Marshfield (Wis.) Clinic last week announced it will appeal a $17 million antitrust judgment, saying the case "could profoundly impact" America's rural healthcare delivery.
The clinic said it will seek clarification of the ruling from the 7th U.S. Circuit Court of Appeals in Chicago. It has until April 22 to file an appeal.
"During these times of rapid change in healthcare, it is important that the rules be concise and clearly understood," clinic general counsel Reed Hall said.
But plaintiff Blue Cross and Blue Shield United of Wisconsin said it is clear that Marshfield broke the law.
"We believe the rules are very clear. A jury certainly understood the argument and so did a federal judge who upheld the verdict," Blues spokesman Tom Luljak said.
Last December a federal jury in Madison, Wis., found that the clinic engaged in anti-competitive conduct such as price-fixing and dividing territories with competitors in order to monopolize primary care, pediatric care, specialty care and HMO services.
According to testimony, the result was the Blues paid 10% more for its indemnity patients in central and western Wisconsin than elsewhere and was able to establish a competing HMO.
Marshfield said it will dispute the jury's finding that there is a distinct HMO market independent from other health plans. The clinic argues there is one "healthcare financing" market in which the Blues participates through its indemnity plan.
Blues officials testified there is a distinct market for HMOs and cited HMOs' unique regulations, gatekeepers, lower costs and other characteristics.
Last month U.S. District Judge John Shabaz lowered the jury's $48.5 million damage award to $17 million, but essentially upheld the verdict.
The judge ordered the clinic to give the Blues access to its physicians so the insurer can establish an HMO and told it to end management agreements with neighboring clinics.
He also voided agreements that prohibit Marshfield physicians from providing cross-coverage to non-Marshfield physicians or from leaving to join a competing practice, and pacts that require affiliated physicians to refer non-HMO patients to Marshfield.
He also prohibited Marshfield from any action that would restrict hospital privileges of non-Marshfield physicians.
Hall said he doesn't think the restrictions will impair clinic operations. He said some physicians may want to leave the clinic once noncompete agreements are lifted.