HMOs don't have to file antitrust lawsuits when FTC does it for them
Regarding "HMO sues group for antitrust violations" (Article, Oct. 2): Your article about Susquehanna Health System states, "Antitrust suits filed by HMOs against providers are rare." While such direct litigation may be unusual, we all too often see for-profit managed care plans employ the good services of the Federal Trade Commission to bring unwarranted antitrust allegations against physician groups.
Consider the case of Texas Surgeons, P.A., of Austin, Texas. For nine months, this small group of surgeons asked to negotiate a proposed 40% reduction in their fee schedule with two large health plans. The nonnegotiable proposal would have put them in financial distress, if not out of business. The doctors sought a less drastic reduction and, after the plans refused, notified their patients that they could not afford to keep the contract but would continue to see them until they found other physicians still under contract.
In a business tactic that is being exploited by investor-based insurance companies across the country, the plans alleged antitrust violation, which the FTC was more than eager to pursue. The physicians endured more than six figures in legal fees for the privilege of just saying "no thank you" to an unreasonable proposal.
Under the duress of extended litigation, the surgeons signed a consent order with the FTC to dismiss the case. They admitted no wrongdoing and were confident that, had the case gone forward, they could have disproved all the allegations.
There is far more to negotiating a managed care contract than raising prices, although for far too long many employers have shopped those contracts solely on price, ultimately at the expense of their employees' care. Most of the contract provisions directly and indirectly relate to the kind of care physicians are permitted to provide.
Were it merely a question of fees, the standard HMO physician contract would be about two pages, instead of 50.
Both recently enacted Texas state laws and the Campbell bill have a single aim: To help correct the gross imbalance of power that pits large, profit-driven health plans and the federal government against doctors who believe those 50-page, take-them-or-leave-them contracts just aren't good medicine.
--J. James Rohack, MD, President,
Texas Medical Assn., Austin, Texas
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"Yes, we are 'undercoding' "
Regarding "Doctors alerted to pitfalls in Medicare undercoding" (Article, Sept. 18): Let me state that my three partners and I began undercoding in response to the Medicare "correct coding" investigation horror stories.
We are a four-surgeon orthopedic group that sees about 20 to 25 patients per office day per doctor. We enjoy taking time with each patient and providing a detailed orthopedic history, exam, assessment and discussion with our patients.
After having an office staff-produced review of coding/Medicare coding compliance, however, we realized we would not be able to "justify" higher codes since we "only" focus on the musculoskeletal system and do not obtain an extensive review of systems or extensively examine other body systems at either new or follow-up patient visits.
We also realized that the discussions we have with the patients, which include showing and explaining x-rays, models and handouts, and teaching them physical therapy exercises and other self-care treatment, did not "justify" a higher code.
We have not changed how we treat patients, but we do fear "fraud and abuse" investigations where the dollars assessed for incorrect coding are based on extrapolations from the review of relatively few patients' records. Yes, we are "undercoding."
--James Spiegel, MD
Santa Cruz, Calif.
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"Lawsuits against firearms manufacturers are ridiculous"
Regarding "Gun makers targeted in anti-violence campaign" (Article, Sept. 25): Your article certainly seems slanted in favor of firearms registration and regulation. It even provides a Weblink to the Center to Prevent Handgun Violence.
Are you now going to publish an article that contradicts the one published and list the Web site for the National Rifle Assn.?
Physicians are quite shortsighted if they think firearms registration will prevent criminal elements from obtaining firearms. Such a philosophy would favor much tighter control of drivers' licenses and vehicle ownership -- which would not reduce vehicular accidents and deaths. Only tighter enforcement of current laws on vehicles and education of drivers would reduce accidents and deaths.
Likewise, enforcement of current laws on firearms with punishment of perpetrators will cut the use and ownership of firearms by criminals. Lawsuits against firearms manufacturers are ridiculous, as would be lawsuits against vehicle production companies to remove vehicles from our streets and highways. Punish criminals -- not law-abiding citizens.
--John P. Tyson, MD
Denison, Texas
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