Proposed Consent Agreement In the Matter of Roaring Fork Valley Physicians I.P.A., Inc., FTC File No. 061 0172 #546725-00011

Submission Number:
Christiaan Maurer
Roaring Fork IPA (CAM is the new RFIPA President)
Initiative Name:
Proposed Consent Agreement In the Matter of Roaring Fork Valley Physicians I.P.A., Inc., FTC File No. 061 0172
The mission of the IPA has always been to make healthcare in the Valley more efficient, less costly and of higher quality. In fact, the IPA was formed in 1996 at the request of the Rocky Mountain Health Plan, which asked the IPA to become its partner so that more people could get access to healthcare at a reasonable cost. The RMHP was recently found to have the lowest cost Medicare program in the country, and we still have a contract with the RMHP, 16 years later. The IPA was also a founding partner in the Community Health Plan, a local, low cost health plan sponsored by the Valley’s Chambers of Commerce and originally funded by a grant from the U.S. Department of Rural Health Policy. Our purpose in joining with the Chambers to form the Community Health Plan was and is to provide greater access to affordable health insurance coverage for the Valley’s residents. The physicians of the IPA believe that we have fulfilled the IPA’s mission, by offering significant payment discounts to consumers and health plans, and by creating and adopting care guidelines to increase the quality and effectiveness of the healthcare purchased in the Valley. The IPA categorically denies the FTC’s allegations that Valley physicians engaged in illegal price fixing. The IPA always encouraged individual members to evaluate contracts independently and to sign contracts that made sense for the financial needs of their medical practice. More contracts means more insurance access for ourselves, our patients, our neighbors and our families. Therefore, the IPA has never stood in the way of direct contracting between individual physicians who are members of the IPA and insurance companies, as the FTC contends. In fact, we offered evidence to the FTC that a snapshot survey of the IPA’s members found that at least 56 individual physicians had signed over eighty direct contracts with commercial health insurers during the period 2003-2007. There has always been a healthy amount of direct insurance-company-to-physician contracting in this Valley. The IPA developed policies that it believes are legal under the antitrust laws, and conducted its contracting process in accordance with those policies. Each IPA member decides independently whether to accept a contract offered by an insurance company. Once the member decides to accept the contract, however, then the IPA helps with contract administration. The IPA thus has significant administrative expenses, paid by member dues. To use these dues effectively, the IPA has required that a large percentage of its members accept the contracts before the IPA would serve as the contract administrator. An insurance company that wanted to contract with a smaller group of physicians could always do so, working directly with the physicians. To be efficient in its administration, the IPA also decided not to administer contracts built on the Medicare system of payment. Independent physician practices could, and did, accept these kinds of contracts. The FTC nonetheless contends that the IPA is obligated to administer contracts with all kinds of payment styles, including the Medicare payment system. Finally, the IPA told its members that it would be a best practice for an insurance payment contract to have an annual cost of living adjustment, or “COLA.” It means contracts can be stable from year to year, so that consumers can count on their doctors’ participation without worrying that annual contract negotiations will disrupt the continuity of their care. In 2010, the most common cost of living increase under the IPA’s contracts was 3.7%. If you contrast this with the 2010 rise in insurance premiums – in some cases by as much as 40% . The IPA cooperated fully with the FTC since the onset of the investigation. We felt that the facts, when known, would exonerate us. Unfortunately, despite the IPA spending many hours and a small fortune in our defense, the FTC staff chose to interpret the evidence in a light that we believe does not accurately reflect the IPA’s actions or intentions.