Physician Integrative Efforts and The Antitrust Laws
Today, health insurers control large segments of the covered lives in almost every part of the country. Every day physicians ask themselves what they can do to negotiate more effectively against these powerful health insurers. What can a physician do when a large health insurer simply announces that it is once again lowering reimbursement levels and tries to control the services the physician can provide to patients? How can physicians respond in a way that allows them to provide high quality care to patients and receive appropriate compensation for their services? How can you do this without violating the antitrust laws?
We have helped physicians address these questions for more than a decade.
Creating Collaborative Collectives Among Physicians to Leverage Your Fees
Physicians have a wide range of options when trying to address the considerable market strength of health insurers. Physicians know how to treat patients, and they know what works and what does not work with regard to patient care. When physicians form joint ventures, they can apply their knowledge, experience and training to the real problems that exist in health care markets. This can significantly improve patient care, and put patient care back where it belongs – in the hands of physicians.
Physicians, however, oftentimes compete against one another. Joint ventures and collaborative efforts they enter into can, therefore, raise antitrust concerns. An antitrust concern, however, does not mean that physicians cannot enter into joint ventures and other collaborative arrangements that improve patient care and also increase the reimbursement physicians receive from health insurers. The antitrust laws have considerable flexibility when properly understood. The antitrust laws are actually designed and intended to foster collaborative arrangements that benefit consumers and improve efficiency. The days when large categories of collaborative conduct were simply prohibited are long gone.
It is important to put the antitrust laws into context. Competitors in all sorts of different markets and industries form lawful joint ventures and collaborative arrangements all the time. The courts and government enforcement agencies recognize that many collaborative arrangements between competitors benefit consumers and represent precisely the types of arrangements the antitrust laws encourage. Physicians have the same right to enter into mergers, form joint ventures and other types of collaborative arrangements under the antitrust laws and firms selling standard products. It’s important, however, that physicians work with an attorney knowledgeable in health care antitrust law when forming joint ventures and collaborative arrangements, particularly if these new entities will negotiate fees with health insurers. We have years of experience doing precisely this. Our role is not to simply act as a break on an efficient business arrangement that will benefit patients. Our goal is to identify the antitrust issues and point out the various options available to our clients under the antitrust laws by showing the flexibility in modern antitrust law.
It is a great irony that, while the antitrust laws were designed to benefit consumers, they are oftentimes viewed as impediments to creative ways of improving health care. The antitrust laws do not prevent integrative efforts that improve care, and do not prevent physicians from jointly negotiating fees when they create integrative efficiencies that improve care. We have years of experience advising physicians on this issue.
Helping create a more healthy balance in the health care industry.
Please review the following publications if you would like more information on these topics:
Health Law and Compliance Update, Chapter 3, Antitrust in Evolving And Consolidating Provider and Payer Markets, Published by Aspen, 2007;
Competing in the Marketplace: How physicians can improve quality and increase their value in the health care market through medical practice integration, American Medical Association, March 2007;
Contact the Law Offices of George M. Sanders, P.C. for your legal advice. We serve clients nationwide from Chicago, Illinois. You may reach us at: Phone: 312-624-7642 | Fax: 312-624-7701