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Physician-sponsored legislation under consideration at the state and federal levels could drive up health care costs and hamper buyer-backed data-collection efforts aimed at quality improvement, health care payers fear.
While somewhat different in each state, the measures generally would exempt self-employed doctors from federal antitrust laws when banding together to negotiate contracts. Such an exemption would be allowed if a state provides oversight of the contracts negotiated between doctor groups and payers.
Legislation also has been introduced in the U.S. Congress that would permit antitrust exemptions without requiring any state oversight.
Obtaining an antitrust exemption would permit self-employed physicians to, for example, band together to negotiate as a group with health insurers, self-insured employers or other third-party payers over the amounts physicians are paid for patient care. They could also jointly bargain over such issues as their obligations under utilization review and quality-reporting requirements without violating federal antitrust law.
Joining forces in such a manner currently is prohibited by federal antitrust law.
The legislation introduced at the federal level would amend antitrust law to give doctors who band together similar treatment under the law as is currently afforded to collective bargaining units, such as labor unions, under the National Labor Relations Act. President Clinton and U.S. Attorney General Janet Reno oppose the bill, which is before the House.
The legislative efforts have sparked fierce political battles, pitting employers and insurers against doctor organizations.
The biggest concern voiced by opponents of the measures is that allowing doctors to join together to increase their bargaining clout with health care payers will lead to higher costs.
Doctors say, however, that they need to organize to level the playing field, because health insurers now use their leverage in terms of controlling access to patients to dictate contract terms to self-employed doctors.
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