Proposed Consent Agreement In the Matter of Roaring Fork Valley Physicians I.P.A., Inc., FTC File No. 061 0172 #546725-00012

Submission Number:
Kelly Locke
Locke Family Medicine
Initiative Name:
Proposed Consent Agreement In the Matter of Roaring Fork Valley Physicians I.P.A., Inc., FTC File No. 061 0172
As a recent member of the RFVP IPA, I disagree with the FTC's ruling. I already have 2 contracts with private insurance outside the IPA and likely will sign up for a 3rd soon. The IPA has not limited my ability to contract with insurances that I want and to keep the mix of payors that I need - or prevented insurances from contracting on an individual basis. The 2 current insurer contracts and the future one are not tied to Medicare rates. They are a percentage of charges and this works fine for me - although I have limited leverage to negotiate with these very large corporations. It's unclear to me what reasonable business person would tie their wages to Medicare's fee schedule. Many studies have shown that the Medicare fee schedule does not keep up with inflation (meaning a pay cut every year in buying power) -- plus the yearly threat of a Medicare Fee Schedule Cut due to the flawed formula is unacceptable in a business with high overhead and low margins like Family Medicine. Again, would any reasonable business person tie their fees/salary to a Medicare schedule that threatens to cut their fee every year by 5%, 10%, now 21%(!) unless congress swoops in and passes a last minute law to keep the rates the same or give a very tiny increase in the fee schedule that businesses are supposed to be happy for -- afterall, it wasn't a pay cut? As a small business with 2 providers - my wife and I - we have very little leverage to negotiate reasonable contracts from large insurance companies. We do the best we can legally through our IPA and when that doesn't work, we attempt to contract the best we can outside the IPA. I will likely sign another contract with a private insurance outside the IPA in the next few weeks, but I can assure you that being a reasonable business person, I will not tie that contract to some arbitrary % of the Medicare Fee schedule, but rather a reasonable fee structure that the private insurance and I can live with. I will also continue to negotiate individually with insurances when necessary and do the best I can to negotiate a fare contract - although this becomes more difficult each year as insurances merge and there is less competition among insurances in our region (e.g. Cigna and Great West merger). For your reference... ================================== Link and Headlines about the Medicare impending pay cut... Physicians react to 21% Medicare payment cut - Ortho SuperSite While the House of Representatives voted last week on a bill that would stall the scheduled 21% Medicare physician payment cut, the Senate adjourned without ... Medicare Cuts Pinch Some San Diego County Doctors KPBS More Medicare pressure Sarasota Herald-Tribune New Senate Bill Would Put Off 21.2% Medicare Pay Cut Until Oct. 1 ========================= Here is the AMA's graph showing how the Medicare Fee schedule doesn't keep up with the cost of doing business... Thank you for your time Kelly Locke, MD