Physicians

Antitrust Warfare

Palestrant

Not since the days of monopoly busting and Standard Oil has anti-trust been such a contentious topic in American politics. Today, Teddy Roosevelt has been replaced by Nancy Pelosi and the oil barons have been replaced by……doctors? The healthcare debate is quickly turning into a dog fight about monopolies and price controls, and in doing so, unveiling some of the dark truths about how the money really flows in this country’s largest industry.

Turns out antitrust law has become so contorted and subverted that it now serves the interests of those it was meant to regulate far more than those it was meant to protect. This past week, the FTC announced a consent decree with Roaring Fork IPA, a physician network in Colorado ( click here). Of course, this is less than a week after the Speaker of the House announced that she will pin her party’s hopes of resurrecting healthcare reform on repeal of the 1945 McCarran-Ferguson Act, a little known antitrust exemption that benefits the insurance industry ( click here).

So why has antitrust become all-the-rage-all-of-a-sudden?  The Sherman Antitrust laws were originally intended to prevent monopoly behaviors, however, it has become a key tool in keeping physicians as indentured servants in our healthcare system.  As Medicare continues to reduce payment rates, more and more providers are choosing to opt-out rather than contract to deliver services at a loss. Most notably, the Mayo Clinic chose to do this a few weeks back ( click here).  What is fascinating, however, is that the FTC is claiming that the Roaring Fork’s decision (unlike Mayo’s) constitutes an anti-trust violation so egregious that it is worthy of an investigation and the consent decree.  With 65 physicians, Roaring Fork represents well less than 1% of the physicians in Colorado, so why the anti-trust concern?

The answer lies in the cozy relationship between the insurance industry and the FTC.  Insurers are determined to make sure that physicians are kept from having any leverage nor allowing market forces to create a balanced supply-demand between physicians and patients.  The net goal of both is keeping physician payment artificially low, while maximizing insurance company profits.  For physicians, Roaring Fork should be a wake up call to accelerate their efforts to decrease their dependence on third party payers and their adoption of technologies and services that can even the playing field.

Today we are witnessing a Kafka-esque sequence of events.  Teddy Roosevelt, the original trust buster, would literally bust out laughing if he could see the incumbent political party pinning their hopes for their highest profile political effort on repeal of an anti-trust exemption, while the government chases after……..doctors, for ostensibly violating this same law.  Only in America.

Daniel Palestrant is the CEO of Sermo, the social networking site for physicians. He is a regular contributor to THCB.

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32 replies »

  1. “Let them discover, in their operating rooms and hospital words, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it–and still less safe, if he is the sort who doesn’t.”
    Ayn Rand, ATLAS SHRUGGED
    Seems very appropo to this topic, eh?
    By the way, a lot of what I have noted and proposed about the agenda by the Democrats has been voiced by others of legitimacy and respect in the media. Maybe this does not mean I am right, but, I am not alone.
    And, Ms G-A, collecting money for 4 years does not validate the action. Show me any other prior legislation that took such an action.
    Have a nice weekend, and probably for me a nice few weeks. I am taking time off as a physician and some break from all this hassle of being screwed by the selfish needs of the few.

  2. Perhaps I’m becoming a “usual suspect” here but I think the post raises reasonable points as far as it goes.
    Before launching my rant, I should say I think that the right, left and center rants here ARE intelligent, are interesting and are generally well informed. Angry too, but these *are* desperate times.
    Anyway, I think it’s unfortunate, actually, that those taking a traditional liberal position feel that they should get behind what “health reform” has become. The debate that’s been happening has essentially involved a “democracy of thieves”. The health care *blob* is expanding and someone must pay for it! Now that someone has to be the smaller players – whether this is the individual physician or the individual uninsured person is yet to be decided. They might find other weaker players and crush them too. The financial position of all the players *requires* the continued insane growth of the racket (excuse me “industry”).
    The major players wrote the bill but still couldn’t get it together to pass the bill. Boo hoo. Yes, it seems logical that further schemes of every imaginable sort will be mobilized. A big player sues a small for anti-trust violations – sounds in the ballpark of present senseless sense. If health care costs are going to reach 25% of GDP, the players need to new pockets to reach into. I suppose the alternative would be for players to stop providing as many services and collect the same fees. Torte reform is helpful in this direction but fewer services mean more people wanting to opt out completely.
    Anger’s a pretty usual feeling here. But I think that’s understandable in these circumstances.
    What ironic today is how much well-meaningness gets so much insanity. But another part of these times is difficulty in seeing the big picture.

