Roaring Fork Valley Physicians I.P.A.; Analysis of the Agreement Containing Consent Order to Aid Public Comment, 7266-7268 [2010-3033]

Download as PDF 7266 Federal Register / Vol. 75, No. 32 / Thursday, February 18, 2010 / Notices under the Shipping Act of 1984. Interested parties may submit comments on the agreements to the Secretary, Federal Maritime Commission, Washington, DC 20573, within ten days of the date this notice appears in the Federal Register. Copies of the agreements are available through the Commission’s Web site (http:// www.fmc.gov) or by contacting the Office of Agreements at (202) 523–5793 or tradeanalysis@fmc.gov. Agreement No.: 011426–047. Title: West Coast of South America Discussion Agreement. Parties: A.P. Moller-Maersk A/S; APL Co. Pte Ltd.; Compania Chilena de Navigacion Interoceanica, S.A.; Compania Sud Americana de Vapores, S.A.; Frontier Liner Services, Inc.; ¨ Hamburg-Sud; King Ocean Services Limited, Inc.; Mediterranean Shipping Company, SA; Seaboard Marine Ltd.; South Pacific Shipping Company, Ltd.; and Trinity Shipping Line. Filing Party: Wayne R. Rohde, Esq.; Sher & Blackwell LLP; 1850 M Street, NW.; Suite 900; Washington, DC 20036. Synopsis: The amendment deletes the geographic sections of the Agreement, adds new authority for the parties to form committees, and restates the Agreement. Dated: February 12, 2010. By order of the Federal Maritime Commission. Rachel E. Dickon, Assistant Secretary. [FR Doc. 2010–3065 Filed 2–17–10; 8:45 am] BILLING CODE P FEDERAL TRADE COMMISSION [File No. 061 0172] Roaring Fork Valley Physicians I.P.A.; Analysis of the Agreement Containing Consent Order to Aid Public Comment Federal Trade Commission. Proposed Consent Agreement. AGENCY: WReier-Aviles on DSKGBLS3C1PROD with NOTICES ACTION: SUMMARY: The consent agreement in this matter settles alleged violations of federal law prohibiting unfair or deceptive acts or practices or unfair methods of competition. The attached Analysis to Aid Public Comment describes both the allegations in the draft complaint and the terms of the consent order — embodied in the consent agreement — that would settle these allegations. DATES: Comments must be received on or before March 5, 2010. ADDRESSES: Interested parties are invited to submit written comments VerDate Nov<24>2008 14:39 Feb 17, 2010 Jkt 220001 electronically or in paper form. Comments should refer to ‘‘Roaring Fork Valley, File No. 061 0172’’ to facilitate the organization of comments. Please note that your comment — including your name and your state — will be placed on the public record of this proceeding, including on the publicly accessible FTC website, at (http:// www.ftc.gov/os/publiccomments.shtm). Because comments will be made public, they should not include any sensitive personal information, such as an individual’s Social Security Number; date of birth; driver’s license number or other state identification number, or foreign country equivalent; passport number; financial account number; or credit or debit card number. Comments also should not include any sensitive health information, such as medical records or other individually identifiable health information. In addition, comments should not include any ‘‘[t]rade secret or any commercial or financial information which is obtained from any person and which is privileged or confidential. . . .,’’ as provided in Section 6(f) of the FTC Act, 15 U.S.C. 46(f), and Commission Rule 4.10(a)(2), 16 CFR 4.10(a)(2). Comments containing material for which confidential treatment is requested must be filed in paper form, must be clearly labeled ‘‘Confidential,’’ and must comply with FTC Rule 4.9(c), 16 CFR 4.9(c).1 Because paper mail addressed to the FTC is subject to delay due to heightened security screening, please consider submitting your comments in electronic form. Comments filed in electronic form should be submitted by using the following weblink: (https:// public.commentworks.com/ftc/ roaringforkconsent) and following the instructions on the web-based form. To ensure that the Commission considers an electronic comment, you must file it on the web-based form at the weblink: (https://public.commentworks.com/ftc/ roaringforkconsent.) If this Notice appears at (http://www.regulations.gov/ search/index.jsp), you may also file an electronic comment through that website. The Commission will consider all comments that regulations.gov forwards to it. You may also visit the FTC website at (http://www.ftc.gov/) to read the Notice and the news release describing it. 1 The comment must be accompanied by an explicit request for confidential treatment, including the factual and legal basis for the request, and must identify the specific portions of the comment to be withheld from the public record. The request will be granted or denied by the Commission’s General Counsel, consistent with applicable law and the public interest. See FTC Rule 4.9(c), 16 CFR 4.9(c). PO 00000 Frm 00036 Fmt 4703 Sfmt 4703 A comment filed in paper form should include the ‘‘Roaring Fork Valley, File No. 061 0172’’ reference both in the text and on the envelope, and should be mailed or delivered to the following address: Federal Trade Commission, Office of the Secretary, Room H-135 (Annex D), 600 Pennsylvania Avenue, NW, Washington, DC 20580. The FTC is requesting that any comment filed in paper