To improve the quality of care in the American healthcare system, improve access to the system, and to reduce the cost of care, primary care physicians should be granted a limited exemption from federal and state antitrust legislation, so they can effectively negotiate with health insurance companies and become stronger patient advocates.
The American Academy of Family Physicians (AAFP) believes that:
- America needs a solid primary care foundation for its healthcare system to:
- provide high quality medical care,
- reduce the cost of medical care by reducing unnecessary hospitalizations and emergency department visits, and
- provide access to all Americans who seek entry to the medical system;
- Health care reform will increase the need for:
- greater access to primary care practices,
- better management of patients’ acute and chronic illnesses, and
- preventive services, such as immunizations, health screenings, etc.
- The McCarran-Ferguson Act, 15 USC §§ 1011-1015, which exempts health insurance companies from federal anti-trust legislation that applies to most businesses, has:
- led to the consolidation of health insurance companies and thus limited competition among them, thereby giving them superior negotiating leverage with primary care physicians, and
- given them extraordinary control over benefit design, coverage exclusion, patient co-pay and deductible design, and formulary design, which adversely affects patients’ welfare.
- Health insurers’ current payment policies have not adequately compensated primary care practices, as evidenced by:
- the number of primary care practices that have closed in recent years, and
- the choice by the majority of US medical students to go into secondary and tertiary care specialties rather than primary care.
- The end result of these trends has been runaway inflation in the health care sector and inferior care for our citizens compared to that of other countries with strong primary care foundations.
Therefore, the AAFP recommends that:
- America’s primary care physicians be given the same exemption from federal anti-trust legislation that is enjoyed by health insurance companies under the McCarran-Ferguson Act;
- Any exemption for primary care physicians from federal anti-trust legislation, as is enjoyed by health insurance companies under the McCarran-Ferguson Act, be extended to state anti-trust legislation;
- That primary care physicians be permitted to collectively negotiate with health insurers on matters including, but not limited to:
- fees for providing primary care services, including those for ancillary services they provide in their offices,
- monthly retainers, stipends, or capitations intended to cover care management and other non-face-to-face care, such as population management, quality improvement, etc.;
- utilization management (including, but not limited to, therapeutic and diagnostic denials and preauthorization processes),
- and any other matter that affects the quality of care received by patients.
As a consequence, the AAFP believes that Americans shall:
- Have access to the health care system through strong and capable primary care practices;
- Have patient advocates within the system who know first-hand their medical needs and who have adequate negotiating leverage to effect change on their behalf; and
- See an end to the inflationary spiral in the healthcare sector of our economy.