Should Physicians Be Exempt from Antitrust Laws?
Pretzer, Michael, Medical Economics
A year ago, Rep. Tom Campbell, R-CA, introduced the Quality HealthCare Coalition Act, which would make it legal for doctors to bargain collectively with managed care organizations. It would not, however, give them the right to strike.
Many observers thought that HR 1304, as it's known, had no chance of passage and that the collective bargaining issue would be dead by now. But that's not quite the way it's playing out. Although the bill's future remains in doubt-the House plans to consider HR 1304 this year, but no one in the Senate has introduced companion legislation-- the issue is alive and reasonably well.
The AMA is pushing hard for HR 1304, while the health plan trade group, AAHP, is fighting equally hard against it. A hypothetical debate between the two lobbying powerhouses would go something like this:
Is HR 1304 necessary?
AMA: Yes. Six giant health insurance companies now control the health care marketplace. These plans control quality, cost, and access to health care. Physicians have little or no opportunity to advocate for the best care. Independent physicians can jointly present information regarding patient care to health plans. But they have no ability to negotiate jointly. If physicians refuse to contract because a health plan won't listen, they risk antitrust charges and stiff penalties.
AAHP: No. Physicians can and do form organizations-group practices, IPAs, and PHOs-to gain leverage and negotiating strength. In addition, health plans have a variety of mechanisms that encourage physicians to help improve quality of care. In many of the areas, physician involvement is required by federal and state laws and regulations, National Association of Insurance Commissioners model acts, and private accreditation standards.
Isn't the real issue money, not quality?
AMA: No. HR 1304 is about giving health care professionals the power to negotiate all contract terms and conditions to promote quality health care. Many physicians are currently presented with contracts that, for example, prohibit discussion of treatment options, restrict access to specialty care, and contain payment schemes that limit medically necessary care. Those provisions are detrimental to patient care.
AAHP: Yes. Doctors' real complaint is that the antitrust laws prevent them from jointly negotiating fees. …