In the Matter of Cooperativa de Medicos Oftalmologos de Puerto Rico, File No. 1410194 #00004

Submission Number:
Outside the United States
Initiative Name:
In the Matter of Cooperativa de Medicos Oftalmologos de Puerto Rico, File No. 1410194
As a medical doctor in Puerto Rico I want to state that when three large medical plans control most of a patient population, in this case non-indigent patients over 65, that they are defacto's monopolies. When one of those medical plans decides to unilaterally cut fees a provider has the choice of losing a third of his patient base and going out of business or accept whatever rate the insurance company decides to impose. The only limit is when the provider fees are so low that the provider does, indeed, go out of business or moves out of the territory. By definition, when there is no choice but to either accept a contract or go out of business the group offering the contract functions as a monopoly. Surgical ophthalmology is a geriatric specialty where the vast majority of patients receive medicare, medicaid or both. Only medicare advantage plans service this population and the heavy regulations associated with type of plan greatly limits entry of new competitors into this market. Very few patients in Puerto Rico have standard medicare because they cannot afford the deductibles and co pays. This creates a monopoly situation where each plan has the ability to individually impose its will. Without the organizational ability offered by oftacoop the practice of ophthalmology will suffer great losses, severely affecting the standard of care on the island. Ultimately the cost cutting of the medical plans comes at the expense of better equipment and service for patients. Medical plans do no provide medical service, only physician providers do. We will respond by cutting the quality of care enough to stay in business and that means that ultimately patients in Puerto Rico will receive third world medical care.