Private Practice Corner By Rodney W. Rieger, MD Clinical Nurse Specialist Providing medical care involves not only abilities and knowledge but also our ability to control our contracting environment. Never before has so much of the clinical decision power been taken away from the treating physician and given to anonymous poorly trained clerks. The insurance industry was granted a major exemption from the Sherman Antitrust Act by congress in 1949. They have used this to accomplish consolidation, eliminating competition between insurance carriers, and removing any choice of participation in the health care marketplace from individual or group practice physicians. Yet the full weight of the Sherman Antitrust Act applies to the individual physicians and groups elimination their ability to act as professionals to monitor and maintain the quality of medical practice. To stand together professionally and eliminate the egregious gag clauses and other unprofessional agreements that are in "take it or leave it" contracts offer by the insurance industry, recent physician groups have attempted to negotiate using the so-called third party messenger exemption to the Antitrust Act in order to gain some collective bargaining power. Blue Cross/Blue Shield and other entities jumped all over this with an immediate Justice Department investigation. The Federation of Physicians and Dentists has been sued by the Justice Department to cease and desist these activities, impugning that even if the Federation acted as a messenger only, it could not help but to advise physicians as to the suitability and desirability of contracts. This Justice Department action is ongoing and will take at least a further three to six months to clarify what possible punitive action they can take against the physicians involved, particularly in the state of Delaware. Clearly medicine is not comparable to the production of gasoline, the selling of hamburgers, or any of the other economic activities that can be broken down into a provision of a commodity. Quite clearly without the intervention of physicians in the actions of the insurance companies, our patients are up against a very dangerous wall of cost containment and insurance profits endangering our patients’ very lives. Physicians need to be able to negotiate in an organized professional manner with insurance carriers and government and to maintain the health and lives of our patients as well as our professional basis of action. Mr. Tom Campbell, a US Congressman from California, has introduced a physician’s modification to the Antitrust Act which would allow physicians either in solo practice or in groups to bargain collectively through whatever organizations they determine would represent them best. This was a House Bill last year and was presented at a hearing of Henry Hyde’s Judiciary Committee. Congressman Hyde had a hard time accepting the concept that physicians should be viewed as workers or laborers. However, the way we are recompensed for our services and the way we are currently being treated by the insurance industry make us little better than piecework laborers. The American Medical Association is beginning a program to fully support the reintroduction of this law. We hope that the AAOS will also participate in this action. The old adage is still quite true that "all politics are local," and it is extremely important for orthopedic surgeons in whom particular districts’ Representatives Henry Hyde and Dennis Hastert reside do what they can in their power to encourage their Representatives to support and act as cosponsor of this bill. It is secondarily important, of course, for all Representatives in all districts to lend their support, for only through once again acting as a profession, which we are presently denied the ability to do, that we can regain control and protect our patients’ very safety and well being. For further details please write or E-mail me at reiger@inil.com. I am in the process of setting up a meeting with the three Congressmen now to further promote its passage and encourage their support. Return to the IOS Newsletter Educational Meetings and Program | Board of Directors | Residency | Find a Surgeon | Membership | Allied Association Links | Newsletter | Governmental Affairs | IAOS Main Page All material Copyright from the Illinois Association of Orthopaedic Surgeons, all rights reserved.