  3. Dr. Palestrant’s comments, however impassioned, reflect a fundamental misunderstanding of the antitrust laws. As has been restated dozens of times by the courts in the past 40 years, the antitrust laws protect competition (i.e. consumuers) not competitors. Further, there is not, as suggested by Dr. Palestrant, a conflict between antitrust laws directed at market structure and monopolization (Section 7 of the Clayton Act, and Section 2 of the Sherman) and law directed against conspiracy/price fixing (Section 1 of the Sherman Act). In some ways, it is a simple as two wrongs don’t make a right. The answer to an overly concentrated payor or hospital market is not to permit price fixing by physicians, which would make consumers even worse off, but to address the structural problem.
    As for why antitrust law as become “all the rage”–at least in Congress–is because it is a good scapegoat for an inability to make the difficult decisions required for meaningful reform. There is little doubt that McCarran-Ferguson exemption for insurers should be repealed. The notion, however, that such a repeal will restructure health care markets is ridiculous. There have been dozens of antitrust cases against health insurers over the years, and without exception the exemption has made no difference to the outcome. The exemption is typically cited in cases in which the insurer would have won anyway under traditional antitrust principles.
    Lastly, and as noted by Gregg, the FTC action giving rise to Dr. Palestrant’s article is utterly routine. Since the onset of managed care and as later accelerated by concerns about the Clinton reform proposals, physicians have experimented with a large variety of ways to improve their bargaining posture. Although many mechanisms are lawful (if they have a likelihood of improving efficiency), price fixing in the guise of collaboration is not.

  4. I would be interested in Dr. Palestrant’s assessment of the IPA a few miles away in Grand Junction. It seems to be doing fine, and even had a review by the FTC. Perhaps part of the difference is being organized around the interests of patients and patient care instead of physician interests.

  5. MD as HELL, I agree with you 100%.
    However, physician reimbursement is not a monolithic subject. There is tremendous inequity in how different specialties are getting paid for services, and I think that needs to be addressed.

  6. Margalit,
    They have been cutting physician reimbursement for years. This past Monday my urgent care did not take Medicare patients because of the fee cut. In order to cut more there must be a fundamental change in my costs. I employ a lot of people just to file forms, just to keep records. I have a substantial insurance bill. If I get to support all of this and nothing left for me, the service is not available.
    I need a system where my overhead is far lower than it is right now. This is not it.

  7. “I AM STILL WAITING FOR SOMEONE TO TAKE A SHOT AT EXPLAINING THE 4 YEAR WAIT FOR THE LEGISLATION TO TAKE EFFECT!!!”
    Dr. Exhausted,
    I believe I answered your question shortly after you posed it in the Confused thread. Here is my opinion again:
    “The provisions not kicking in for 4 years is very unfortunate and it is there more than likely to make the savings look bigger than they actually are.
    ………
    Posted by: Margalit Gur-Arie | Mar 1, 2010 9:23:07 PM”
    Nobody here, or anywhere else for that matter, thinks this bill is perfect, or that Congress is wise and selfless. Quite the opposite.
    However, considering the circumstances, this bill is as good as it gets. For now.
    And, no, physicians are not distrusted by the public. Nobody blamed physicians for the HMO debacle. What you are hearing here is not much different than what you are saying: we need to cut costs and physician reimbursement is a large part of the costs, therefore physician reimbursement will have to be cut, along with insurers profits, hospital revenue and patients ability to get everything they want. Everybody will have to contribute, and that is pretty much what you are saying too. I think….

