth their sole preferred provider for all services— primary, secondary, and tertiary. McKenzie introduced evidence of a few specific instances of PeaceHealth’s bundled discounting practices.

For example, in 2001, PeaeeHealth was the only preferred provider of hospital care under the preferred provider plan (“PPP”) of Regence BlueCross BlueShield of Oregon (“Regence”). 2 At that time, Re-gence was paying PeaeeHealth a 76% reimbursement rate for all of PeaceHealth’s medical services, including primary, secondary, and tertiary services. Around that time, pursuant to McKenzie’s request, Regence considered adding McKenzie to the PPP as a preferred provider of primary and secondary services. When Re-gence’s contract with PeaeeHealth came up for its annual renewal, Regence solicited two proposals from PeaeeHealth. Under one proposal, PeaeeHealth would remain the only preferred provider. Under the other proposal, McKenzie would be added as a preferred provider. Peace-Health offered an 85% reimbursement rate for all services if it remained Regence’s sole preferred provider of primary, secondary, and tertiary services, and a 90% reimbursement rate if McKenzie was added as a preferred provider of primary and secondary services. Regence thereafter declined to • include McKenzie as a preferred provider.

That same year, McKenzie sought and received admission as a preferred provider of primary and secondary sendees under the preferred plan offered by Providence Health Plan (“Providence”). Until then, PeaeeHealth was the only preferred provider of primary, secondary, and tertiary services in the Providence preferred plan. Upon McKenzie’s admission as a preferred provider, PeaeeHealth increased its reimbursement rate with Providence from 90% to 93%.

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Cascade Health Solutions v. PeaceHealth, 502 F.3d 895, 2007 U.S. App. LEXIS 21075, 2007 WL 2473229 (9th Cir. 2007).

502 F.3d 895 (Cascade Health Solutions v. PeaceHealth) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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