Today's News

Friday, March 17, 2000

H.R. 1304 aims to level negotiating playing field

By Kathy Pontzer Senior associate AAOS Washington Office

The introduction of the Quality Health Care Coalition Act, HR. 1304, last year by Rep. Tom Campbell (R-Calif.) and Rep. John Con-yers (D-Mich.) was an attempt to respond to the erosion of the physician-patient relationship. As the result of unprecedented changes to the health care delivery system, concerns of patient access to necessary care have become more widespread and the quality of patient care is being increasingly scrutinized.

With a few large managed care companies now controlling most of the health care market, more physicians are being forced into signing bad contracts. The negotiating component of the contract process is seriously lacking with managed care insisting on participation terms that can effect the way physicians interact with their patients. H.R. 1304 is an attempt to level the negotiating power between physicians and health plans.

Support for H.R. 1304 has climbed from 20 to more than 190 cosponsors in the U.S. House of Representatives. But not all legislators are convinced that this is the best way to tackle some of the problems with managed care. Concerns still exist on the part of many legislators on the right way to proceed to ensure that patients are receiving quality health care.

Specifically, H.R. 1304 would allow physicians to come together in carefully reviewing and negotiating the terms of their contracts with managed health care plans and other payers. Physicians would receive the same exemptions from the antitrust laws that unions now receive, without actually having to belong to a trade union.

Current federal antitrust laws severely restrict physicians in their ability to effectively negotiate with health insurance plans. Individual doctors can only negotiate through the third party messenger model where the doctor designates an agent to negotiate on his or her behalf and collective negotiations with other physicians, except certain joint ventures, is forbidden. Under H.R. 1304, physicians would be required to negotiate fair fees in good faith and no fees would be paid to physicians unless the health plan and the physicians agreed.

Some concerns expressed by legislators are expected to be addressed through amendments added during "mark-up" and approval of the legis-lation by the full House Judiciary Committee in mid-March. One amendment will likely further clarify that these negotiations between physicians and health care plans would not fall under the jurisdiction of the National Labor Relations Act (NLRA) or the authority of the National Labor Relations Board (NLRB). Unlike the NLRA, which requires negotiations, H.R. 1304 merely allows such discussions among physicians and health plans. Neither party is under any obligation to negotiate or to accept an agreement. Also, physicians cannot collectively decide to cease providing patient care.

A sunset provision will likely be added to the legislation, requiring Congress to review of the impact of these collective bargaining changes in three years.

On the Senate side, while several legislators have said they support modifications to the antitrust rules for physicians, no one, to date, is willing to take the lead in introducing parallel legislation.

The challenge of the ortho-paedic community is to educate legislators on the impact the management of the health care delivery system has had on the practice of orthopaedic care. Legislators need to hear from physicians about their concerns with their specific contractual arrangements with managed care plans and whether they believe that they can continue to provide quality patient care under the terms of these agreements. Among the problems, contracts have minimized the decision-making role of the physician in determining patient access to care, imposed unsafe restrictions on doctor-patient communications and have allowed managed care plans to control how confidential information will be used without consulting doctors.

Rep. Campbell will speak at 9 a.m. today in the Auditorium

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Last modified 17/March/2000 by IS