Related Experiment Video

Updated: Oct 9, 2026

Focal Laser Ablation of Prostate Cancer: An Office Procedure
11:07

Focal Laser Ablation of Prostate Cancer: An Office Procedure

Published on: March 30, 2021

Physician fee-setting requires scrutiny

C E Barnes

    Physician Executive
    |December 10, 1988
    PubMed

    Insights

    Physicians in health maintenance organizations (HMOs) and preferred provider organizations (PPOs) can mitigate antitrust risks by sharing in financial losses and profits. This approach addresses legal concerns related to physician fee-setting strategies.

    Area of Science:

    • Health Law
    • Antitrust Law
    • Healthcare Economics

    Background:

    • Physician fee-setting in managed care organizations (MCOs) like HMOs and PPOs presents potential antitrust liabilities.
    • Understanding these legal risks is crucial for healthcare providers and organizations.

    Purpose of the Study:

    • To identify strategies for physicians to avoid antitrust litigation related to fee-setting within MCOs.
    • To provide guidance on structuring financial arrangements to mitigate legal risks.

    Main Methods:

    • Analysis of legal precedents and antitrust regulations concerning physician compensation models.
    • Review of risk-sharing mechanisms in healthcare contracts.

    Main Results:

    • Sharing the risk of profit and loss is a key strategy for physicians to avoid antitrust liability.
    • This risk-sharing aligns physician incentives with the financial performance of the MCO.

    Conclusions:

    • Implementing profit and loss sharing in physician contracts can effectively reduce antitrust exposure.
    • Legal counsel from experienced healthcare law firms is recommended for navigating these complex issues.

    More Related Videos

    Measuring Psoriasis Severity at Home02:28

    Measuring Psoriasis Severity at Home

    Published on: March 1, 2024

    Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease06:16

    Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease

    Published on: August 9, 2024

    Related Concept Videos

    Issues And Trends In Healthcare Delivery System01:29

    Issues And Trends In Healthcare Delivery System

    The issues and trends in healthcare delivery are constantly changing. The COVID-19 pandemic is one recent issue that wreaked havoc on healthcare systems, causing a shortage of healthcare workers, high demand for medicines and supplies, and increased medical expenditure due to a lack of insurance. Other issues include rising healthcare costs and care fragmentation.
    Cost Containment
    Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
    Methods of Documentation III: PIE01:21

    Methods of Documentation III: PIE

    Problem-intervention-evaluation (PIE) is a systematic approach to documentation used in healthcare settings for clinical decision-making and patient care planning. It is a structured approach to organizing patient data based on problems, interventions, and evaluations. Here's a breakdown of its key features and considerations:
    Methods of Documentation VI: Case Management Model01:15

    Methods of Documentation VI: Case Management Model

    The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
    For example, a patient with a chronic illness...
    Ethical Issues01:27

    Ethical Issues

    Nurses are essential in patient care, upholding the ethical principles of their profession and effectively navigating ethical dilemmas. Neglecting ethical issues can lead to inadequate patient care, compromised therapeutic relationships, and moral distress among healthcare workers.
    Ethical Concerns in Healthcare:
    Standards of Care I01:22

    Standards of Care I

    Federal statutes profoundly impact nursing practice, providing critical guidelines to ensure patient care is equitable, accessible, and of the highest quality. The following laws address distinct aspects of healthcare provision and patient rights:
    Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment01:08

    Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment

    Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...