“The bill's attempt to confer antitrust immunity is unnecessary for legitimate collaborations and, if effective, would encourage groups of private healthcare providers to engage in blatantly anticompetitive conduct,” the FTC's 10-page comment letter (PDF) concluded. “In summary, FTC staff is concerned that this legislation is likely to foster anticompetitive conduct that is inconsistent with federal antitrust law and policy, and that such conduct could work to the detriment of Connecticut healthcare consumers.”
According to the letter, the FTC issued a similar comment on a similar bill in 2011, and its opposition stems from how the “central purpose of the bill appears to be to permit physicians to extract higher reimbursement rates from health plans,” while not establishing an integrated practice to achieve lower costs and better-coordinated care. The letter also states that healthcare collaborations are already permissible under current antitrust laws if they foster competition and create added value for purchasers.
“The antitrust laws are not a barrier to the formation of efficient healthcare collaborations that benefit healthcare consumers,” according to the letter.
The comment was requested by state Sen. Catherine Osten and state Rep. Peter Tercyak, both Democrats.
“We put forth this bill because we really needed to get some specific answers from the FTC, and you can't ask a question without having some proposed legislation,” Osten said in an e-mail. “Now that we have received the FTC's letter, it will be reviewed by Labor Committee members, who will then have to determine if there is any way to allow the type of collaborations sought by advocates. My opinion is this FTC opinion puts up significant hurdles to that type of legislation."
A joint Labor and Public Employees Committee composed of state senators and representatives endorsed the bill with an 11-7 vote on March 14.
According to a committee report, the bill was opposed by Conn. Attorney General George Jepsen, Anthem Blue Cross and Blue Shield and the Connecticut Association of Health Plans. They testified at a March 5 hearing that providers already can form independent practice organizations that can negotiate with health plans.
The bill received support from the Connecticut Academy of Family Physicians and three local medical societies.
Dr. John Foley, a cardiologist and president of the Connecticut State Medical Society, also testified on behalf of the CSMS and seven other state physician groups. He said the bill is needed because a majority of the state's physicians practice in small, nonintegrated offices and lack negotiating power with the state's “consolidated and highly concentrated” health insurance market.
“We ask this committee to support House Bill 6431, which provides relief for physicians and is aimed at permitting balanced, informed and good-faith negotiations with health insurers and other entities, specific to how medical care is delivered to patients in the state of Connecticut,” Foley testified (PDF). “Such good-faith negotiations do not regularly occur in today's managed-care environment, but they are necessary to ensure that physicians and other healthcare providers can make effective decisions on medical care and treatment.”
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