  8. To state, as Dr. Palestrant does, that “insurers are determined to make sure that physicians are kept from having any leverage nor allowing market forces to create a balanced supply-demand between physicians and patients” misses the whole point of insurance.
    Because few medical prices are formed in normal market circumstances it is impossible to know what prices would be if patients and providers figured it out amongst themselves.
    We need less insurance, not more. Entire specialties, especially primary-care physicians, internists, perhaps pediatricians and ob-gyns, too, should never have to deal with an insurer through their entire careers.
    With respect to the McCarran-Ferguson Act, which leaves regulating insurance to the states, I recently wrote a short briefing paper making the case for the status quo (http://tinyurl.com/yhqj9po). However, I have also written another one making the case that the Federal Trade Commission has no business interfering in provider consolidation within states (http://tinyurl.com/y8zetz5).

  9. Hmmm, to rbar:
    1. I do not agree with your perspective that physicians have the level of trust and respect with the American public, at least of now as compared to over 20 years ago, which does coincide with the onset of managed care. Patients by in large felt we sold them out, and by being silent and not advocating for them, much less ourselves, we did sell them out!
    2. What defines rich, doctor? If you go by Obama and his attack on taxing those “rich”, that line seems to be $250K, and I would hazard to guess that over 50% of our colleagues, as doctor income alone, do not get to that figure. And note my comment “doctor alone”, as MDs who make side investments that bring them in income does not constitute clinical income. And that is where the detractors and attackers try to blur that line. So, I don’t even break $200K a year since I have been practicing, more than 15 years now, thus I don’t call myself rich, and again, bristle when people make that overgeneralization.
    3. People in academic centers make 50-70% of what is made in private practice? In 2010? No, sir, the question in this time is why are physicians trying to get into academic and hospital staff positions, as there is not the steady and reliable income stream to guarantee solvency in private practice alone. And I am a bit leery you say this as a doctor, as I think most of my average colleagues know this and thus why they are suspicious of this legislative onslaught.
    4. Not directed to you, but to these repeated comments about transparency in the office, or really lack of it as claimed, how do most primary care doctors, at least for their specialty, know what they will be reimbursed by the various third party sources that comprise, what, 70% of the average PCP practice? Do you non-clinicians really think and believe that most practices still set prices in the office and collect them? This is 2010, America, not 1980. And this is the covert agenda, in my opinion, by those promoting this legislation, that tries to vilify us as a profession.
    Look, I am not a surgeon, I am not an entrepeneur, I believe in the Hippocratic Oath I voiced when I graduated medical school, and I am a passionate advocate for health care needs. The system as is sucks, needs to be changed, and all parties involved need to sacrifice and maintain realism. Politicians do not know the word sacrifice, I have no idea how they define realism, and I AM STILL WAITING FOR SOMEONE TO TAKE A SHOT AT EXPLAINING THE 4 YEAR WAIT FOR THE LEGISLATION TO TAKE EFFECT!!!
    It is hard to come up with lies and deflections that have the chance to fly, eh?

