Ad Directory
American Physicians Insurance Company ..................................................36
Ardenwood Group ....................................34 Athenahealth…............................................23 Centers for Medicare & Medicaid Services… ................................................. ..17
Covenant Medical Group ..........................9 DaVita Labs… ............................................... .6 Frost Bank ....................................................33 Kindred Healthcare…. ............................... .18 Leichter Law… ..............................................21 Lillibridge…....................................................41 MedExchange… .......................................…43 Regions Mortgage ................................…..41 Sharp & Cobos, P.C. Attorneys at Law… ................................................... ..30
Stillwater National Bank .........................24 Texas Department of State Health Services HIV/STD… ............................. ..30
Texas Medical Association Have a Heart…. ...................................... .50 HIT… ............................................................38 Home Study Course… ..........................43 Medical Jobs Center ...........................IBC Membership… ....................................... ..44 Mobile Application…. ............................49 Physicians Benevolent Fund…. .........33 Physician Oncology Education Program…. .............................................. .3 Practice Consulting… .......................... ..37
Texas Medical Association Insurance Trust ...........................................................BC
Texas Medical Liability Trust… .......... ..IFC TEXPAC… ......................................................38
Kell West aren’t planning to file a lawsuit against United Regional for its contract- ing practices.
“Right now we’re happy we’re able to give all insurance companies a chance to contract with Kell West,” Dr. Myers said.
United Regional responds In a press release, United Regional said it is pleased the lawsuit has been resolved. “While we disagree with the depart- ment’s interpretation of the facts and would have welcomed the opportuni- ty to address this matter in a court of law, we believe it is in the best interest of United Regional and our patients to instead move forward with our total attention and resources focused on our passion of providing excellence in health care for the communities we serve,” the press release says. United Regional added that, “There appears to be little, if any, correlation be- tween the involved contracts and United Regional’s growth of the last few years. Instead, evidence shows that our prog- ress is the result of many strategic and operational factors.” In a letter, United Regional President and Chief Executive Officer Phyllis Cowl- ing wrote that contractual provisions allowed each plan to elect one of two options:
• Designate United Regional as its lo- cal in-network hospital and receive deeper discounts on United Regional services, or
• Provide an unlimited range of local hospital providers and receive more shallow discounts on United Regional services.
“In other words, the contracts pro-
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vided for discounts corresponding to a plan’s expected volume commitments and at the election of the plan,” Ms. Cowling wrote.
She added that since United Region- al can “provide significant services not available elsewhere in our local area, and because the majority of residents of the Wichita Falls area obtain their hospital care from United Regional, the Department determined that the ‘either/ or’ provision outlined above must be
48 TEXAS MEDICINE November 2011
eliminated from these contracts, and we agreed to do so. Thus, we will be taking appropriate steps to ensure fulfillment of our obligations in resolution of this matter.”
FTC bars physician group from joint price negotiations
An association representing 900 physi- cians in the Amarillo area agreed to a Federal Trade Commission (FTC) or- der barring it from jointly negotiating the prices it charges insurance provid- ers. The FTC alleged in a complaint filed with the order that the association, Southwest Health Alliances, Inc., d/b/a BSA Provider Network, has violated fed- eral law since 2000 by fixing the prices its member doctors would charge insur- ers. This led to higher prices for consum- ers and businesses, FTC maintained. The FTC order settling the charges
prohibits Southwest Health from similar conduct in the future. The association also is settling similar charges brought by the Texas Attorney General’s Office. Southwest Health is an independent practice association (IPA) consisting of multiple, independent medical practices with approximately 900 physician mem- bers — 300 of whom provide primary care services — in the Amarillo area. Ac- cording to the FTC’s complaint, since at least 2000, the network has restrained competition by entering into and imple- menting agreements to fix the prices and terms at which it would contract with health plans, and has collectively nego- tiated the terms and conditions under which it would deal with health plans. The FTC contends that the agree- ments eliminated competition and harmed consumers by increasing prices for physician services. Collective price negotiation and agreements between IPAs and health care providers may be justified under some circumstances. For example, if an IPA clinically or financial- ly integrates its members’ practices, this
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