Docs and Collective Bargaining: Has the ACA Opened a Door?

Robert W. Morrow, MD


September 20, 2012

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Hi. Welcome to the Transparent Medical Practice blog. This is Bob Morrow, a family physician from the Bronx and Clinical Associate Professor in the Department of Family and Social Medicine at the Albert Einstein College of Medicine.

Perhaps you have been listening to some of these blogs, perhaps not. Today's topic is going to be difficult. I need you to wrap your minds around a concept that was recently told to me that I am starting to get used to. It comes down to the question of collective bargaining or collective negotiation between physicians and health plans.

If you are a guy like me in a small practice, you know that you are not permitted to negotiate your fees -- mostly because health plans are not interested, they have already negotiated huge fees with the local large medical centers, and they don't have any money left over for primary care and small practices.

So are we allowed to negotiate as a group where we might have some influence? No. That violates the Sherman Act and is a crime because, as you might or might not understand, physicians in small practices are monopoly sellers and the monopoly health plans that run many of the markets are considered buyers, so we are conspiring to raise prices on helpless buyers.

What can we do about this? Currently, we can ask our state legislators to make amendments to this law so that we are allowed to bargain, but even in a liberal state like New York, this has gone virtually nowhere in the legislature.

So what has changed? What am I asking you to think about right now? If you buy into the idea of collective bargaining -- deciding on the conditions of work, what the appropriate fees are, and the appropriate things we are supposed to be doing -- now that the Affordable Care Act has been passed through the Supreme Court, we are left in a peculiar situation. The federal government is not only in a position to determine various conditions of care for Medicare, Medicaid, and Veterans Affairs, but also over a large swath of the commercial industry. We are no longer dealing state by state with different entities, but rather with the federal government, which has a regulatory role in almost all of healthcare throughout the country.

This puts us in a position as organizations and as individuals to bind together and approach our elected representatives in the federal government to say that we would like a voice as professionals in how care is given and how care is paid for.

It is my sense that this is a very important opening for us to rediscuss the issue of collective negotiation around how doctors should be paid and how the medical pie should be divided up. As you probably know from hearing me talk about the Relative Value Scale Update Committee of the American Medical Association, the way it is done now is pretty bad. It pretty much favors the specialist and procedures and punishes primary care, which would give us better and cheaper healthcare.

Think about this as the federal government becomes a major player in the regulations of our services and where we are now, in the position with national organizations to approach and try to negotiate what rates should be paid for our work and how that should be decided.

Think about that. Hopefully, I made it clear enough. I'm Dr. Bob Morrow and this is the Transparent Medical Practice blog. Thanks for coming.