  10. I sometimes read articles on this blog that are strangely out of touch, not just with facts but with the Zeitgeist. This one is near the top. The only mentions of anti-trust law I see in the popular media regard health insurers, not providers. You have to dig pretty deep to pretend that provider anti-trust is a common topic of discussion, or that there is a groundswell of new political opposition to provider consolidation or collusion. And even if there were, this article does nothing whatsoever to establish that. As others have mentioned, the Colorado judgment referred to is a perfectly ordinary application of an old law. It’s also a sensible law, as Gregg Masters explained.
    ExhaustedMD rails against monetary interests in other sectors of the health care industry, but his comments almost without exception are motivated by the desire to get more money for providers. Usually people conceal their hypocrisy better than that.
    The sense of victimization among physicians is stunning for such a privileged group. It comes from a wounded sense of pride. rbar makes some very good points that are doubly-appreciated for coming from a physician. Although, rbar, you are mistaken about the following: “the orthopedic surgeon points out that most CEOs make multiple times what he/she makes.” Not true. Look at this list of top paying jobs from Forbes. Surgeons come in at #1, while CEOs are #10. Oh, and 9 of the top 10 jobs are in Medicine. The illusion that CEOs get paid more comes from thinking only about a small number of huge corporations. Most corporations, of course, are not so large. (Incidentally, those surgeon pay numbers for Forbes are considerably lower than the average of physician surveys I’ve seen…not sure why the discrepancy).
    The idea that physicians are “indentured servants” to insurers is ridiculous. No one is forcing them to contract with insurers. They do it out of self-interest. We don’t often think of it this way, but the primary function of insurers is to protect people from the monetary demands of providers. If insurance didn’t do that, it wouldn’t exist as a business. Health insurance would not be a several hundred billion dollar industry if it did not protect people from the monetary demands of providers in order to receive services.
    The average physician here makes twice what one does in other developed nations. And yet, they feel aggrieved and victimized here. I would bet physicians are happier in most other developed nations. Physicians should not be small businessmen, forced to deal in all the headaches of a small business, and drawn to think of their own profit and loss so incessantly that it becomes an obsession. No wonder some physicians are exhausted. Salaried payment is a much superior system.
    Last point: there are other professions where rates are set by third parties through contractual arrangements. The example of mechanics was given. Turns out there are plenty of mechanics who have contracts with car insurers. Those contracts exist for very similar reasons to physician-insurer contracts.

  11. rbar – I agree that physicians should be sufficiently well compensated financially to attract and hold smart and dedicated people. That said, I think the profession still has a lot to answer for in the following areas:
    1. Lack of price transparency. As Peter says, it’s generally virtually impossible to find out what anything costs in advance other than, perhaps, a routine office visit. This is especially true when PCP’s need to refer patients to specialists or to a hospital.
    2. Resistance to having their clinical outcomes and those of their hospital(s) publicly disclosed.
    3. Opposition to allowing NP’s, PA’s and other mid-levels to practice at the top of their license to help alleviate the shortage of primary care doctors.
    4. Efforts to stifle or eliminate competition at every turn including, most recently, from retail store clinics staffed by NP’s.
    Separately, when it comes to medical care, we generally rely on doctors to tell us what services, tests, procedures, drugs, referrals, etc. that we need. Sometimes not getting appropriate care on a timely basis can be life threatening. This is quite different from services offered by plumbers, auto mechanics, lawyers, etc. The latter three can usually quote a price before services are rendered which doctors and hospitals generally can’t or won’t. Finally, any episode of care that includes an inpatient hospital stay or outpatient visit can easily run into thousands of dollars even for relatively simple procedures. Only a small percentage of the population can handle costs of that magnitude on their own which makes it especially galling to be unable to determine the cost in advance especially for the uninsured.

  12. There will be no legitimate health care reform until the HMO’s are no longer allowed to collude and price fix via their anti-trust exemption.

  13. Sorry, dear colleague, but Peter hit the nail on the head. And opposed to your perception, doctors have an excellent reputation in the US and among the most trusted professions.
    I agree that there is financial pressure on us docs, but it pressure on a relatively priviliged group. To set things straight, I do think docs should be reimbursed well considering the long training, call duty, responsibility, demanding interaction with sick and/or demanding patients … but we should not be physicians to become rich. I met quite a few fee for service (or better: fee for procedure) docs who have overwhelming financial interests. And of course I also know a lot of physicians dedicated to their patients well being; and even the most dedicated physicians know that in order to be a great clinician, communicator and human being in the long run, good conditions (incl. pay) are a prerequisite, esp. in an affluent society like ours. But tell me, exhaustedMD, why are there so many excellent colleagues in academic centres, making about 50-80% of what they could make in private practice?