form be sent by courier or overnight service, if possible, because U.S. postal mail in the Washington area and at the Commission is subject to delay due to heightened security precautions. The Federal Trade Commission Act (‘‘FTC Act’’) and other laws the Commission administers permit the collection of public comments to consider and use in this proceeding as appropriate. The Commission will consider all timely and responsive public comments that it receives, whether filed in paper or electronic form. Comments received will be available to the public on the FTC website, to the extent practicable, at (http://www.ftc.gov/os/ publiccomments.shtm). As a matter of discretion, the Commission makes every effort to remove home contact information for individuals from the public comments it receives before placing those comments on the FTC website. More information, including routine uses permitted by the Privacy Act, may be found in the FTC’s privacy policy, at (http://www.ftc.gov/ftc/ privacy.shtm). FOR FURTHER INFORMATION CONTACT: Constance M. Salemi (202-326-2643), Bureau of Competition, 600 Pennsylvania Avenue, NW, Washington, D.C. 20580. SUPPLEMENTARY INFORMATION: Pursuant to section 6(f) of the Federal Trade Commission Act, 38 Stat. 721, 15 U.S.C. 46(f), and § 2.34 the Commission Rules of Practice, 16 CFR 2.34, notice is hereby given that the above-captioned consent agreement containing a consent order to cease and desist, having been filed with and accepted, subject to final approval, by the Commission, has been placed on the public record for a period of thirty (30) days. The following Analysis to Aid Public Comment describes the terms of the consent agreement, and the allegations in the complaint. An electronic copy of the full text of the consent agreement package can be obtained from the FTC Home Page (for February 3, 2010), on the World Wide Web, at (http:// www.ftc.gov/os/actions.shtm). A paper copy can be obtained from the FTC Public Reference Room, Room 130-H, E:\FR\FM\18FEN1.SGM 18FEN1 Federal Register / Vol. 75, No. 32 / Thursday, February 18, 2010 / Notices 600 Pennsylvania Avenue, NW, Washington, D.C. 20580, either in person or by calling (202) 326-2222. Public comments are invited, and may be filed with the Commission in either paper or electronic form. All comments should be filed as prescribed in the ADDRESSES section above, and must be received on or before the date specified in the DATES section. WReier-Aviles on DSKGBLS3C1PROD with NOTICES Analysis of Agreement Containing Consent Order to Aid Public Comment The Federal Trade Commission has accepted, subject to final approval, an agreement containing a proposed consent order (‘‘proposed order’’) with Roaring Fork Valley Physicians I.P.A., Inc., (‘‘RFV’’). The agreement settles charges by the Federal Trade Commission that RFV violated Section 5 of the Federal Trade Commission Act, 15 U.S.C. § 45, by, among other things, orchestrating and implementing pricerelated agreements and concerted refusals to deal among competing physician members of RFV to maintain and raise the price at which RFV’s physician members contract with payers. The proposed order has been placed on the public record for 30 days to receive comments from interested persons. Comments received during this period will become part of the public record. After 30 days, the Commission will review the agreement and the comments received, and will decide whether it should withdraw from the agreement or make the proposed order final. The purpose of this analysis is to facilitate public comment on the proposed order. The analysis is not intended to constitute an official interpretation of the agreement and proposed order or to modify their terms in any way. Further, the proposed order has been entered into for settlement purposes only and does not constitute an admission by the proposed respondent that it violated the law or that the facts alleged in the complaint (other than jurisdictional facts) are true. The Complaint The allegations of the complaint are summarized below. RFV is a type of organization commonly referred to in the health care industry as an ‘‘independent practice association’’ because its members consist of independent physicians in solo and small group practices. RFV is controlled by and organized in substantial part for the pecuniary benefit of its approximately 85 physician members. RFV is located in Garfield County, Colorado. VerDate Nov<24>2008 14:39 Feb 17, 2010 Jkt 220001 The complaint alleges that since at least 2003 RFV, although purporting to use a messenger model, negotiated price-related terms on behalf of its members for the purpose of increasing and maintaining the rates for services provided by RFV’s otherwise competing physician members. RFV increased rates by demanding that payers include automatic annual cost of living adjustments (COLAs) in their contracts. RFV held lengthy bargaining sessions with payers to pressure them into including COLAs and other terms in their contracts. To protect the automatic increases, RFV refused to messenger contracts with Medicare-based rates because of their potential to decline. RFV feared Medicare-based rates would decline over time. The complaint also alleges that since at least 2003 RFV and its members engaged in concerted refusals to deal with payers except upon the