The right to reject what plans demand: The Montana radiology case

Physicians' ability to stand together helped stop a health plan's lawsuit to force doctors to sign a bad contract.

Editorial. May 2, 2005.

With the market power that health plans hold over physicians, contract negotiations often come down to: Take it or leave it. Until recently, there was a threat that "leave it" would be struck from the list of options.

When Missoula Radiology decided that "leave it" was a better option than "take it" when it came to BlueCross BlueShield of Montana's contract, the plan's response was "sue it." Fortunately, after organized medicine and many of the doctors in Missoula rose up to support the practice against the plan, the Blues' last response was "settle it."

The plan's recent settlement with the practice allowed the doctors to keep the right to say no to a contract they didn't like. It also blunted any immediate threat of other plans thinking of strong-arming physicians to pick up a pen and sign. The settlement was a major victory for physicians, and a reminder of what can be accomplished for doctors when they stand together.

Nominally, the lawsuit was about antitrust: that the 12-physician practice was throwing its weight around in its market-dominant position as the only radiologists in town. Yet painting the group as a sinister monopoly was a flimsy argument -- it had grown internally, not by acquiring other practices. The plan claimed that Missoula Radiology had acted illegally, in part because it had exclusive contracts for radiology at the city's two hospitals. But the hospitals said they wanted the exclusive deals to guarantee 24-hour call.