For Your Information
Announced
Actions for November 4, 2003
Issuance of staff advisory letter: The
staff of the Federal Trade Commission has advised Medical
Group Management Association (MGMA) that it does not intend
to recommend that the Commission challenge MGMA’s plan
to conduct and publish the results of a physician survey
relating to various aspects of physicians’ relationships
with health insurers. MGMA is a professional association
that represents medical practice administrators. It has approximately
19,000 members who manage physician practices containing
220,000 doctors throughout the United States.
According to the staff letter, signed
by Jeffrey W. Brennan, Assistant Director of the Health
Care Services and Products
Division of the FTC’s Bureau of Competition, MGMA plans
to conduct a survey of insurer payments to medical groups
and of medical groups’ satisfaction with certain aspects
of their relationships with insurers, including the adequacy
of specialty networks, insurers’ rate of denials of
claims for services, and the time it takes for insurers to
pay for physician services. MGMA will send the initial survey
to Colorado family practitioners, general internists, pediatricians,
and obstetrician-gynecologists. It will offer the results
for commercial sale to interested parties. Among other things,
the survey reports will show the distribution of payments
by insurers for specific services. MGMA will publish only
aggregated information relating to prices paid by all the
insurers whose data are reflected in the survey; it will
not collect or report information on prices paid by individual,
named insurers. If the program is successful in Colorado,
MGMA may expand it to other states and specialties.
The survey of insurer payments is
similar to an exchange of physician price information,
the staff letter noted, and
could, in some circumstances, be part of a price-fixing arrangement
or could facilitate sellers’ tacit coordination of
their competitive behavior. In this instance, however, the
staff has concluded that MGMA’s decision to adopt certain
safeguards – preventing disclosure of the underlying
payment data to physicians, focusing on past or current rather
than future payments, publishing only statistics that combine
data from at least five respondents, and publishing the information
in an aggregated form that prevents disclosure of the prices
paid by individual insurers or received by individual physician
practices – provides significant protection against
use of the information to restrict competition among physicians.
In addition, according to the staff letter, the circumstances
of the proposed activity provide no indication that it is
likely to encourage restraints on the competitive process,
or is intended to do so. The staff letter concludes, therefore,
that the potential pro-competitive effects of providing market
participants with information on insurer payments are likely
to outweigh any risk that particular groups of doctors in
some locations might use the information to facilitate anticompetitive
conduct. If some doctors use the information illegally to
restrict competition, the letter cautions, the staff would
recommend that the Commission take appropriate enforcement
action.
The staff letter also concludes
that MGMA’s plan
to collect and disseminate aggregated information about insurers’ referral
networks, their rates of claim rejections and payments times,
and physicians’ satisfaction with payers’ responsiveness
to questions or concerns about claims or payments is not
likely to promote anticompetitive conduct by physicians.
(Staff contact is Judith A. Moreland, Bureau of Competition,
202-326-2776).
Submission of FTC report to the Senate Special Committee
on Aging: The Federal Trade Commission has submitted
its most recent Staff Report on Activities Affecting Older
Americans
to the Senate Special Committee on Aging. The report describes
the FTC’s law enforcement initiatives within its consumer
protection and competition missions that are of particular
importance to older consumers, and highlights the Commission’s
consumer education program from September 2001 to August
2003. The FTC staff prepared the report at the request of
the Senate Special Committee on Aging, and the report is
now available on the FTC’s Web site. The Commission
vote to approve the submission of the report was 5-0. (FTC
File No. P984904; see related press release dated October
4, 2001.)
Commission approval of final consent order: Following
a public comment period, the Commission has approved a final
consent order in the matter concerning
South Georgia Health Partners, L.L.C. The Commission vote
to approve the final consent order was 4-0-1, with Commissioner
Pamela Jones Harbour not participating. (FTC File No. 011-0222,
staff contact is Steven J. Osnowitz, Bureau of Competition,
202-326-2746; see press release dated September 9, 2003.)
Copies of
the documents mentioned in this release are available from
the FTC’s Web site at http://www.ftc.gov and
also from the FTC’s Consumer Response Center, Room
130, 600 Pennsylvania Avenue, N.W., Washington, DC 20580.
Call
toll-free: 1-877-FTC-HELP.
MEDIA CONTACT:
Office of Public Affairs
202-326-2180
(http://www.ftc.gov/opa/2003/11/fyi0363.htm)
|
Related Documents:
Medical Group Management Association (MGMA)
Staff Summary of Federal
Trade Commission Activities Affecting Older Americans:
September 2001 - August 2003: A Commission Staff Report
to the United States Senate Special Committee on Aging
- Text of
the Report [PDF 121K]
South
Georgia Health Partners, File 0110222,
Docket No. 4100
|