collectively-agreed upon contract terms demanded during negotiations. RFV organized concerted refusals to deal by requiring payers contracting with RFV to persuade 80 percent of all RFV members and 50 percent of each RFV specialty (‘‘80/50 rule’’) to accept their contracts. After a payer satisfied the 80/ 50 rule, RFV signed, administered and bound all the members to the payer’s contract. RFV refused to messenger the contract of a payer who failed to satisfy the 80/50 rule. RFV reinforced the 80/ 50 rule by refusing to provide unsuccessful payers with the identity of the members willing to accept their contracts. RFV’s refusal prevented the unsuccessful payers from contracting directly with individual physicians willing to accept the proposed contract terms. RFV also reinforced its concerted refusals to deal by encouraging members to only use the IPA for their contracting. RFV targeted its concerted refusals at national payers and warned members against contracting with them. Most national payers attempting to contract with RFV could not satisfy the 80/50 rule. RFV members did not engage in any efficiency-enhancing integration of their practices sufficient to justify the collectively negotiation or the concerted refusals to deal. Accordingly, the complaint alleges that RFV violated Section 5 of the FTC Act. The Proposed Order The proposed order is designed to remedy the illegal conduct charged in the complaint and prevent its recurrence. It is similar to recent consent orders that the Commission has issued to settle charges that physician groups engaged in unlawful agreements PO 00000 Frm 00037 Fmt 4703 Sfmt 4703 7267 to raise fees they receive from health plans. The proposed order’s specific provisions are as follows: Paragraph II.A prohibits RFV from entering into or facilitating any agreement between or among any physicians: (1) to negotiate with payers on any physician’s behalf; (2) to deal, refuse to deal, or threaten to refuse to deal with payers; (3) on any terms on which a physician is willing to deal with any payer; or (4) not to deal individually with any payer, or not to deal with any payer other than through RFV. Other parts of Paragraph II reinforce these general prohibitions. Paragraph II.B prohibits RFV from facilitating exchanges of information between physicians concerning any physician’s willingness to deal with a payer or the terms or conditions, including price terms, on which the physician is willing to deal with a payer. Paragraph II.C bars attempts to engage in any action prohibited by Paragraph II.A or II.B, and Paragraph II.D proscribes RFV from inducing anyone to engage in any action prohibited by Paragraphs II.A through II.C. As in other Commission orders addressing providers’ collective conduct with health-care purchasers, Paragraph II excludes certain kinds of agreements from its prohibitions. First, RFV is not precluded from engaging in conduct that is reasonably necessary to form or participate in legitimate joint contracting arrangements among competing physicians, such as a ‘‘qualified risk-sharing joint arrangement’’ or a ‘‘qualified clinicallyintegrated joint arrangement.’’ The arrangement, however, must not restrict the ability of, or facilitate the refusal of, physicians who participate in it to contract with payers outside of the arrangement. As defined in the proposed order, a ‘‘qualified risk-sharing joint arrangement’’ possesses two characteristics. First, all physician participants must share substantial financial risks through the arrangement, such that the arrangement creates incentives for the physician participants jointly to control costs and improve quality by managing the provision of services. Second, any agreement concerning reimbursement or other terms or conditions of dealing must be reasonably necessary to obtain significant efficiencies through the joint arrangement. A ‘‘qualified clinically-integrated joint arrangement,’’ on the other hand, need not involve any sharing of financial risk. Instead, as defined in the proposed E:\FR\FM\18FEN1.SGM 18FEN1 WReier-Aviles on DSKGBLS3C1PROD with NOTICES 7268 Federal Register / Vol. 75, No. 32 / Thursday, February 18, 2010 / Notices order, physician participants must participate in active and ongoing programs to evaluate and modify their clinical practice patterns in order to control costs and ensure the quality of services provided, and the arrangement must create a high degree of interdependence and cooperation among physicians. As with qualified risk-sharing arrangements, any agreement concerning price or other terms of dealing must be reasonably necessary to achieve the efficiency goals of the joint arrangement. Paragraph III, for three years, requires RFV to notify the Commission before it enters into any arrangements to act as a messenger or an agent on behalf of any physicians, with payers regarding contracts. Paragraph IV sets out the information necessary to make the notification complete. Paragraph V, for three years, requires RFV to notify the Commission before participating in contracting with health plans on behalf of either a qualified risksharing or a qualified clinicallyintegrated joint arrangement. Paragraph VI sets out the information necessary to satisfy the notification requirement. Paragraph VII imposes other notification obligations on RFV and requires the