The passage of the healthcare reform bill will have a devastating impact on physician-owned hospitals, the patients they treat, and the communities they serve, according to Physician Hospitals of America. Molly Sandvig, Executive Director of PHA, the legislation virtually destroys over 60 hospitals that are currently under development, and leaves little room for the future growth of the industry.
Independent practice associations (IPA) appear to be on the decline, but providers should give such alliances a second look, says Randi Kopf, RN, MS, JD, principal at Kopf HealthLaw, LLC, in Rockville, MD. The problem isn't with providers working cooperatively. Rather, problems arise when providers are too loosely connected but try to negotiate collectively. Substantial integration should be the goal, Kopf says.
A look at recent Federal Trade Commission (FTC) activity makes it clear that without substantial integration, collective negotiations can put an IPA at risk of FTC action.
In a June 2009 California case, the FTC found that a 600- physician IPA in California violated federal antitrust law by fixing prices charged to insurers. The IPA ultimately agreed to a consent order that barred it from collectively negotiating fee-for-service reimbursements "and engaging in related anticompetitive conduct."
The IPA did not engage in any activity that might justify collective agreements on the prices its members would accept from insurers, the FTC found. The IPA had not "clinically or financially integrated their practices to create efficiencies sufficient to justify the complained-of conduct."
In contrast, in a 2007 opinion, the FTC concluded that collective negotiation was not illegal price-fixing because the "substantial integration by its physician participants … has the potential to result in the achievement of significant efficiencies that may benefit consumers." Joint contracting was "subordinate to, reasonably related to, and may be reasonably necessary for, or to further" the IPA's ability to achieve the potential efficiencies.
The proposed joint pricing and collective negotiations were "ancillary" to the integration and achievement of efficiencies.
For participants in a clinically integrated venture to jointly negotiate price and price-related terms, the joint negotiation must be reasonably necessary to achieve the legitimate pro-competitive purposes of the joint venture. Much of this is outlined in the Department of Justice's and FTC's Statement 8, available at www.ftc.gov.
The message is much the same as it has been for years, says Kopf. The FTC has simply spelled it out. She cites some of the basics to emerge from the FTC statements, opinions, and actions. Integration, she points out, involves:
Financial risk-sharing mechanisms
Cooperative activities to achieve efficiencies in delivery of clinical services
A high degree of interdependence and cooperation
Reasonably necessary joint pricing and collective negotiation to the integration and achievement of efficiencies
This article was adapted from one that originally appeared in the March 2010 issue of The Doctor's Office, a HealthLeaders Media publication.
Senate Republicans have successfully identified two minor violations of reconciliation rules in the final piece of the healthcare package, forcing the Senate to change the reconciliation bill and ship it to the House of Representatives for final passage. But Democratic leaders said the provisions that will be struck do not significantly affect the student loan program or the healthcare bill overall. The corrected legislation most likely will not be subjected to additional challenges when it is sent back to the House and is expected to receive final approval before the weekend, the Washington Post reports.
The day after President Barack Obama signed the landmark health bill into law, Maryland Gov. Martin O'Malley announced a task force to oversee the implementation of federal changes, a move the governor said aims to make Maryland a national leader in the healthcare overhaul. O'Malley said the legislation builds on Maryland's efforts in recent years to expand coverage by adding thousands of parents and their children to the Medicaid rolls, offering assistance to small businesses to provide coverage to their employees, and letting young adults stay on their parents' healthcare plans to age 25, the Baltimore Sun reports.
Federally funded health clinics are set to play an even larger role in the revamped healthcare landscape, which expands Medicaid and other insurance coverage and sharply increases funding for the clinics, the Wall Street Journal reports. The healthcare overhaul that President Barack Obama signed Tuesday boosts funding by $10 billion over five years for the clinics, known as community health centers. The clinics currently receive about $2 billion of federal funds annually, and offer care such as basic blood and dental work to 20 million patients in hundreds of locations across the U.S.
A February survey conducted by Harris Interactive on behalf of iVillage found that women heavily rely on the Internet as a health resource before turning to a family member or visiting a doctor. Anonymous peer networking and sharing common experiences is what drives women online for health matters, with 4 out of 5 (82%) saying there are reasons to feel uncomfortable when discussing health concerns or questions with friends or family members. Over half of women (59%) said that discussing health concerns with people they know can be embarrassing.