The Federation of Physicians and Dentists is seeking a change in antitrust laws so physicians in private practice can collectively bargain with managed-care companies.
The Tallahassee, Fla.-based federation, which represents 8,500 doctors, is part of the Alliance of Healthcare and Professional Employees, and has regional offices in Arizona, Connecticut, the District of Columbia, Florida and Texas.
The federation argues that because of managed care's growing control of market share, physicians are more like employees than self-employed contractors.
"It's really the insurance industry that functions as a monopolistic power," says the union's executive director, Jack Seddon. "It has the power to force reimbursements down below Medicare and at the same time to increase premiums."
The federation primarily plays the role of consultant and third-party messenger for its private-practice members to managed-care companies.
Under federal antitrust laws, it is still illegal for independent physicians to talk with one another about price, Seddon says. But the union can empower these doctors by helping them better understand the contracts they sign. The federation also gathers and publishes information on the range of fees being paid by managed-care companies in various markets.
"It's an uphill battle," Seddon says, "but in most cases we have improved the terms and conditions of the provider arrangements."
Robert Weinmann M.D., president of the Oakland, Calif.-based Union of American Physicians and Dentists, says his union also has found a legitimate way to protect its independent physician members. The union has set up a not-for-profit independent practice association. Almost half of the 2,000 private-practice doctors represented by the union have signed on to the IPA, Weinmann says, because they get paid better and they know the union doesn't want a piece of the action.
Texas and Washington have passed laws designed to protect private practice physicians from federal antitrust suits, allowing them to negotiate with health plans under state supervision. Some call the laws toothless, especially the Texas measure. There, the proposed rules issued by the attorney general's office are too burdensome and require too much proprietary information from physicians.
"We don't necessarily want collective bargaining," says Ken Ortolon, a spokesman for the Texas Medical Association. "But (doctors) do want to be able to get a decent contract with the HMOs that protects their own interests and the interests of their patients."
Jerry Patterson, executive director of the Texas Association of Health Plans, says there will be no collective bargaining between health plans and doctors because there is no true protection against antitrust violations built into the legislation.
"We do not want to expose our doctors to antitrust suits," Patterson says. "It's a no-win deal for the TMA, which is using it as a platform whose sole purpose is to promote the Campbell bill."
The Health Care Coalition Act, also known as the Campbell bill for its chief proponent, Rep. Tom Campbell (R-Calif.), also proposes changing federal antitrust law to allow independent doctors to bargain collectively with health plans.
The bill is slated for committee consideration in early March. The American Medical Association strongly supports the Campbell bill, as do the National Doctors Alliance and other unions.
"We believe these people are the most vulnerable," says National Doctors Alliance President Barry Liebowitz, M.D. "If the Campbell bill passes, the unions will be there to teach the lessons of collective bargaining."