termination of certain contracts that were entered into illegally. Paragraph VII.A require RFV to distribute the complaint and order to (1) physicians who have participated in RFV since 2001; (2) to various past and current personnel of RFV; and (3) to payers with whom RFV has dealt since 2001. Paragraph VII.B requires RFV, at any payer’s request and without penalty, to terminate its existing contracts with the payer for the provision of physician services. Paragraph VII.B allows certain contracts currently in effect to be extended at the written request of the payer no longer than one year from the date that the order becomes final. Paragraph VII.C requires RFV to distribute payer requests for contract termination to physicians who participate in the contract Paragraph VII.D requires RFV for three years, to provide new members, personnel, and payers not previously receiving a copy, a copy of the Order and the Complaint. Paragraph VII.D also requires RFV to publish annually a copy of the Order and the Complaint in its newsletter. Paragraphs VIII, IX, and X impose various obligations on RFV to report or provide access to information to the VerDate Nov<24>2008 14:39 Feb 17, 2010 Jkt 220001 Commission to facilitate the monitoring of compliance with the order. Finally, Paragraph XI provides that the order will expire in 20 years. By direction of the Commission. Donald S. Clark Secretary. [FR Doc. 2010–3033 Filed 2–17–10: 7:19 am] BILLING CODE 6750–01–S DEPARTMENT OF HEALTH AND HUMAN SERVICES [Document Identifier: OS–0990–New] Agency Information Collection Request; 60-Day Public Comment Request Office of the Secretary, HHS. In compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is publishing the following summary of a proposed information collection request for public comment. Interested persons are invited to send comments regarding this burden estimate or any other aspect of this collection of information, including any of the following subjects: (1) The necessity and utility of the proposed information collection for the proper performance of the agency’s functions; (2) the accuracy of the estimated burden; (3) ways to enhance the quality, utility, and clarity of the information to be collected; and (4) the use of automated collection techniques or other forms of information technology to minimize the information collection burden. To obtain copies of the supporting statement and any related forms for the proposed paperwork collections referenced above, e-mail your request, including your address, phone number, OMB number, and OS document identifier, to Sherette.funncoleman@hhs.gov, or call the Reports Clearance Office on (202) 690–6162. Written comments and recommendations for the proposed information collections must be directed to the OS Paperwork Clearance Officer at the above e-mail address within 60days. Proposed Project: Evaluation of Medicare Personal Health Records Choice Pilot—OMB No. 0990–NEW— Office of the Assistant Secretary for Planning and Evaluation. AGENCY: PO 00000 Frm 00038 Fmt 4703 Sfmt 4703 Abstract: Since 2003, HHS has worked toward the goal of establishing electronic, longitudinal health records for Americans that can be accessed safely, across the Internet, and anytime and anywhere by patients, doctors, and other health care providers. In addition to electronic health records (EHRs), where health information is created, stored and accessed mainly by health care organizations and practitioners, personal health records (PHRs), electronic, patient-centered applications and services, are gaining increasing recognition and momentum. Current PHR business models represent broad and varied uses, from disease management to health promotion, with sponsors consisting of commercial vendors, heath plans, employers, and health care providers. We know very little about why consumers, and specifically Medicare beneficiaries, elect to use PHRs and what functionality they want from a PHR. Understanding these needs will be critical if HHS and the Centers for Medicare & Medicaid Services (CMS) are to pursue PHRs as a tool to empower consumers to manage their health and have the capability to link to their provider’s EHR. In January 2009, CMS launched a new program in Arizona and Utah, the Medicare PHR Choice Pilot (PHRC). This pilot encourages Medicare fee-forservice (FFS) beneficiaries to take advantage of the newer, more robust Internet-based tools for tracking their health and health care services. This is the first pilot to offer a choice of PHRs to Medicare FFS beneficiaries, including PHRs with additional functionality and direct data linkages for the consumers. Pilot participants can choose among GoogleHealthTM, NoMoreClipboardTM, PassportMDTM, and HealthTrioTM, competitors in the open PHR market. HHS’ Office of the Assistant Secretary for Planning and Evaluation (ASPE) has contracted with Mathematica Policy Research to conduct an evaluation of this pilot program, including a PHR enrollee user satisfaction survey to assess barriers, facilitators, and satisfaction with the PHRs. A selfadministered paper-and-pencil instrument will be the primary data collection mode for the PHRC user satisfaction survey, with telephone followup for mail nonrespondents. The one-time data collection field period is expected to be 12 weeks in Fall 2010. E:\FR\FM\18FEN1.SGM 18FEN1

