A proposal allowing physicians to collectively bargain with health plans may be winning support in Washington as an alternative to managed-care reform.
The proposal, introduced in March by Reps. Tom Campbell (R-Calif.) and John Conyers (D-Mich.), would allow physicians to collectively negotiate with health plans on payment rates and patient-care issues (See bill synopsis). Theoretically, physicians would re-establish patient rights on an ad hoc basis through such negotiations.
Under current antitrust laws, only physicians employed by a health plan can collectively negotiate their fees with their employers.
The bill, which was introduced last year but wilted before serious debate began, is gaining far more support this year. Some of the credit goes to the American Medical Association, which has aggressively pushed the bill both on Capitol Hill and to its members.
But credit also goes to some provider groups, which believe that physicians could use such bargaining power to wrest more patient-friendly policies from plans, including direct access to specialists and a binding external review of any coverage denials.
"Negotiations (under the Campbell-Conyers bill) should be limited to quality and access to care, not fee schedules," said Robert Doherty, senior vice president for governmental affairs and public policy at the American College of Physicians-American Society of Internal Medicine. The college supports the access and quality-of-care provisions of the bill, not the economic aspects.
The Campbell-Conyers bill and patient-protection measures are alike in that they reflect the feelings that physicians and patients have little or no power in talking with health plans, Doherty said.
Campbell's office has seized on that sentiment to win support for his bill, which has already signed on 115 House co-sponsors.
"Many people who opposed and continue to oppose the patients' bill of rights are in support of our bill (as a way to get) to those problems," a spokesman for Campbell said. "Our bill lifts federal restrictions as opposed to imposing new ones (as the managed-care reform bills do)."
Among the co-sponsors are Reps. John Boehner (R-Ohio), Tom Coburn (R-Okla.), Greg Ganske (R-Iowa) and Charlie Norwood (R-Ga.). Ganske and Coburn are physicians, and Norwood is a dentist. All four congressmen came out with managed-care reform bills this year.
Last year, Campbell voted against both Republican and Democrat patient-protection proposals because they included too many federal mandates, his spokesman said.
For the same reason, Campbell also opposes the Patients' Bill of Rights Act of 1999, proposed by Rep. John Dingell (D-Mich.), and Norwood's Patient Access to Responsible Care Act.
However, some providers argue that the Campbell bill would not eliminate the need for managed-care reform legislation.
"If the Campbell bill goes through, it certainly makes changes in the way physicians approach contracts and fees," said Robert Graham, M.D., executive vice president of the 88,000-member American Academy of Family Physicians. "But I can't see how that would address some patients' bill of rights issues."
The AAFP has endorsed the Campbell bill but is also behind Ganske's managed-care reform measure.
Insurers, who don't like either the Campbell bill or the proposed managed-care reform legislation, blasted assertions that physicians could use their bargaining power to improve their patients' lot.
"We support the antitrust exemptions that are already in place for physicians," said Susan Pisano, a spokeswoman for the American Association of Health Plans. "This (Campbell) bill is really about income protection for physicians, not patient protection."
"The Campbell bill has little to do with quality and everything to do with (more) money (for doctors)," said Richard Coorsh, a spokesman for the Health Insurance Association of America. "Both it and the patient-protection bills are bad, and consumers would suffer either way."
The HIAA, fearing the bill's increasing popularity and looking to sink it, commissioned a study that found such a measure could increase the nation's healthcare costs by up to $80 billion a year in 2000.
That study, released June 9, also said that health insurance premiums could rise as much as 11% in 2000 in the years immediately following passage of the bill.
While the Campbell bill is not a perfect substitute for managed-care reform, passing such a measure could make it easier for payers to swallow the patient-protection pill, some advocates said.
"The HMO industry should think twice about this because it could resolve some issues that are currently problems," Doherty said. "One of the reasons people are going to Congress is because they feel disenfranchised. They can't deal with managed care as equals."
The AMA, which has chosen to make collective bargaining the centerpiece issue at its annual meeting this week in Chicago, said it has not backed down from supporting managed-care reform legislation.
"There are certain issues that physicians wouldn't have control over, like emergency room pre-authorizations and external review," said Brenda Craine, an AMA spokeswoman. "We're going to focus on the patients' bill of rights for those issues."
But other observers, including insurers, see the AMA's aggressive advocacy as a sign that the Campbell bill is the organization's top priority.