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Blues plan sues physicians who won't join network

Antitrust attorneys are watching the Montana case closely to see if the dispute breaks new legal ground in managed care negotiations and physician-hospital contracting.

By Robert Kazel, amednews staff. Nov. 8, 2004.

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Organized medicine has often argued that health plans exert an overwhelming amount of market power over physicians. But BlueCross BlueShield of Montana claims, in a federal antitrust lawsuit against a physician group, that the problem is the other way around.

In response, physicians say the Blues' action is more evidence of plans' willingness to bully physicians to accept their meager terms.

Antitrust attorneys across the nation are watching the progress of the Blues' lawsuit against Missoula Radiology, the only radiology practice in Missoula, Mont. The Blues plan says the suit, which seeks to break up a 12-physician group it calls a "predatory monopoly," is about market competition, not the group's refusal to be part of the plan's network.

But many doctors say if the Blues plan is successful in its case, it could embolden other plans to sue physicians who refuse to sign a contract. In fact, after the lawsuit was filed Sept. 14, a seven-physician neurology group and a six-physician surgery group announced they would drop their Blues contracts, in part to show solidarity with Missoula Radiology.

"They're going to prove with this [suit] they can do it and then subtly make an implicit threat to other groups: 'We can do this to you if you don't join our network,' " said Nick Chandler, MD, president of Missoula Neurological Associates.

Dr. Chandler, who is also chair of InterWest Health, a Missoula PPO that competes with BlueCross, said the suit bothers him from two perspectives. "As a physician it sends chills down my spine, and as a managed care executive I think there are certain business practices that managed care organizations can't ethically adopt."