Agencies

[Federal Register Volume 75, Number 32 (Thursday, February 18, 2010)]
[Notices]
[Pages 7266-7268]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-3033]


=======================================================================
-----------------------------------------------------------------------

FEDERAL TRADE COMMISSION

[File No. 061 0172]


Roaring Fork Valley Physicians I.P.A.; Analysis of the Agreement 
Containing Consent Order to Aid Public Comment

AGENCY: Federal Trade Commission.

ACTION: Proposed Consent Agreement.

-----------------------------------------------------------------------

SUMMARY: The consent agreement in this matter settles alleged 
violations of federal law prohibiting unfair or deceptive acts or 
practices or unfair methods of competition. The attached Analysis to 
Aid Public Comment describes both the allegations in the draft 
complaint and the terms of the consent order -- embodied in the consent 
agreement -- that would settle these allegations.

DATES: Comments must be received on or before March 5, 2010.

ADDRESSES: Interested parties are invited to submit written comments 
electronically or in paper form. Comments should refer to ``Roaring 
Fork Valley, File No. 061 0172'' to facilitate the organization of 
comments. Please note that your comment -- including your name and your 
state -- will be placed on the public record of this proceeding, 
including on the publicly accessible FTC website, at (http://www.ftc.gov/os/publiccomments.shtm).
    Because comments will be made public, they should not include any 
sensitive personal information, such as an individual's Social Security 
Number; date of birth; driver's license number or other state 
identification number, or foreign country equivalent; passport number; 
financial account number; or credit or debit card number. Comments also 
should not include any sensitive health information, such as medical 
records or other individually identifiable health information. In 
addition, comments should not include any ``[t]rade secret or any 
commercial or financial information which is obtained from any person 
and which is privileged or confidential. . . .,'' as provided in 
Section 6(f) of the FTC Act, 15 U.S.C. 46(f), and Commission Rule 
4.10(a)(2), 16 CFR 4.10(a)(2). Comments containing material for which 
confidential treatment is requested must be filed in paper form, must 
be clearly labeled ``Confidential,'' and must comply with FTC Rule 
4.9(c), 16 CFR 4.9(c).\1\
---------------------------------------------------------------------------

