Some groups that represent physicians say the costly antitrust verdict against Marshfield (Wis.) Clinic could chill the growth of rural group practices.
The American Group Practice Association, the American Medical Association and the State Medical Society of Wisconsin will put their concerns in friend-of-the-court briefs to be filed in the clinic's appeal.
"We want to make it clear that the expansion of medical groups into rural areas, where you necessarily have a high market concentration, is not an antitrust violation," said attorney Kathy Kenyon, AGPA's director of development and health policy analysis.
She said she's particularly concerned about part of an opinion by U.S. District Judge John Shabaz referring to an illegal "relationship of competing sellers." She said it could be interpreted as prohibiting physician-owned HMOs from contracting with physicians who are nonowners.
Last December, a jury found the clinic and its Security Health Plan HMO violated antitrust laws and awarded plaintiff Blue Cross and Blue Shield United of Wisconsin $54 million in damages. Shabaz lowered the amount to $17 million.
Blue Cross is trying to establish a competing HMO in central and northern Wisconsin.
The clinic filed its notice of appeal to the 7th U.S. Circuit Court of Appeals in Chicago on April 21.
The organizations said the threat of antitrust litigation could discourage group practices from expanding into underserved areas.
Blue Cross offered evidence that Marshfield's dominance brought high prices to the area. But Kenyon said the clinic also provided high quality, which was not considered.
"This case really punishes Marshfield in part for trying to improve quality in rural areas," she said.
James R. Troupis, lead counsel for the Blues plan, said Marshfield actually opposed better access to care.
"When other physicians attempted to come into those markets, the Marshfield Clinic did what it could to discourage them from coming in. Aside from being bad medicine, that is not typical of rural healthcare, where people cover for each other," Troupis said.
He said he's surprised the state medical society and AMA are getting involved because the clinic's exclusionary practices violated the rights of physicians to practice where they choose.
The Medical Group Management Association, whose executive director, Frederick J. "Fritz" Wenzel, is a former Marshfield official, is considering the matter, a spokesman said.