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Sunday, June 06, 2010

Is refusal to accept government price controls "price fixing"

According to this article in the Christian Science Monitor, the Justice Department says it is -at least in regard to as physicians.

This governmental action seems to go past earlier efforts by the Federal Trade Commission who previously considered effort by groups of physicians to band together to try and increase their bargaining position with third parties as violating antitrust laws. See here for my 2007 commentary on one such case. Now physicians seem to have another governmental entity with even bigger teeth ( potential criminal penalties), the Justice Department, to content with as they deal with third party payers in and out of government.

Here is a quote from the CSM article describing the nature of the teeth"

"This is another reason why the DOJ’s presence in a physician case is more disturbing than the normal FTC case. The DOJ has a number of “tools” the FTC does not, including the self-granted power to award amnesties from criminal prosecutions to the first “conspirator” to step forward and provide evidence against one’s competitors.

A doctor that feared prosecution could seek amnesty — and provide the Justice Department a blank check to rummage through his files and private communications. And if that doesn’t work, the DOJ can always seek wiretaps of physicians’ phones and computers, a power awarded the DOJ during a 2006 renewal of the PATRIOT Act. The potential exposure of your physician’s confidential records — including your medical records — is limitless ."

As long as insurers set the prices for medical services and the FTC and now the Justice Department prohibits physician groups from fairly negotiating for fees, efforts by physicians to support and take part in P4P programs in the hope that the downward spiral of fees for primary care will be halted will be less effective than rearranging deck chairs on a sinking ship.More and more "going Gault" seems to be the way to go.My take on medical going Gault is to have a retainer practice and do not deal with insurers in and out of government.Unfortunately this seems feasible only for primary care docs.I don't see that arrangement viable for surgeons and procedurists.

H/T to Medical Pastiche.See here. See also here for a discussion of this recent development in limiting the ability of physicians to negotiate with third party payers from the blog " Road to Hellth"


Roy M. Poses MD said...

Remember, though, that it is the opaque RBRVS Update Committee (RUC), supposedly a private effort by the AMA that is just exercising its "First Amendment" rights to free speech, that fixes those physician payments.
See: http://hcrenewal.blogspot.com/2010/06/ruc-off-new-england-journal-once-again.html

We can blame the government for overly heavy-handed enforcement, and we can blame the government for fixing physician payments, not negotiating them.

But remember, the government also gave control over these payments to maybe what it thought was a representative physicians' group. And that group ran with this responsibility, to the detriment of us cognitive and primary care physicians.

We have met the enemy and he is us.

james gaulte said...

No question much to our detriment but I would argue ultimately not just to the primary care and non-procedurists. The surgeons et al have done better but to acquiesce to the governments price controls and be part of the process is to virtually guarantee you will also snared.Chickens come home and hoist on ones own petard is in their future as well.