    \1\ The comment must be accompanied by an explicit request for 
confidential treatment, including the factual and legal basis for 
the request, and must identify the specific portions of the comment 
to be withheld from the public record. The request will be granted 
or denied by the Commission's General Counsel, consistent with 
applicable law and the public interest. See FTC Rule 4.9(c), 16 CFR 
4.9(c).
---------------------------------------------------------------------------

    Because paper mail addressed to the FTC is subject to delay due to 
heightened security screening, please consider submitting your comments 
in electronic form. Comments filed in electronic form should be 
submitted by using the following weblink: (https://public.commentworks.com/ftc/roaringforkconsent) and following the 
instructions on the web-based form. To ensure that the Commission 
considers an electronic comment, you must file it on the web-based form 
at the weblink: (https://public.commentworks.com/ftc/roaringforkconsent.) If this Notice appears at (http://www.regulations.gov/search/index.jsp), you may also file an electronic 
comment through that website. The Commission will consider all comments 
that regulations.gov forwards to it. You may also visit the FTC website 
at (http://www.ftc.gov/) to read the Notice and the news release 
describing it.
    A comment filed in paper form should include the ``Roaring Fork 
Valley, File No. 061 0172'' reference both in the text and on the 
envelope, and should be mailed or delivered to the following address: 
Federal Trade Commission, Office of the Secretary, Room H-135 (Annex 
D), 600 Pennsylvania Avenue, NW, Washington, DC 20580. The FTC is 
requesting that any comment filed in paper form be sent by courier or 
overnight service, if possible, because U.S. postal mail in the 
Washington area and at the Commission is subject to delay due to 
heightened security precautions.
    The Federal Trade Commission Act (``FTC Act'') and other laws the 
Commission administers permit the collection of public comments to 
consider and use in this proceeding as appropriate. The Commission will 
consider all timely and responsive public comments that it receives, 
whether filed in paper or electronic form. Comments received will be 
available to the public on the FTC website, to the extent practicable, 
at (http://www.ftc.gov/os/publiccomments.shtm). As a matter of 
discretion, the Commission makes every effort to remove home contact 
information for individuals from the public comments it receives before 
placing those comments on the FTC website. More information, including 
routine uses permitted by the Privacy Act, may be found in the FTC's 
privacy policy, at (http://www.ftc.gov/ftc/privacy.shtm).

FOR FURTHER INFORMATION CONTACT: Constance M. Salemi (202-326-2643), 
Bureau of Competition, 600 Pennsylvania Avenue, NW, Washington, D.C. 
20580.

SUPPLEMENTARY INFORMATION: Pursuant to section 6(f) of the Federal 
Trade Commission Act, 38 Stat. 721, 15 U.S.C. 46(f), and Sec.  2.34 the 
Commission Rules of Practice, 16 CFR 2.34, notice is hereby given that 
the above-captioned consent agreement containing a consent order to 
cease and desist, having been filed with and accepted, subject to final 
approval, by the Commission, has been placed on the public record for a 
period of thirty (30) days. The following Analysis to Aid Public 
Comment describes the terms of the consent agreement, and the 
allegations in the complaint. An electronic copy of the full text of 
the consent agreement package can be obtained from the FTC Home Page 
(for February 3, 2010), on the World Wide Web, at (http://www.ftc.gov/os/actions.shtm). A paper copy can be obtained from the FTC Public 
Reference Room, Room 130-H,

[[Page 7267]]

600 Pennsylvania Avenue, NW, Washington, D.C. 20580, either in person 
or by calling (202) 326-2222.
    Public comments are invited, and may be filed with the Commission 
in either paper or electronic form. All comments should be filed as 
prescribed in the ADDRESSES section above, and must be received on or 
before the date specified in the DATES section.

