Tuesday,
June 10, 2003
Morning Session: 9:15 a.m. – 12:30 p.m.
Afternoon Session: 2:00 p.m. – 5:00 p.m.
Quality and Consumer
Protection: Market Entry
In health care, market entry is influenced by
a number of factors, including the necessity of
meeting state regulatory requirements such as
licensure and certificate of need. Professional
associations and individual providers have used
a variety of strategies to limit entry by potential
competitors and prevent unbundling and de-skilling
of the services that they provide. Thus, in many
states, there are significant limitations on market
entry by new competitors, and opposition to the
efforts of existing competitors to expand the
range of services they provide. What does the
empirical evidence indicate about the cost, quality,
and availability of services provided by nurse-midwives,
nurse-anesthetists, dental hygienists, physician-assistants,
pharmacists, optometrists, physical therapists,
and other professionals and para-professionals?
What regulatory and non-regulatory strategies
have been employed to restrict independent practice
or broadened clinical autonomy by these providers?
What reasons have been advanced to justify such
restrictions on entry? Do the regulatory strategies
that have been employed reflect the least restrictive
means of accomplishing the intended objectives?
What consumer information and protection issues
would be raised by a less-restrictive environment
for market entry?
Morning Session Panelists:
- Susan Apold, American College of Nurse Practitioners
- Tammi
O. Byrd, [Addendum]
American Dental Hygienists’ Association
- John Hennessy, Kansas City Cancer Centers
- Morris
Kleiner, [Document
2] University of Minnesota
- Lynne Loeffler, American College of Nurse
Midwives
- Tom
Piper, American Health Planning Association
- Megan D. Price, Professional Nurses Services,
Inc.
- Robin
Wilson, University of South Carolina School
of Law
Afternoon Session Panelists:
- Jeffrey
C. Bauer, Superior Consultant Company,
Inc.
- Gregg Bloche, M.D., Georgetown University
School of Law
- Steven Lomazow, M.D., American Academy of
Neurology
- Francis J. Mallon, American Physical Therapy
Association
- Jerome H. Modell, [Document
2] M.D., representing American Society
of Anesthesiologists
- Michael
Morrisey, University of Alabama
- Dr. Russ Newman, American Psychological
Association
Wednesday
June 11, 2003
Morning Session: 9:15 a.m. – 12:30 p.m.
Noerr Pennington/State
Action
How do Noerr Pennington and the state action doctrines
affect competition law and policy? Are there specific
anti-competitive practices that current enforcement
efforts have not addressed because of the Noerr
Pennington or state action doctrines, including
but not limited to abuses of state licensure,
certificate of need and other regulatory and petitioning
processes? Does competition law and policy impede
providers from jointly discussing their concerns
with government payors? What are the appropriate
boundaries for these doctrines given the competing
interests at stake? Are antitrust enforcement
efforts appropriately targeted in light of the
impact of the Noerr Pennington and state action
doctrines?
Panelists:
- Meredyth
Smith Andrus, Office of the Attorney General,
Maryland
- John
Delacourt, Federal Trade Commission
- Clark
Havighurst, Duke University Law School
- Kenneth
W. Kizer, M.D., [Document
2] [Document
3] [Document
4] [Document
5 ] National Quality Forum
- Dr.
Brenda Lyon, National Association of Clinical
Nurse Specialists
- Mark
McClure, D.D.S, [Document
2], [Document
3] National Integrative Health Associates
Wednesday
June 11, 2003
Afternoon Session: 2:00 p.m. – 5:00 p.m.
Long Term Care/Assisted
Living Facilities
An increasing number of elderly Americans spend
time in long term care or an assisted living facility.
What is the nature of the information that is
disclosed to such consumers about the cost and
quality of the services they will receive? Is
the type and amount of the information that these
facilities provide concerning quality adequate
to allow consumers to make well-informed purchasing
decisions? If not, what additional information
do consumers need or want to make such decisions
and why are these facilities not already providing
it in the marketplace? Does the quantity and quality
of the information that consumers would find helpful
vary? What is the state of the art with regard
to measures of nursing home and assisted living
facility quality, whether structure, process,
or outcome? What are the risks of relying on (and
disclosing) process-based measures of quality?