  14. Typical, Peter. You either missed the point, or, I believe you chose to ignore the point. Other professions do not allow their profession to have outsiders set their fees, which is true for what I believe applies to over 65% of us. But, no, you and others want to use the 5% who try to gouge patients and insurers, if they could, and use them as the poster child for the whole 100% of the profession.
    Are you the person who reads about a bad cop and tells everyone who would listen that all cops are bad? That is how I interpret yours and other commenters’ points.
    It is time for physicians to read and understand how there is this undercurrent out there that wants to portray the majority of us, physicians, as primary villians, as these people are trying to deflect from their covert supporters who really benefit from this health care deform, or, they just typify the mob mentality and go after the easy prey, those like us who are invested in the public and don’t easily fight back.
    Well, guess what? I am tired of the bs being sold here and their expecting no one to challenge back. No one seems to answer the key question about this health care bill: why does it take 4 years to be implemented?
    I’ll tell you why no one of honesty and accountability is answering it: because there is no legitimate answer, as it is an illegimate agenda, and too many Americans are too stupid or trusting to think or know otherwise. Tax and collect monies for 4 years and then put it into play? And people are pissed about the Bernie Madoffs’ of society? You supporters are pathetic, affected people who lie out there silent are pathetic, and the “greening” of medicine is not just pathetic, it borders on evil.
    Sorry, maybe read as a rant, but how I see it and as far as I am concerned, it has to be put out to be read, digested, and considered or dismissed.
    By the way, Peter, the comment as I intended was, do you call your treating doctor a money grabbing bastard?
    Because your comments seem to echo that!

  15. “I’m curious, do you say this to the provider in front of you when he is trying to treat you?”
    Hey doc, how much is this going to cost me?
    Sorry patient, I don’t know, that’s not what I’m concerned about. You’ll have to speak with my office administrator or billing department, but the total cost will depend on a lot of things.
    But doc, can’t I get a quote first so that I can shop around?
    Quote? You mean you want me to act as if I’m a mere plumber?

  16. You haven’t disaapointed so far, commenters.
    http://www.realclearmarkets.com, piece by Bill Flax, March 3.
    Hope you make some time to read it.
    Because he is right. And only those, for the most part, who are NOT health care providers in some form, cling to this perverse notion that health care is a right. Sure, like your plumber HAS to come fix your pipes. Like your accountant HAS to do your taxes. Here’s my favorite: your private attorney HAS to represent you in court, for a nominal if not pro bono expense. Oh yeah, the usual suspects will twist this as not equivalent, and how ALL doctors are just money grabbing bastards.
    I’m curious, do you say this to the provider in front of you when he is trying to treat you? No, I am sure not, because that would not be convenient, would it.
    I just am amazed of the silence from alleged clinician readers at this site. Why this crap in DC is happening in the first place. Hey colleagues, silence is death.
    And, Americans, wait until you see what providers stick around to accept these terms by DC. I’ll be back at the end of the week with my favorite quote from Ayn Rand’s book, ATLAS SHRUGGED. I’m sure it will be well received.

  17. This anti-trust effect is not the doing of docs, they’re just the healthcare providers with enough clout to actually be able to say ‘no’.
    Take a look at who controls prices of things. Take a look at who’s getting rich without any actually directly benefiting the patient.
    Monopolization of business in health care is a scheme in which insurers control the purse- and marionette strings, along with those entities large enough to give them a run for the money, drug companies in cahoots with whoever sets reimbursement rates in tandem with different lobbyist effects on Medicare which work integrally with insurers.
    It’s clearly not just one single controller, but insurers get to call the shots, with the benefits managers as their handmaiden. Malpractice lawyers, hospitals receiving Medicare and Medicaid subsidies, stand-alone clinics; they all have tar on their shoes.
    I only wish the docs had gotten together with other health care professionals e.g. pharmacists, a little earlier in the game, but at this point, it’s more evident to the average citizen the type, depth, and amount of monkeyshines that have been going on for some time.

  18. Good link Kim. One important paragraph reads:
    “According to some study respondents, the shift in negotiating power to providers needs urgent policy attention. “I am shocked there isn’t an outcry over the fact that our costs are driven out of control,” one health plan executive complained. “We would like to establish some sort of boundary, beyond which these guys can’t go. We’d welcome some regulatory intervention to break up these monopolies, because they are just killing us.”
    Looks like the ones caught in the cross hairs of providers and insurance companies will be premium payers. Anyone now think “free” enterprise is the solution to advancing healthcare costs?