Analysis of Agreement Containing Consent Order to Aid Public Comment

    The Federal Trade Commission has accepted, subject to final 
approval, an agreement containing a proposed consent order (``proposed 
order'') with Roaring Fork Valley Physicians I.P.A., Inc., (``RFV''). 
The agreement settles charges by the Federal Trade Commission that RFV 
violated Section 5 of the Federal Trade Commission Act, 15 U.S.C. Sec.  
45, by, among other things, orchestrating and implementing price-
related agreements and concerted refusals to deal among competing 
physician members of RFV to maintain and raise the price at which RFV's 
physician members contract with payers.
    The proposed order has been placed on the public record for 30 days 
to receive comments from interested persons. Comments received during 
this period will become part of the public record. After 30 days, the 
Commission will review the agreement and the comments received, and 
will decide whether it should withdraw from the agreement or make the 
proposed order final.
    The purpose of this analysis is to facilitate public comment on the 
proposed order. The analysis is not intended to constitute an official 
interpretation of the agreement and proposed order or to modify their 
terms in any way. Further, the proposed order has been entered into for 
settlement purposes only and does not constitute an admission by the 
proposed respondent that it violated the law or that the facts alleged 
in the complaint (other than jurisdictional facts) are true.

The Complaint

    The allegations of the complaint are summarized below.
    RFV is a type of organization commonly referred to in the health 
care industry as an ``independent practice association'' because its 
members consist of independent physicians in solo and small group 
practices. RFV is controlled by and organized in substantial part for 
the pecuniary benefit of its approximately 85 physician members. RFV is 
located in Garfield County, Colorado.
    The complaint alleges that since at least 2003 RFV, although 
purporting to use a messenger model, negotiated price-related terms on 
behalf of its members for the purpose of increasing and maintaining the 
rates for services provided by RFV's otherwise competing physician 
members. RFV increased rates by demanding that payers include automatic 
annual cost of living adjustments (COLAs) in their contracts. RFV held 
lengthy bargaining sessions with payers to pressure them into including 
COLAs and other terms in their contracts. To protect the automatic 
increases, RFV refused to messenger contracts with Medicare-based rates 
because of their potential to decline. RFV feared Medicare-based rates 
would decline over time.
    The complaint also alleges that since at least 2003 RFV and its 
members engaged in concerted refusals to deal with payers except upon 
the collectively-agreed upon contract terms demanded during 
negotiations. RFV organized concerted refusals to deal by requiring 
payers contracting with RFV to persuade 80 percent of all RFV members 
and 50 percent of each RFV specialty (``80/50 rule'') to accept their 
contracts. After a payer satisfied the 80/50 rule, RFV signed, 
administered and bound all the members to the payer's contract. RFV 
refused to messenger the contract of a payer who failed to satisfy the 
80/50 rule. RFV reinforced the 80/50 rule by refusing to provide 
unsuccessful payers with the identity of the members willing to accept 
their contracts. RFV's refusal prevented the unsuccessful payers from 
contracting directly with individual physicians willing to accept the 
proposed contract terms. RFV also reinforced its concerted refusals to 
deal by encouraging members to only use the IPA for their contracting. 
RFV targeted its concerted refusals at national payers and warned 
members against contracting with them. Most national payers attempting 
to contract with RFV could not satisfy the 80/50 rule. RFV members did 
not engage in any efficiency-enhancing integration of their practices 
sufficient to justify the collectively negotiation or the concerted 
refusals to deal. Accordingly, the complaint alleges that RFV violated 
Section 5 of the FTC Act.

