E/M Coding Alert - 2006 Issue 13
Don't Let Hospital Talk To Insurers For You
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Article Overview
This article explains a Federal Trade Commission advisory opinion concerning a physician-hospital contracting model and its potential antitrust implications. It is relevant to physicians, hospitals, managed care contracting teams, compliance staff, and healthcare administrators who follow payer contracting and physician network arrangements. The article focuses on the proposed structure, the FTC’s concerns, and the organization’s stated efficiency and care-improvement goals.
Why This Topic Matters
Healthcare contracting arrangements can raise antitrust and compliance issues, especially when pricing and payer negotiations are centralized. Understanding the FTC’s position helps organizations assess physician-network deal structures and evaluate whether proposed efficiencies are likely to address regulatory concerns.
What You Will Learn
- The general antitrust issues raised by physician contracting through a hospital-affiliated organization.
- How an FTC advisory opinion can affect healthcare network and managed care contracting structures.
- The types of efficiency and care-improvement claims organizations may raise in support of centralized contracting arrangements.
- How payer negotiation models can intersect with federal competition concerns.
Who Should Read This
- Physicians
- Hospital administrators
- Managed care contracting professionals
- Healthcare compliance officers
- Healthcare attorneys
- Practice management leaders
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