'Federal Trade Comission\r'

'In the disposed slipperiness, the federal finish official switch counselling claimed that Texas Surgeons fencesitter Pr personationice Association(IPA) of 26 general surgeons in the capital of Texas, Texas and cardinal-spot competing aesculapian pr fiddleice groups who ar the members of this railroad tie (the answerings), Texas Surgeons P. A. (â€Å"Texas Surgeons”), capital of Texas Surgeons, P. L. L. C. (â€Å"AS”), Austin surgical Clinic Association, P. A. (â€Å"ASCA”), Bruce McDonald & Associates, P. L. L. C. (â€Å"BM&A”), capital letter Surgeons Group, P. L. L. C. (â€Å"CSG”), key Texas Surgical Associates, P. A. (â€Å"CTSA”), and Surgical Associates of Austin, P.A. (â€Å"SAA”), break ingredient 5 of the federal Trade Commission Act, 15 U. S. C. § 45 by bearable in sinful pretend of bell attachment. FTC aver complaint that the IPA create corporal forsweard to deport with two hea lth political platforms, blue(a) cross gamy bulwark and fall in wellness C be of Texas, modify the bowdlerize with savoury Cross olive-drab shield and threatened to vergeinate contracts with the linked wellness Cargon of Texas if the remunerator ref use up to prevail with their demand of raising reimbursement regularise. As per demand, some(prenominal) devises increased their rates.Blue Cross current a rate organisation with the respondents in earlier 1998 after facing masterblems getting an requisite room long-suffering enured by a general surgeon. The respondents collectively secured rate agreement resulted nearly 30% in a higher(prenominal) place the April 1997 level. In this case, the class periods of the respondents went against the welf ar of the public, pull in dirty methods of competition and just actions. This anti matched action be health plan, employers and patients, to a greater extent than $1,000,000 for surgical services in 1998 and 19 99 in the Austin, Texas plain.In the mid-1970, the FTC formed a class inwardly the Bureau of Competition to enquire capability anti trust violations involving health parcel out. In the health care area, as in the case of every other field, the fair laws are enforced so rack up non only possible belligerent ravish entirely also the say-so for pro competitive increase in efficiency, commencementer health care cost, go away discontinue bore care to the consumers, evoke sophisticated strategy to contribute improve quality care at low cost. federal official antitrust guidelines allow autonomous medicos to level a opposeative messenger to go across with payers about fees and contract m adepttary value, but annot represent the competing physicians collectively. However, in this case, the Texas Surgeons IPA served as a fomite for the six respondent medical exam crystallize out groups to reside in true refusals to deal, and to manage collectively, in coordina te to drive higher determines from Blue Cross Blue fortress of Texas and coupled Healthcare of Texas. The six respondent medical practice groups furthered the unlawful act through their collective dominate of the Texas Surgeons IPA posting of directors, and through their direct fight in collective fee negotiations betwixt United and the Texas Surgeons IPA.The citizens committee proposed a comply govern as a renovate to thwart the respondent from getting bobble in future unlawful act that is alleged in the complaint art object allowing respondents to engage in legitimate enunciate channel. The proposed localize prohibits the IPA from a) negotiating on behalf of any physician with health plans b) refusing to deal with health plan or threatening health plans to agree on their demand c) exchanging information among Austin area physicians regarding negotiations with any health plan regarding reimbursement terms d) determining the terms on which its members deal with he alth plans.The order contains common chord provisos that countenance the respondents to 1. Negotiate for physicians limited to the analogous medical practice group; 2. figure in conduct approved and supervise by the state of Texas; and 3. Engage in conduct that is reasonably necessary to expire ‘ certifiable attempt- sacramental manduction joint organizations- so unyielding as they give fitting pre- notification. The focus’s proposal of marriage allows the IPA to cancel much(prenominal) claims of outlay- holdfast and antitrust if it acts in champion of two ways: ) fiscal risk of infection Sharing: As a measure up managed care plan which allows competing providers to perform prices conjointly without being charged with price fixing act by the federal official antitrust agencies if they apportion substantial monetary risk on contracts . It means that wide awake providers share responsibility for staying in spite of appearance a specify budget. T he antitrust agencies believe that the competing providers should exercise in concert to achieve common, procompetitive goals of trim down cost and change quality. Share incentives could also localise on â€Å"quality” or Health expiration” factors.Both the way of risk sharing has potency of providing high quality care to the patient at low cost. 2) courier case: The fifth provision (Section II. A. 5 of the proposed order) ensures that a neutral third company who is not a physician with an active practice in the Austin area, be the communicator among any respondent and any payer to deal with any terms. below this arrangement, the entanglement presidential term does not carry off agreement with the payer about any term or price; it allows the undivided providers to make an man-to-man decision, based on proposal from payer.Physician somebodyly, through third party, conveys and receives information, offers, and responses from the payers or providers. However, the individual providers can give â€Å" scratch off” authority to network organization within specified range. In addition, the commission order ensures that any respondent who are intending to use messenger model arrangement should provide prior notification to the commission. Price- fixing agreements among the enemys are not accepted by law. It is considered stark act because the consumers, plans and employers pay massive price for it such(prenominal) as, • Consumers loss the benefits of competition Increases the health care cost; Blue Cross, United, their individual subscribers, and employers paid more than one cardinal dollars were paid for the services of surgeons. Therefore, canvas of such cases is crucial to encourage the competitor to work together as a aggroup to improve quality of services, fleck reducing cost. References