The American Medical Association last week testified in favor of a Texas bill that would carve out a special antitrust exemption for competing doctors who want to negotiate collectively with health plans on clinical and administrative issues.
AMA trustee Donald Palmisano, M.D., told the Texas House insurance committee that passage would be a first step in addressing health plans' "inappropriate leverage over physicians and patients."
Health plans and business interests testified against the bill, saying it would lead to higher prices and diminish access to care. Jerry Patterson, executive director of the Texas Association of Health Plans, said the association fears the bill would be a step toward full collective bargaining by competing doctors.
The bill would permit competing physicians to negotiate with health plans in nine contract areas, such as timing of payments and termination criteria, without fear of antitrust prosecution. Under the doctrine of state action immunity, states may exempt certain groups from federal antitrust laws.
The bill specifically prohibits physicians from collectively negotiating fees and does not allow doctors to organize boycotts. Collective negotiations would apply only to health plans covering at least 25,000 enrollees, and contracts would be subject to the approval of the state insurance commissioner.
The legislation was introduced by state Rep. John Smithee, a Republican from Amarillo, and is based on model legislation developed by the AMA and supported by the Texas Medical Association.
Separately, the AMA last week unveiled a draft set of standards to measure physician performance. Proposed standards include providing feedback to physicians, which the AMA said is often lacking in managed-care plans' quality improvement programs. The AMA will use the standards to identify quality improvement programs in which physicians may participate for credit under the American Medical Accreditation Program.