The Proposed Order

    The proposed order is designed to remedy the illegal conduct 
charged in the complaint and prevent its recurrence. It is similar to 
recent consent orders that the Commission has issued to settle charges 
that physician groups engaged in unlawful agreements to raise fees they 
receive from health plans.
    The proposed order's specific provisions are as follows:
    Paragraph II.A prohibits RFV from entering into or facilitating any 
agreement between or among any physicians: (1) to negotiate with payers 
on any physician's behalf; (2) to deal, refuse to deal, or threaten to 
refuse to deal with payers; (3) on any terms on which a physician is 
willing to deal with any payer; or (4) not to deal individually with 
any payer, or not to deal with any payer other than through RFV.
    Other parts of Paragraph II reinforce these general prohibitions. 
Paragraph II.B prohibits RFV from facilitating exchanges of information 
between physicians concerning any physician's willingness to deal with 
a payer or the terms or conditions, including price terms, on which the 
physician is willing to deal with a payer. Paragraph II.C bars attempts 
to engage in any action prohibited by Paragraph II.A or II.B, and 
Paragraph II.D proscribes RFV from inducing anyone to engage in any 
action prohibited by Paragraphs II.A through II.C.
    As in other Commission orders addressing providers' collective 
conduct with health-care purchasers, Paragraph II excludes certain 
kinds of agreements from its prohibitions. First, RFV is not precluded 
from engaging in conduct that is reasonably necessary to form or 
participate in legitimate joint contracting arrangements among 
competing physicians, such as a ``qualified risk-sharing joint 
arrangement'' or a ``qualified clinically-integrated joint 
arrangement.'' The arrangement, however, must not restrict the ability 
of, or facilitate the refusal of, physicians who participate in it to 
contract with payers outside of the arrangement.
    As defined in the proposed order, a ``qualified risk-sharing joint 
arrangement'' possesses two characteristics. First, all physician 
participants must share substantial financial risks through the 
arrangement, such that the arrangement creates incentives for the 
physician participants jointly to control costs and improve quality by 
managing the provision of services. Second, any agreement concerning 
reimbursement or other terms or conditions of dealing must be 
reasonably necessary to obtain significant efficiencies through the 
joint arrangement.
    A ``qualified clinically-integrated joint arrangement,'' on the 
other hand, need not involve any sharing of financial risk. Instead, as 
defined in the proposed

[[Page 7268]]

order, physician participants must participate in active and ongoing 
programs to evaluate and modify their clinical practice patterns in 
order to control costs and ensure the quality of services provided, and 
the arrangement must create a high degree of interdependence and 
cooperation among physicians. As with qualified risk-sharing 
arrangements, any agreement concerning price or other terms of dealing 
must be reasonably necessary to achieve the efficiency goals of the 
joint arrangement.
    Paragraph III, for three years, requires RFV to notify the 
Commission before it enters into any arrangements to act as a messenger 
or an agent on behalf of any physicians, with payers regarding 
contracts. Paragraph IV sets out the information necessary to make the 
notification complete.
    Paragraph V, for three years, requires RFV to notify the Commission 
before participating in contracting with health plans on behalf of 
either a qualified risk-sharing or a qualified clinically-integrated 
joint arrangement. Paragraph VI sets out the information necessary to 
satisfy the notification requirement.
    Paragraph VII imposes other notification obligations on RFV and 
requires the termination of certain contracts that were entered into 
illegally. Paragraph VII.A require RFV to distribute the complaint and 
order to (1) physicians who have participated in RFV since 2001; (2) to 
various past and current personnel of RFV; and (3) to payers with whom 
RFV has dealt since 2001. Paragraph VII.B requires RFV, at any payer's 
request and without penalty, to terminate its existing contracts with 
the payer for the provision of physician services. Paragraph VII.B 
allows certain contracts currently in effect to be extended at the 
written request of the payer no longer than one year from the date that 
the order becomes final. Paragraph VII.C requires RFV to distribute 
payer requests for contract termination to physicians who participate 
in the contract Paragraph VII.D requires RFV for three years, to 
provide new members, personnel, and payers not previously receiving a 
copy, a copy of the Order and the Complaint. Paragraph VII.D also 
requires RFV to publish annually a copy of the Order and the Complaint 
in its newsletter.
    Paragraphs VIII, IX, and X impose various obligations on RFV to 
report or provide access to information to the Commission to facilitate 
the monitoring of compliance with the order. Finally, Paragraph XI 
provides that the order will expire in 20 years.
    By direction of the Commission.

Donald S. Clark
Secretary.
[FR Doc. 2010-3033 Filed 2-17-10: 7:19 am]
BILLING CODE 6750-01-S