In a sign that physicians don't think last year's easing of federal antitrust rules went far enough, Rep. Henry Hyde (R-Ill.) has reintroduced a bill making it easier for network-forming doctors to avoid price-fixing charges.
A staffer for Hyde, chairman of the House Judiciary Committee, said the new bill is identical to one the congressman introduced last year.
That measure, which died despite being approved by the Judiciary Committee, would have let physicians form nonintegrated networks to jointly pursue service contracts without automatically violating federal antitrust laws. The laws bar competitors from jointly setting prices for their services.
Such conduct is per se, or automatically, illegal. But Hyde's bill would force the two agencies charged with enforcing the laws-the Federal Trade Commission and U.S. Justice Department-to judge whether networks pose any real anticompetitive risks under a more lenient analysis, called a "rule of reason" approach.
The Justice Department and the FTC released guidelines last year opening the door to networks that don't integrate financially but share clinical and quality information (Sept. 2, 1996, p. 4). Despite those guidelines, the American Medical Association continued to support the Hyde bill.
The reintroduction of the bill is likely to increase friction between physicians and hospitals over who will control provider networks in local markets.
"If it is the same bill, we would be in opposition," said Richard Wade, executive vice president for communications at the American Hospital Association. "Our view has always been that you don't need to change the law. You need clearer guidelines. This would clear a path for physicians that doesn't need to be cleared."
The AHA and AMA already are sparring over Medicare-reform language that relates to provider-sponsored networks (Dec. 9, 1996, p. 5).
The language at the center of the dispute would determine what share of services network providers in Medicare provider-sponsored organizations would be required to deliver themselves and how much they could refer to providers on contract.
Doctors, without direct access to hospital resources, want a lower threshold so they can form physician-only networks. Hospitals want a higher threshold so they can't be excluded from physician networks.
Likewise, hospitals fear that looser antitrust enforcement under the Hyde proposal might also give physician networks the market power to boycott or otherwise exclude hospitals trying to form their own integrated delivery systems in local markets.