Tuesday, June 10, 2003
Morning Session: 9:15 a.m. - 12:30 p.m.
Afternoon Session: 2:00 p.m. - 5:00 p.m.

Quality and Consumer Protection: Market Entry

In health care, market entry is influenced by a number of factors, including the necessity of meeting state regulatory requirements such as licensure and certificate of need. Professional associations and individual providers have used a variety of strategies to limit entry by potential competitors and prevent unbundling and de-skilling of the services that they provide. Thus, in many states, there are significant limitations on market entry by new competitors, and opposition to the efforts of existing competitors to expand the range of services they provide. What does the empirical evidence indicate about the cost, quality, and availability of services provided by nurse-midwives, nurse-anesthetists, dental hygienists, physician-assistants, pharmacists, optometrists, physical therapists, and other professionals and para-professionals? What regulatory and non-regulatory strategies have been employed to restrict independent practice or broadened clinical autonomy by these providers? What reasons have been advanced to justify such restrictions on entry? Do the regulatory strategies that have been employed reflect the least restrictive means of accomplishing the intended objectives? What consumer information and protection issues would be raised by a less-restrictive environment for market entry?

Morning Session Panelists:

• Susan Apold, American College of Nurse Practitioners
• Tammi O. Byrd, American Dental Hygienists' Association
• John Hennessy, Kansas City Cancer Centers
• Morris Kleiner, University of Minnesota
• Lynne Loeffler, American College of Nurse Midwives
• Tom Piper, American Health Planning Association
• Megan D. Price, Professional Nurses Services, Inc.
• Robin Wilson, University of South Carolina School of Law

Afternoon Session Panelists:

• Jeffrey C. Bauer, Superior Consultant Company, Inc.
• Gregg Bloche, M.D., Georgetown University School of Law
• Steven Lomazow, M.D., American Academy of Neurology
• Francis J. Mallon, American Physical Therapy Association
• Jerome H. Modell, M.D., representing American Society of Anesthesiologists
• Michael Morrisey, University of Alabama
• Dr. Russ Newman, American Psychological Association

Wednesday June 11, 2003
Morning Session: 9:15 a.m. - 12:30 p.m.

Noerr Pennington/State Action

How do Noerr Pennington and the state action doctrines affect competition law and policy? Are there specific anti-competitive practices that current enforcement efforts have not addressed because of the Noerr Pennington or state action doctrines, including but not limited to abuses of state licensure, certificate of need and other regulatory and petitioning processes? Does competition law and policy impede providers from jointly discussing their concerns with government payors? What are the appropriate boundaries for these doctrines given the competing interests at stake? Are antitrust enforcement efforts appropriately targeted in light of the impact of the Noerr Pennington and state action doctrines?

Panelists:

• Meredyth Smith Andrus, Office of the Attorney General, Maryland
• John Delacourt, Federal Trade Commission
• Clark Havighurst, Duke University Law School
• Kenneth W. Kizer, M.D., National Quality Forum
• Dr. Brenda Lyon, National Association of Clinical Nurse Specialists
• Mark McClure, D.D.S, National Integrative Health Associates

 

Wednesday June 11, 2003
Afternoon Session: 2:00 p.m. - 5:00 p.m.

Long Term Care/Assisted Living Facilities

An increasing number of elderly Americans spend time in long term care or an assisted living facility. What is the nature of the information that is disclosed to such consumers about the cost and quality of the services they will receive? Is the type and amount of the information that these facilities provide concerning quality adequate to allow consumers to make well-informed purchasing decisions? If not, what additional information do consumers need or want to make such decisions and why are these facilities not already providing it in the marketplace? Does the quantity and quality of the information that consumers would find helpful vary? What is the state of the art with regard to measures of nursing home and assisted living facility quality, whether structure, process, or outcome? What are the risks of relying on (and disclosing) process-based measures of quality? How would competition on quality measures affect costs, prices, and decisions by payors and customers? How does compensation affect quality? Can compensation be harnessed to enhance the performance of nursing homes and assisted living facilities?

Panelists:

• Toby S. Edelman, Center for Medicare Advocacy
• Karen Love, Consumer Consortium on Assisted Living
• Barbara Manard, American Association of Homes and Services for the Aging
• Barbara Paul, M.D., Center for Medicare and Medicaid Services
• Jan Thayer, National Center for Assisted Living
• Keren Brown Wilson, Jessie F. Richardson Foundation

Thursday June 12, 2003
Morning Session: 9:15 a.m. - 12:30 p.m.

Financing Design/Consumer Information Issues

For the non-elderly, health care is financed through voluntary insurance contracts. Employment-based health insurance covers the majority of non-elderly insured Americans. How effectively do employers reflect the preferences of their employees in designing and implementing health insurance coverage? What distortions result from making employers the nexus of health insurance? Are there off-setting advantages associated with having employers involved in the health insurance market? What changes have there been in the structure of employment-based health insurance in recent years? What information is disclosed to employees in connection with obtaining health insurance? How does employment-based health insurance differ from insurance available in the individual market? Health insurance is aggressively regulated by the states, with more limited regulation by the federal government. What are the effects of this regulation on the cost and content of the health insurance products available in the marketplace? Does such regulation correct for specific failures in the market for health insurance coverage? Has the emergence of new forms of health insurance coverage (i.e., point-ofservice options, consumer-driven health insurance, and medical savings accounts) had an effect on the health insurance market and the regulatory environment?

Panelists:

• Marcia L. Comstock, M.D., Wye River Group on Healthcare
• Helen Darling, Washington Business Group on Health
• Newt Gingrich, The Gingrich Group
• Warren Greenberg, George Washington University
• Greg Kelly, Coalition against Guaranteed Issue
• David Lansky, Foundation for Accountability
• Michael Young, Aon Consulting

Thursday June 12, 2003
Afternoon Session: 2:00 p.m. - 5:00 p.m.

Information and Advertising

To what extent do consumers use quality information in making choices among health care financing arrangements and among health care providers? What information regarding quality is available to consumers? How accurate is this information? Does the quantity and quality of the available information depend on the nature of the underlying condition (i.e., acute v. chronic) and treatment (i.e., surgical v. medical; curative v. palliative; elective v. necessary)? What effects does this information have on the behavior of health care providers? What quality information do health care providers disseminate through advertising? What characteristics distinguish health care providers who provide quality information through advertising from those who do not? Do health care providers who advertise quality differ from those who advertise price or other attributes of their services? What percentage of health care providers engage in any advertising? What role does comparative advertising (including scorecards) play in competition among health care providers? What role does comparative advertising concerning access to specialists or specialized services play in competition among health care financing options? Do governmental or professional restrictions limit the advertising of health care goods and services based on quality? What are the effects of these restrictions on competition in markets for health care goods and services? What are the pro-competitive justifications for such restrictions? What empirical evidence supports these justifications?

Panelists:

• Laura Carabello, CPRi Communications
• Bernie Dana, American Health Care Association
• Helen Darling, Washington Business Group on Health
• John E. Gebhart, III, DoctorQuality.com
• Richard Kelly, Federal Trade Commission
• Douglas D. Koch, M.D., Baylor College of Medicine
• Thomas Henry Lee, Jr., M.D., Partners Healthcare
• Peter M. Sfikas, American Dental Association