  19. Yes, excellent point to illustrate the exquisite chaos and irony in which our industry tries to operate. On one end we have the Roaring Fork consent agreement properly, in my judgment, applying antitrust law to the IPA’s operational paradigm, and reminding them of the ‘indica of integration’ and how they can stay on the ‘sunny side of the street’ it you will.
    Then there is the recent ‘Unchecked Provider Clout In California Foreshadows Challenges To Health Reform’ piece cited by twa and kim above; arguing that integration drives concentration, which in turn drives costs UP: http://content.healthaffairs.org/cgi/content/full/hlthaff.2009.0715v1.
    So just what are physicians to do? Kinda breaths life into the cash medicine or direct practice movement, no? A rational response by docs to an irrational and no win system of incentives and mis-aligned law.
    Good grief! No wonder, I am recovering from this industry.

  20. As a related side note, perhaps Palestrant has been spending too much time reading the comments of some of the physicians on his site. This site is an interesting contrast, between the wonderful clinical, problem solving, information sharing side where doctors help each other with clinical issues, and the business/practice oriented forums that are largely ruled by some of the most vicious and vile commentary I have ever seen. As evidenced by this thread, the inability of physicians to connect organization and structure with the impact on patient care is astonishing.

  21. This seems like the pot calling the kettle black. Has anyone looked at the recent article by Berenson, et. al that was recently published in Health Affairs (http://www.hschange.com/CONTENT/1118/)? It focuses on provider consolidation & the impact on prices. It’s an arms race between providers & payers about dominance – and in many markets the provider systems are “winning.”

  22. Perhaps this is a key finding (from the FTC document):
    “29. Respondent and its physician members have not undertaken any programs or activities that create any integration among their members in the delivery of physician services sufficient to justify their acts or practices described in the foregoing paragraphs. Respondent’s members do not share any financial risk in providing physician services, do not collaborate in a program to monitor and modify their clinical practice patterns to control costs or ensure quality, or otherwise integrate their delivery of care to patients.”
    Anyone paying the slightest bit of attention to the FTC rulings knows that clinical integration is an important part of their criteria in these matters.
    In line with Gregg Masters comment – it is interesting that this issue arises at the same time this comes out:
    “Unchecked Provider Clout in California Foreshadows Challenges to Health Reform”
    (http://www.chcf.org/topics/healthinsurance/index.cfm?itemID=134178)

  23. Lots of rich politicians, rich lawyers, rich doctors all indulging in protracted arguments… lots of clever rich men who all know they just need to keep talking and nothing will change…
    Meanwhile the poor are suffering and dying…
    God bless America, sorry that should read – Sod the poor American.

  24. This is not a doc bash post; but where has Palestrant been? The FTC rules for IPAs that are not economically integrated, i.e., sharing risk, can NOT act as unions lest they be slapped for anti-trust reasons. This has been they way it is for 20 plus years, so lets not pretend this action is either arbitrary, nor over-reach of enforcement action.
    Docs need integrate financially and clinically, and then they can set fees, and say no whenever and wherever they choose. IPAs where always to be transitional vehicles towards medical group formation, some true blue others of the ‘without walls’ variety, then the era of risk push back descended upon us.
    Now we here talk again about ACOs, global or bundled payment options; there is no way those terms, i.e., ‘cap 2.0’ can be overlaid/administered on a non risk bearing IPA with adequate MSO infrastructure.
    So docs need organize to build leverage against the healthplans, otherwise, better perfect the ‘messenger model’ role or else you will be at risk.
    Search FTC consent agreements and look up the System Health Providers (SHP) story, Dallas, Texas. We were slapped big time in late 90s. I know this drama well. Better know the facts and the law specific to IPAs…been around for quite a while.

