Anti Trust Policy

May 25th, 2007 | Regulatory Matters

During my work on the in-progress 3rd edition of my book, I reviewed the current stance of the "Agencies" – Federal Trade Commission and Department of Justice – with respect to joint negotiations and similar activities by physicians (Improving Health Care: A Dose of Competition, July 2004). Predictably, I found no change in the longstanding opposition to same and continued strenuous enforcement activity. Several things were of particular interest, however.

Allied Health Professionals such as CRNAs or dental hygienists are an increasingly critical part of the healthcare delivery system. In many instances, they represent a critical profit center for the physicians (or dentists) who supervise them. In the case of CRNAs for example, in many states they cannot practice independent of physician supervision; in states where they are permitted to, hospital policy may preclude it. Although they do much the same work as anesthesiologists, they are paid less than half the salary.

Dental hygienists generally cannot practice independently of a dentist’s supervision. Given the profitability of the typical hygienist in a dental practice – one of the principal value drivers of the practice – it is not difficult to see why the Agencies believe that a change in licensing would lead to lower prices. Therein lies the Agencies’ problem with state-based licensing of Allied Health Professionals by Boards often controlled by the supervising profession (again, physicians or dentists) who have a vested financial interest in reducing potential competition.

I would observe as well that the move of mega-retailer Walmart and CVS into the in-store walk-in clinic using physician extenders gives this issue particular import.

Anti-trust enforcement is shared with the individual states’ attorneys general and the Agencies pass along their recommendations. Therefore "stand by for news…"

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