The clock ran out Monday on a trial scheduled to last exactly 5,340 minutes. Lawyers for St. Lukes Health System and its opponents raced to make final points about the systems multimillion-dollar acquisition of the Saltzer Medical Group last year.
The Federal Trade Commission and Saint Alphonsus Health System called witnesses who rebutted St. Lukes claims that owning Saltzer is critical to the systems plans to improve health care and control rising health-insurance costs.
David Dranove, a health-industry management and strategy professor at Northwestern University, rejected an argument by a St. Lukes economist that patients will simply leave a health system if that system raises prices above competitive levels.
We just cant expect pricing pressure to be imposed by patients, he said. Patients may not pay attention to prices paid by insurers and whether those prices have risen, he said. Those who do may discover its hard to shop around for a cheaper doctor, he said.
Dranove said that if St. Lukes is allowed to keep Saltzer and employ its more than 40 doctors, Well be stuck with a dominant provider with none of the benefits that St. Lukes has promised.
Kenneth Kizer, a former emergency doctor and a former undersecretary for health in the U.S. Department of Veterans Affairs, downplayed the assertions by St. Lukes executives that the system is on track to make transformational changes to health care.
Theres nothing special St. Lukes is doing that isnt being done elsewhere in the country, he said. The systems quality claims are speculative and not merger-specific, he said.
Kizer pointed to industry studies and reports that, he said, cast doubt on whether St. Lukes can achieve its goals. A key study found that independent doctor groups provided higher-quality, lower-cost care than hospital-employed groups.
But later, a St. Lukes lawyer dug up that study and pointed to sentences that seemed to contradict Kizers assertions and to support St. Lukes theory of primary-care focused integration.
More than 25 lawyers were in court for Mondays session. Many are health-care antitrust specialists flown in from Chicago, Detroit, California and Washington, D.C. They spent the past four weeks sparring before U.S. District Judge B. Lynn Winmill, with an occasional dust-up over time limits or surprise witness testimony only to talk and laugh with their rivals when court is in recess.
Before he left, Winmill praised both sides for the absolute highest quality of lawyering that I saw in this courtroom, adding that he wished the press and public could have been present for the entire trial, since it truly was of the first order.
The trial ran several minutes longer than the time Winmill alloted. Lawyers will return to the courtroom Nov. 7 for closing arguments. Winmill could issue his verdict before Christmas.