Public Health Law Map - Beta 5 - Medical and Public Health Law Site

collective action, a close reading indicates no change from prevailing antitrust rules.
The only safety zones provided in the guidelines are for physician networks that
involve significant shared financial risk and that do not have more than 20% of the
market for exclusive arrangements, or 30% for nonexclusive arrangements. Although
the guidelines say that it is possible to have complying networks without substantial
shared financial risk, the criteria they use for evaluating these networks imply that it
is unlikely many will pass. The guidelines make clear that informal associations of
physicians that engage in anticompetitive activities, such as boycotts of MCOs or
other bargaining activities, will be treated harshly:
In contrast to integrated physician network joint ventures, such as these
discussed above, there have been arrangements among physicians that have
taken the form of networks, but which in purpose or effect were little more
than efforts by their participants to prevent or impede competitive forces
from operating in the market. These arrangements are not likely to produce
significant procompetitive efficiencies. Such arrangements have been, and
will continue to be, treated as unlawful conspiracies or cartels, whose price
agreements are per se illegal. [Id. at B(1).]
I. References - Team Care
1. Managed Care
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Appelbaum PS. Managed care and the next generation of mental health law. New
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Barratt K. Reviewing gag clauses in managed care contracts. Wisc Med J.
1996;95:249–250.
Beinecke R, Pfeifer R, Pfeiffer D, Soussou N. The evaluation of fee for service and
managed care from the viewpoint of people with disabilities in the USA. Disabil
Rehabil. 1997;19:513–522.
Bettman JW, Demorest BH, Craven ER. Risk management issues in the new
managed care environment. Survey Ophthalmol. 1996;41:268–270.
Bitterman RA. Managed care authorization for emergency department services: a
medical risk to patients, a legal risk for doctors and hospitals. NC Med J.
1997;58:260–263.
Boyd JW. The human toll of managed care. Pharos. 1997;60:32–34.
Brody BA. Ethical issues raised by managed care. Tex Med. 1997;93:43–45.
Brody H, Bonham VL Jr. Gag rules and trade secrets in managed care contracts:
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