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Joint Negotiation is reintroduced
CLEVELAND —
AMC/NOMA affirms its longstanding support of a bill designed to give
physicians leverage to negotiate patient care issues and health care
costs. House Bill 325 – the Ohio
Health Care Provider Negotiation Act was introduced in the Ohio Legislature
by Representative Jim Trakas (R – Independence) along with 19 cosponsors
prior to the summer break of the legislature. Representative Trakas indicated that
“from the point of view of a patient, he became frustrated with the health
care process” and decided to develop into legislation a concept that had been
originally presented to him by the past president of the Academy of Medicine
of Cleveland/Northern Ohio Medical Association (AMC/NOMA), Victor M. Bello,
M.D. AMC/NOMA supports this concept
and applaud Representative Trakas for introducing this important legislation
that had its genesis through a concept first presented to him by physician
leadership from the AMC/NOMA. “The physician
members of the AMC/NOMA and our leadership have been working towards getting
this type of legislation passed for two years, and will continue to take the
lead for the physicians in Northeastern Ohio to assure that our voices are
heard in Columbus,” stated Ronald A. Savrin, M.D., current president of the
AMC/NOMA. “The purpose of this
legislation is to put the negotiating power back where it belongs, in the
hands of the physicians that provide the patient care so that we can
negotiate what we know is in the best interest of our patients.” The bill is
designed to provide a pro-active, market-driven solution to the imbalance of
power in the health care market by waiving antitrust laws and allowing
medical providers to jointly negotiate patient care issues with insurance
companies and HMOs. The bill, which
is modeled after legislation from other states, will represent the broad and
common interests of physicians and patients on issues that affect access,
quality and the cost of health care.
The bill will also allow independent health care providers to join
together to negotiate non-fee related contract terms with insurers. Some of these terms include definition of
medical necessity, patient referral standards and procedures, utilization
review criteria, and payment methods and timing. The passage of this type of legislation
has become a necessity in recent years due to the consolidation of insurance
companies. In the last seven years,
the number of insurance companies has dropped from 18 to six, creating an
imbalance of power between physicians and the insurance entities. It has also been reported that more than
27,000 of the 140,000 bills introduced in state legislatures across the
nation have been in response to the current state of the health care
industry. “If this legislation were
to pass, it would serve to reduce the number of bills introduced on a yearly
basis to the state legislature related to insurance and other health care
related issues”, Savrin stated. What is the joint
negotiation bill? The bill provides a limited antitrust exemption to physicians
and other health care providers for the purpose of negotiating non-fee
contractual issues with insurance companies and in certain instances, to
negotiate fee-related matters. It is
designed to provide a proactive, market-driven solution to the imbalance of
power in the health care market by waiving antitrust laws and allowing
medical providers to jointly negotiate patient care issues with insurance
companies. |
Who could act as a negotiating representative for these
groups of physicians? The bill would require that each group name a joint
negotiation representative to speak for the group. This representative could be a medical society, a consulting
firm, an attorney, or a union representative. Can reimbursement
and other fee-related issues be discussed? Reimbursement and fee-related issues may be discussed and
negotiated with insurers by groups of health care providers ONLY upon the
approval of the Ohio Attorney General in those situations where the insurer
is found to have significant market share. Is an insurer required to negotiate with a group of
physicians and/or other health care providers? No, insurers are not required to negotiate with any group of
health care providers. However, it is
the firm belief of the AMC/NOMA that physicians and other health care
providers will work together in groups that will be attractive to insurers. If an insurer is not required to recognize a group of
physicians and discussions of fee-related issues are limited, then how will
this legislation help physicians? Many of the
most difficult aspects of the current managed care marketplace involve the
web of “red tape” that seems to be designed to make the practice of medicine
more difficult for physicians. This
legislation will allow groups of physicians to negotiate with insurers to
change the dynamics of managed care by moving away from rules imposed on
physicians by contracts to provisions of contracts negotiated by physicians. What effect would
this legislation have on patient care? The bill is being described as a “patient protection bill”
because it serves as a proactive solution to addressing patient care
problems. The legislation would level
the playing field and allow physicians to negotiate with managed care plans
on issues that would affect patient care.
The purpose of the legislation is to put the negotiating power back
where it belongs, in the hands of the physicians that provide the patient
care so that we can negotiate what we know is in the best interest of our
patients. What will the
bill allow for? The bill will allow independent health care providers to join
together to negotiate non-fee related contract terms with insurers, included
but not limited to: • Definition of medical necessity; • Utilization review criteria and
procedures; • Preventive care and medical management
policies; • Drug formularies; • Quality assurance programs; • Liability issues; • Payment methods and timing; • Claim documentation requirements and
administrative procedures; • Credentialing standards and procedures; • Dispute resolution mechanisms; • “All
products” clauses. |
