AMA Persistence Brings New AntiTrust Rules

The President of the American Medical Association declared the revisions of the antitrust guidelines released today by the Federal Trade Commission and the Department of Justice "a significant step forward in ending the discrimination of prior agency policies against physician joint ventures."

Said Daniel H. Johnson Jr., M.D. AMA president, "The revised guidelines should result in more choice for patients, more competition, and better health care. Our persistence has paid off. There is more to be done, but he agencies have done three things we asked for:

"First, they have acknowledged the fundamental changes in the health marketplace, in particular the power of insurance companies and employers, and the benefits to patients of physician designed and controlled ventures."

"Second, they have agreed not to hold physician joint ventures "per se" unlawful simply because they do not reimburse physicians under a capitation mechanism, whereby physicians were rewarded for providing fewer services. Fee for service ventures and other kinds of arrangements will now be given an opportunity to demonstrate their merits under a "rule of reason" test, if they are otherwise true joint ventures."

"Third, agencies will now permit physician joint ventures of the size necessary to be competitive. Patients want choice of physicians and plans. The agencies will not block plans with 50 percent of physicians in competitive marketplaces. insurance companies have never had to limit the size of their plans. The narrow "safety zone" formula are not to be taken in any way a maximum tests."

"We believe in an open marketplace and we believe in the value of the patient-physician relationship. Neither ideal was given adequate weight in prior agency interpretations of the antitrust laws."

The revised antitrust guidelines results from an intensive three-year campaign by the AMA aimed at removing barriers to physician joint venture networks. The campaign also results in rhe introduction of the "Hyde Bill" (HR 2925), sponsored by Rep. Henry Hyde, (R, Ill.), chairman of the House Judiciary Committee, with 153 bipartisan co-sponsors. The bill would require a "rule of reason" approach to physician networks.

"FTC Chairman Robert Pitofsky, Assistant Attorney General Anne Bingaman, and their respective staffs have responded with a more reasonable set of enforcement policies," Dr. Johnson said.

"While today's action represents a milepost, we still have a way to go before we reach a level playing field," he added. "The health care market is undergoing rapid changes. Antitrust and other regulatory policies will require even deeper adjustments. We will continue to work with Mr. Hyde and other Congressional supporters on reasonable antitrust policy."

"Finally, it should be noted that the new antitrust guidelines represent a defeat of an intense insurance industry campaign to block changes in policy. Physician networks now have a great chance to compete effectively with commercial companies, and expand the range of choices available to our patients."