  25. Wanna comment on Roaring Fork consent agreement; deadline looming 3/15/2010. see CFR entry: Roaring Fork Valley Physicians I.P.A.; Analysis of the Agreement Containing Consent Order to Aid Public Comment: http://www.ftc.gov/os/fedreg/2010/february/100218roaringforkanalagree.pdf.
    Also analysis here: http://www.bassberry.com/files/Publication/03196541-30e1-43e9-b1bc-04ea5623ed0f/Presentation/PublicationAttachment/91ac0cfa-d43e-4904-a84b-06916e2e127a/Antitrust19022010.pdf

  26. I have to agree that there is too much whining from our profession … physicians still have enormous job security/mobility and are easily at or above the 3rd income percentile, even in primary care (and these guys really earn their high pay). Yes, reimbursement and conditions may have been better before (you can certainly choose to work less and still make a decent living). And yes, some people (esp. in the finance sector) make larger fortunes, maybe even with less actual responsibility and expertise. But what is actually fair and sustainable, in comparison to other professions/jobs?
    I perceive an extreme imbalance between pay and real productivity (i.e., what good is someone’s work doing, and how much expertise and sweat goes into it) in the US. If someone is making 150 k a year for introducing pet acupuncture, he/she might say that this is a fraction of what a radiologist makes … and the radiologist points to the orthopedic surgeon, who makes double with pointless back surgeries and epidurals … and the orthopedic surgeon points out that most CEOs make multiple times what he/she makes (which may be hundredfold the average US salary). And so on. Since medical care is usually covered by 3rd party payors, benefit of a medical service and reimbursement are decoupled. Eiter we go back to self pay (not very fair to the middle/lower class and anyone who is sick), or we revise the fee schedule and in fact pay doctors based on time, expertise and stress required for a particular service.

  27. Dr. Palestrant I have to ask not what percentage the Roaring Fork IPA represents in Colorado (1%) but what percentage of the market it represents in Roaring Fork?
    From this link: http://www.healthcarefinancenews.com/press-release/sermo-physicians-stunned-ftc-complaint-over-ipas-refusal-accept-medicare
    “The Group argues, however, that it banned Medicare-based rates due to a continuing decline in reimbursements. As a pathologist noted, a similar situation caused his practice income to go down 11% and his personal income to decrease by 22 percent.”
    He didn’t say what his practice or personal income was so that we might duly feel sorry for him?
    “”…The insurance companies can collude to their hearts content, but let physicians refuse to provide a service below its cost of production,”
    Is it really, “below the cost of production” or just a lessor rate they’re unhappy with? Has any physician in the practice ever subjected themselves to quotes for services like most private business needs to?
    “Although physicians expressed their frustration, many pointed out that the underlying legal argument behind the FTC complaint is sound.”
    I won’t defend the practise of insurance companies, but other than tort “reform” how would members of SERMO reduce the unaffordable rising cost of medical care in this country?
    As well Dr. Palestrant your link above is the private one to SERMO, not for everyones’ eyes. Trying to drum up SERMO membership?

  28. Yeah, can’t wait for the “usual suspects” who travel these threads to try to tear at the point of this post!
    Maybe because they think their special interests trump what physicians try to do for patient care.
    Again, take the damn profit margin out of health care and watch the roaches scatter. And by the way, insurers are not the only villians to this health care debacle in this country. But, the common thread among all the guilty parties is pursuing the money, and compromising health care needs is of no concern to these greedy bastards.
    Can’t wait to read the rhetoric that will defend the indefendable. Objective readers, sit back and be amazed and confused!
    By the way, read how they will contort and rationalize that it is ok to continue undercutting physician incomes, but no way can you mess with the attackers’ income streams. Classic NIMBY(Not In My Back Yard) attitudes, just better veiled!!
    You gotta love the mentality of the health care reform supporters. Do as I say, not as I do! I can’t wait if this pathetic legislation passes and some, hell, hopefully all of these stalwart defenders find out their wallets and pocketbooks get pickpocketed to fund all these wonderful agendas the Democrats claim will happen when this takes effect in 2014 (not an error in the date).
    Yeah, I’m the villian here. Just watch the attack!

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