It's hard to know whom doctors dislike most. Hospital executives are always telling them to practice cheaper and faster. Insurers are always telling them what services they can provide and still be paid. And lawyers are always suing them for one thing or another. But at the top of many physicians' "hit lists" are federal regulators, particularly those who are charged with enforcing the industry's fraud, tax and antitrust laws.
In the early 1990s, antitrust officials from the U.S. Justice Department and the Federal Trade Commission began cracking down on individual physicians or small practices that banded together to jointly negotiate fees for their services with health insurance companies. The problem was that in the eyes of the law, individual physicians or practices were competitors. Federal antitrust law bars competitors from conspiring to set prices for their services.
But that threat didn't stop fearless docs. No matter how many physicians got caught and were forced to enter consent agreements with the feds, other physicians kept trying -- sometimes even the same physicians with another scheme. They tried calling themselves by different names, they tried forming pretend labor unions, they tried hiding behind hospitals by forming "physician-hospital organizations." And the feds kept telling them, unless you're economically integrated -- meaning the participating docs are no longer competitors but a single economic entity -- no dice. But the feds did leave the door open slightly to an alternative. Competing physicians could band together and avoid antitrust scrutiny if they integrated clinically. That meant coordinating their practices to achieve certain goals like improving quality or efficiency or reducing duplication -- goals that were so lofty that they outweigh any threats to competition. A number of physicians subsequently said they were clinically integrated, but it was lip service and they got busted anyway.
As reporter Mark Taylor reveals in this issue's cover story (p. 14), physicians may be getting the message. Taylor reports on 300 Colorado physicians who have integrated their practices clinically while still maintaining economic independence. They did so with the blessing of the FTC in a precedent-setting advisory opinion. To what extent did the physicians integrate their practices to satisfy the FTC? Read Taylor's piece to find out and learn how other physicians and practices can work together to avoid signing the next consent agreement.
Please note that I didn't name journalists to the list of professions that doctors love to hate. We here at Modern Physician would like to think it's because we keep them informed and educated on all the healthcare business and policy news affecting the way they practice and manage. In that spirit, we are revamping Modern Physician's daily electronic newsletter, MP Stat, and creating a new electronic publication to serve our readers.
First, we're changing the name of MP Stat to Modern Physician Stat, a simple but important moniker tweak to let you know who is bringing you your daily dose of news for physician executives, leaders and entrepreneurs. More importantly, we're moving the daily publication of Stat up by six hours to better serve your needs. In each issue, you'll get fresh, staff-written reports on healthcare business news that happened late the previous day through early that morning. You'll get a recap of the top stories as well as an exclusive news feature that goes beyond the headlines to examine the people, issues and trends shaping the news. If you don't already subscribe to Stat, please visit our Web site, modernphysician.com.
Secondly, we're launching a new electronic breaking-news service called Modern Physician Alert to keep you abreast of important healthcare business news. You can subscribe to Modern Physician Alert also by visiting modernphysician.com. The revamped and more timely Stat and the new Alert will be available starting in November.
We hope you'll enjoy your new Modern Physician Stat. And we hope you'll subscribe to our newest publication, Modern Physician Alert. Please contact me directly with questions, suggestions or concerns. Thank you.