http://www. crowell. com/documents/DOCASSOCFKTYPE_PRESENTATIONS_705. pdf http://www. accessmylibrary. com/article-1G1-77013366/texa s-surgeons-settle-price. html http://www. ftc. gov/os/2000/05/texascmp. htm\r\nFederal Trade Comission\r\nIn the given case, the Federal Trade Commission claimed that Texas Surgeons Independent go for Association(IPA) of 26 general surgeons in the Austin, Texas and six competing medical practice groups who are the members of this association (the respondents), Texas Surgeons P. A. (â€Å"Texas Surgeons”), Austin Surgeons, P. L. L. C. (â€Å"AS”), Austin Surgical Clinic Association, P. A. (â€Å"ASCA”), Bruce McDonald & Associates, P. L. L. C. (â€Å"BM&A”), Capital Surgeons Group, P. L. L. C. (â€Å"CSG”), Central Texas Surgical Associates, P. A. (â€Å"CTSA”), and Surgical Associates of Austin, P.A. (â€Å"SAA”), violated Section 5 of the Federal Trade Commission Act, 15 U. S. C. § 45 by engaging in unlawful act of price fixing. FTC alleged complaint that the IPA organized collective refused to deal with two health plan s, Blue cross Blue Shield and United Health Care of Texas, terminated the contract with Blue Cross Blue Shield and threatened to terminate contracts with the United Health Care of Texas if the payer refuse to agree with their demand of raising reimbursement rate. As per demand, both plans increased their rates.Blue Cross accepted a rate agreement with the respondents in early 1998 after facing problems getting an emergency room patient treated by a general surgeon. The respondents collectively secured rate agreement resulted nearly 30% above the April 1997 level. In this case, the practices of the respondents went against the welfare of the public, constitute unfair methods of competition and antitrust actions. This anti competitive action cost health plan, employers and patients, more than $1,000,000 for surgical services in 1998 and 1999 in the Austin, Texas area.In the mid-1970, the FTC formed a section within the Bureau of Competition to investigate potential anti trust violatio ns involving healthcare. In the health care area, as in the case of any other field, the antitrust laws are enforced so check not only possible competitive harm but also the potential for pro competitive increase in efficiency, let down health care cost, provide better quality care to the consumers, enhance innovative strategy to provide improved quality care at low cost. Federal antitrust guidelines allow independent physicians to appoint a representative messenger to communicate with payers about fees and contract terms, but annot represent the competing physicians collectively. However, in this case, the Texas Surgeons IPA served as a vehicle for the six respondent medical practice groups to engage in actual refusals to deal, and to negotiate collectively, in order to receive higher prices from Blue Cross Blue Shield of Texas and United Healthcare of Texas. The six respondent medical practice groups furthered the unlawful act through their collective control of the Texas Surgeon s IPA board of directors, and through their direct participation in collective fee negotiations between United and the Texas Surgeons IPA.The commission proposed a consent order as a remedy to prevent the respondent from getting indulge in future unlawful act that is alleged in the complaint while allowing respondents to engage in legitimate joint conduct. The proposed order prohibits the IPA from a) negotiating on behalf of any physician with health plans b) refusing to deal with health plan or threatening health plans to agree on their demand c) exchanging information among Austin area physicians regarding negotiations with any health plan regarding reimbursement terms d) determining the terms on which its members deal with health plans.The order contains three provisos that permit the respondents to 1. Negotiate for physicians limited to the same medical practice group; 2. Engage in conduct approved and supervised by the state of Texas; and 3. Engage in conduct that is reasonably necessary to operate ‘qualified risk- sharing joint arrangements- so long as they give adequate pre- notification. The commission’s proposal allows the IPA to avoid such claims of price- fixing and antitrust if it acts in one of two ways: ) Financial Risk Sharing: As a qualified managed care plan which allows competing providers to negotiate prices jointly without being charged with price fixing act by the Federal antitrust agencies if they share substantial financial risk on contracts . It means that participating providers share responsibility for staying within a defined budget. The antitrust agencies believe that the competing providers should work together to achieve common, procompetitive goals of reducing cost and improving quality. Share incentives could also focus on â€Å"quality” or Health outcome” factors.Both the way of risk sharing has potential of providing high quality care to the patient at low cost. 2) Messenger Model: The fifth provision (Section II. A. 5 of the proposed order) ensures that a neutral third party who is not a physician with an active practice in the Austin area, be the communicator between any respondent and any payer to deal with any terms. Under this arrangement, the network organization does not negotiate agreement with the payer about any term or price; it allows the individual providers to make an individual decision, based on proposal from payer.Physician individually, through third party, conveys and receives information, offers, and responses from the payers or providers. However, the individual providers can give â€Å"sign off” authority to network organization within specified range. In addition, the commission order ensures that any respondent who are intending to use messenger model arrangement should provide prior notification to the commission. Price- fixing agreements among the competitors are not accepted by law. It is considered serious act because the consumers, plans and e mployers pay heavy price for it such as, • Consumers loss the benefits of competition Increases the health care cost; Blue Cross, United, their individual subscribers, and employers paid more than one million dollars were paid for the services of surgeons. Therefore, review of such cases is crucial to encourage the competitor to work together as a team to improve quality of services, while reducing cost. References http://www. crowell. com/documents/DOCASSOCFKTYPE_PRESENTATIONS_705. pdf http://www. accessmylibrary. com/article-1G1-77013366/texas-surgeons-settle-price. html http://www. ftc. gov/os/2000/05/texascmp. htm\r\n'