The California Medical Association is quietly pushing a bill to give physicians the right to band together to negotiate with health plans by saying it is a dispute resolution plan.
Last year's collective bargaining bill died in a state Senate committee after CMA officials decided not to pursue it and waited to see whether Congress would pass a similar bill. Congress didn't pass the Campbell Bill, and now CMA officials are billing this year's attempt as a way to settle disputes--financial and nonfinancial--between health plans and physicians.
As written, Assembly Bill 1600 would give physicians the right to force health plans to use an arbitrator rather than a mediator to resolve disputes. Binding arbitration requires both sides to comply with the decision of an arbitrator. In mediation, both sides discuss possible compromises but no resolution is required.
Jack Lewin, M.D., chief executive of the association, says the bill doesn't give physicians any rights that don't already exist under state law allowing businesses to negotiate on a class-action basis.
"This bill looks like it's going to give us some great new powers," Lewin says. "But it does nothing more than level the playing field and say the state will resolve problems like late bills."
Officials with the California Association of Health Plans say the bill is a wolf in sheep's clothing. The bill would go far beyond finding solutions to disputes, they say. CAHP officials argue the bill would allow physicians to "form a cartel," force plans into arbitration and significantly increase healthcare costs.
"The reality is the subtle (attempt at collective bargaining)," says spokesperson Bobby Pena. "Although it doesn't have the antitrust exemption language, it gets at the same goal, suggesting that physicians who are independent contractors to join together to collectively bargain," Pena says. "It is an end around to get at what they wanted last year."
The U.S. Justice Department's antitrust division, as well as other government entities, last year opposed federal and state proposals to give physicians the right to collectively bargain. The Justice Department testified at state and federal levels that such bills would violate antitrust laws.
CMA officials, however, insist AB 1600 is meant only to give physicians another avenue to work with insurers.
California law requires physicians to mediate with insurers, and mediation doesn't require a decision or agreement to be reached, Lewin says.
The health plans "clearly have a reason to avoid arbitration," he says.
"AB 1600 is an attempt to resolve disputes working together. There needs to be something on the physicians' side to get the health plans to the table . . . There's no way for (physicians) to collectively talk without violating antitrust regulations."
In fact, the Department of Managed Health Care recently fined a health plan for delaying payments.
Laws passed during the 2000 legislative session address fair billing and payment issues and give physicians a way to address issues such as late payments or
nonpayments, Pena says.
It isn't that CAHP is opposed to working with CMA officials to resolve issues, Pena says, it's that AB 1600 is bad public policy.
"We're not looking to take the CMA on in some battle. We're not looking to be confrontational with them," Pena says. "But we're not going to let a bill that will hurt the healthcare system in California go unchecked.
"We can work with the CMA. But we can't let ridiculous, unwarranted legislation go by."