AMA to Congress: Consider the physicians in cutting healthcare costs
Despite the temptation to conclude that anything that drives down medical fees is good for consumers, many policy experts have asserted that lower fees paid by insurers may result in high premium for patients, according to a Sept. 9 statement submitted to the U. S. House Ways and Means Health Subcommittee by the American Medical Association (AMA).
The AMA’s statement examined the consolidation in the healthcare industry, including areas where changes are needed to protect patients and encourage the success of new models of patient care.
"Existing antitrust policies allow significant consolidation in some areas of our healthcare system while overly restricting the coordination of care by physicians," wrote AMA President Peter W. Carmel, MD. "It is time to update these policies to allow physicians in all practice sizes the ability to lead and participate in innovative new models of care while protecting patients from anticompetitive practices."
A full 78 percent of office-based physicians in the U.S. work in practices with nine physicians or less, and a majority of those are in practices of one to four, according to the statement. Under existing antitrust enforcement policies, these physician practices are effectively prohibited from forming clinically integrated groups that can contract with private payors and participate in care improvement and coordination efforts, the Washington, D.C.-based organization asserted.
Over the last decade, AMA studies have consistently found that a majority of local health insurance markets across the U.S. are highly concentrated, which can mean decreased competition and higher prices for patients. “The most recently published AMA study, ‘Competition in Health Insurance: A Comprehensive Study of U.S. Markets (2010 update),’ found that the vast majority of health insurance markets across the U.S. are highly concentrated and are dominated by one or two health insurers,” the statement said. “Specifically, the study found that 80 percent of the metropolitan areas examined were highly concentrated based on the 2010 Horizontal Merger Guidelines, and in nearly half of the metropolitan areas examined, one insurer had at least a 50 percent market share.”
The AMA urged the committee to be mindful of the role that physicians play in patient care in that they are critical in efforts to improve quality and provide coordinated care for patients. The physicians should be supported in these efforts, rather than penalized, by antitrust law and enforcement.
"We applaud the Ways and Means Committee for examining current policies related to consolidation in healthcare," Carmel concluded. "We will continue to work with them to design policies that encourage the development of innovative, physician-led new models of patient care designed to improve quality, lower costs and promote competitive healthcare markets."
Read the statement here.
The AMA’s statement examined the consolidation in the healthcare industry, including areas where changes are needed to protect patients and encourage the success of new models of patient care.
"Existing antitrust policies allow significant consolidation in some areas of our healthcare system while overly restricting the coordination of care by physicians," wrote AMA President Peter W. Carmel, MD. "It is time to update these policies to allow physicians in all practice sizes the ability to lead and participate in innovative new models of care while protecting patients from anticompetitive practices."
A full 78 percent of office-based physicians in the U.S. work in practices with nine physicians or less, and a majority of those are in practices of one to four, according to the statement. Under existing antitrust enforcement policies, these physician practices are effectively prohibited from forming clinically integrated groups that can contract with private payors and participate in care improvement and coordination efforts, the Washington, D.C.-based organization asserted.
Over the last decade, AMA studies have consistently found that a majority of local health insurance markets across the U.S. are highly concentrated, which can mean decreased competition and higher prices for patients. “The most recently published AMA study, ‘Competition in Health Insurance: A Comprehensive Study of U.S. Markets (2010 update),’ found that the vast majority of health insurance markets across the U.S. are highly concentrated and are dominated by one or two health insurers,” the statement said. “Specifically, the study found that 80 percent of the metropolitan areas examined were highly concentrated based on the 2010 Horizontal Merger Guidelines, and in nearly half of the metropolitan areas examined, one insurer had at least a 50 percent market share.”
The AMA urged the committee to be mindful of the role that physicians play in patient care in that they are critical in efforts to improve quality and provide coordinated care for patients. The physicians should be supported in these efforts, rather than penalized, by antitrust law and enforcement.
"We applaud the Ways and Means Committee for examining current policies related to consolidation in healthcare," Carmel concluded. "We will continue to work with them to design policies that encourage the development of innovative, physician-led new models of patient care designed to improve quality, lower costs and promote competitive healthcare markets."
Read the statement here.