Auclair, Robert A., Frigoletto, Maria, Waris, Ali
Description
Product Description
There is no profession in the U.S. more affected by antitrust laws than medical profession. The law generally affects physicians
...
in the following context:
(a) termination or suspension of hospital privileges stemming from peer review, and exclusive dealings; (b) physicians' relationships with the buyers of their services; (c) physicians' network joint ventures; (d) practice mergers.
STAFF PRIVILEGES: In hospital-privilege cases, antitrust laws arise in two situations: (1) peer review, and hospital's exclusive dealings. In peer review, if privileges of a physician are terminated or limited due to a negative finding, the affected physician may allege that the review was not based on merit but was aimed at eliminating competition in violation of antitrust laws. As for exclusive dealings, hospitals may arrange to have certain clinical services for patients from an outside individual physician or a single group of specialists to the exclusion of others. Because under certain conditions such exclusive dealings may curb competition, antitrust laws are involved.
PHYSICIAN-BUYER RELATIONSHIPS: Often a single buyer of health care services is so large that it effectively controls the provider market and, therefore, can dictate pricing and providers' dealings with other payors. Such a buyer is said to have MONOPSONY power. Such power is manifested in the form of unfair bargaining such as the imposition of the Most Favored Nations clause on physicians and other providers. The MFN clause requires providers to give the imposing payor the same lowest rates that they would give to any other payor. Such contractual conditions have negatively affected payors' competitors and physicians, often raising antitrust conditions.
PHYSICIAN NETWORK JOINT VENTURES: Independent Practice Associations (IPAs) and Physician-Hospital Associations (PHOs) are vehicles used by physicians to negotiate jointly with the buyers of health care services such as managed care plans. Often these joint ventures are operated in a way that reduces competition in violation of antitrust laws and may expose physicians to private action as well as scrutiny by federal and state law enforcement authorities.
MERGERS: It makes economic sense to managed care (health plans) companies to contract provider services from large health care entities. Providers can also generate efficiencies through economies of scale. Because of these advantages, numerous health care providers have merged in the past decade, giving rise to concerns about reduced competition. As a result all significant mergers ae closely monitored by antitrust law enforcement agencies.
This book has a Q-A format and has been written in a simple and nonlegal language to facilitate understanding of antitrust law by physicians. The work is authentic and is based on about 500 citations, mostly from court opinions.
Review
...hospitals, doctors, health insurers are facing very difficult times in their relationships. This book can help them ask the right questions. ...concise and easy to read. --
G. Martin Dudley, Chairman and CEO, InterGroup Services(PPO), PA, NJ
A light-house in the stormy ocean of medical economics. --
Ali Khojasteh, M.D., President, Columbia Cancer Research Institute, Columbia, MO
A wealth of knowledge on antitrust laws as applied to physicians and hopitals. --
Irvin L. Muszynski, J.D., Dir. Healthcare Systems, American Psychiatric Association, D.C.
Comprehensive yet simple enough for nonlawyers. It will undoubtedly prove invaluable to both doctors and lawyers. --
Andrew L. Schaeffer, Senior Counsel, DuPont Co., Delaware
I must say, I am very impressed. It should be on the reference desk of every physician and health care manager. --
C. William Brett, President, Windmoor Hospitals, FL
Indispensable for a medical practitioner or health lawyer. --
Kenneth R. Sandler,M.D., Professor, Clinical Psychiatry, University of Pennsylvania
About the Author
ALI
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