How would competition on quality measures affect
costs, prices, and decisions by payors and customers?
How does compensation affect quality? Can compensation
be harnessed to enhance the performance of nursing
homes and assisted living facilities?
Panelists:
- Toby S. Edelman, Center for Medicare Advocacy
- Karen Love, Consumer Consortium on Assisted
Living
- Barbara
Manard, American Association of Homes
and Services for the Aging
- Barbara
Paul, M.D., Center for Medicare
and Medicaid Services
- Jan
Thayer, National Center for Assisted Living
- Keren
Brown Wilson, Jessie F. Richardson Foundation
Thursday
June 12, 2003
Morning Session: 9:15 a.m. – 12:30 p.m.
Financing Design/Consumer
Information Issues
For the non-elderly, health care is financed through
voluntary insurance contracts. Employment-based
health insurance covers the majority of non-elderly
insured Americans. How effectively do employers
reflect the preferences of their employees in
designing and implementing health insurance coverage?
What distortions result from making employers
the nexus of health insurance? Are there off-setting
advantages associated with having employers involved
in the health insurance market? What changes have
there been in the structure of employment-based
health insurance in recent years? What information
is disclosed to employees in connection with obtaining
health insurance? How does employment-based health
insurance differ from insurance available in the
individual market? Health insurance is aggressively
regulated by the states, with more limited regulation
by the federal government. What are the effects
of this regulation on the cost and content of
the health insurance products available in the
marketplace? Does such regulation correct for
specific failures in the market for health insurance
coverage? Has the emergence of new forms of health
insurance coverage (i.e., point-ofservice options,
consumer-driven health insurance, and medical
savings accounts) had an effect on the health
insurance market and the regulatory environment?
Panelists:
- Marcia L. Comstock, M.D., Wye River Group
on Healthcare
- Helen Darling, Washington Business Group
on Health
- Newt Gingrich, The Gingrich Group
- Warren Greenberg, George Washington University
- Greg
Kelly, Coalition against Guaranteed Issue
- David
Lansky, Foundation for Accountability
- Michael
Young, Aon Consulting
Thursday
June 12, 2003
Afternoon Session: 2:00 p.m. – 5:00 p.m.
Information and
Advertising
To what extent do consumers use
quality information in making choices among health
care financing arrangements and among health care
providers? What information regarding quality
is available to consumers? How accurate is this
information? Does the quantity and quality of
the available information depend on the nature
of the underlying condition (i.e., acute v. chronic)
and treatment (i.e., surgical v. medical; curative
v. palliative; elective v. necessary)? What effects
does this information have on the behavior of
health care providers? What quality information
do health care providers disseminate through advertising?
What characteristics distinguish health care providers
who provide quality information through advertising
from those who do not? Do health care providers
who advertise quality differ from those who advertise
price or other attributes of their services? What
percentage of health care providers engage in
any advertising? What role does comparative advertising
(including scorecards) play in competition among
health care providers? What role does comparative
advertising concerning access to specialists or
specialized services play in competition among
health care financing options? Do governmental
or professional restrictions limit the advertising
of health care goods and services based on quality?
What are the effects of these restrictions on
competition in markets for health care goods and
services? What are the pro-competitive justifications
for such restrictions? What empirical evidence
supports these justifications?
Panelists:
- Laura
Carabello, CPRi Communications
- Bernie
Dana, [Document
2], [Document
3] American Health Care Association
- Helen Darling, Washington Business Group
on Health
- John
E. Gebhart, III, DoctorQuality.com
- Richard
Kelly, Federal Trade Commission
- Douglas D. Koch, M.D., Baylor College of
Medicine
- Thomas
Henry Lee, Jr., M.D., Partners Healthcare
- Peter M. Sfikas, American Dental Association
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