Antitrust implications of physicians' responses to managed care

As members of the IDSA, you are well aware that, increasingly, private market forces are dramatically transforming the organization of medical care. According to a recent article in the New York Times, almost two-thirds of people insured through employers received their health care from some kind of managed care arrangement in 1994; this figure compares with 47% only 3 years ago. Our members in private practice and in academic medicine are constantly confronted with demands from managed care organizations to control costs and to accept various forms of oversight over medical decision making. Responses by physicians to these demands can involve scrutiny under federal and state antitrust laws. For this reason, we have asked IDSA's counsel, Hogan & Hartson in Washington, D.C., to advise the membership of principles involving the applicability of the antitrust laws within the context of managed care. They have prepared the following article in response to our request. As the authors point out, there are steps that physicians can take in efforts to negotiate successfully with managed care organizations, but some types of conduct run the risk of running afoul of the antitrust laws. In addition, as they suggest, physicians should consult competent counsel before they collaborate with other physicians to respond to the new managed care environment. We recommend careful attention to this timely article and hope you find it useful.