Tuesday, February 11, 2003

Regulators give green light to doctor-pay comparisons

By Tim Bonfield
The Cincinnati Enquirer

Greater Cincinnati doctors have been complaining for years that they have been paid unusually low rates by health insurers. Now, a development in Dayton, Ohio, may help them prove their case.

On Monday, the Federal Trade Commission announced an advisory opinion allowing PriMed Physicians, a group of 62 Dayton-area doctors, to form a "health-care advisory group" to compare physician pay in Dayton with other cities and make the information public.

Until now, there were concerns that any effort by physicians to analyze how insurers set rates would violate federal anti-trust laws.

The Dayton ruling affects Cincinnati doctors - and potentially their patients - in at least three ways:

Greater Cincinnati physicians may become directly involved in the study because MediSync, the same company that provides management services to the PriMed group, also manages three practices in Cincinnati.

The Dayton study could become evidence in a lawsuit that Cincinnati doctors have launched against several large health insurers. The doctors claim the insurers have been fixing prices.

The Dayton study also may influence another physician study launched by the Health Improvement Collaborative of Greater Cincinnatiand funded by the Cincinnati Business Committee.

With a green light from regulators, the Dayton health advisory group will be formed in the next few weeks, said Bob Matthews, chief executive of MediSync. "Our partners found that insurance company policies and procedures were degrading the quality of care that patients receive," Matthews said.

"We felt that the public has both the right to know and the need to know what is happening to their health care."

MediSync also serves Cincinnati doctor groups Health First Physicians, the Family Medical Group and the Centers for Foot and Ankle Care.

The company has not decided whether to include Cincinnati doctors in the Dayton-based study or to launch a separate study for Cincinnati, Matthews said.

Anthem Inc., the largest provider of health insurance in Ohio, reacted cautiously to the FTC opinion.

"We take anti-trust concerns very seriously. That's why our contracts with physicians prevent them from sharing fee information with each other or the public," said Anthem spokesman Joe Bobbey.

Bobbey emphasized that the FTC opinion also states that anti-trust laws prevent doctors from taking collective action to change reimbursement rates.

E-mail tbonfield@enquirer.com

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