Doctors push for right to collective bargaining

Legislation has been introduced that for the first time would give doctors in New York the right to bargain collectively, potentially altering the balance of power between providers and payers.

A bill has been introduced in the state Senate with companion legislation referred to the Ways and Means Committee in the Assembly. The bills call for the state to closely monitor negotiations.

Federal antitrust laws currently prohibit individual physicians from collectively negotiating any contract provisions with managed care entities. But the state legislation would provide that right in New York.

Neil D. Breslin, D-Albany, is the sponsor in the Senate and Ron Canestrari, D-Albany, is the sponsor in the Assembly.

The senate version indicates its goal is to “restore fairness in the contracting process between physicians and large managed care plans by allowing doctors to join together to negotiate contract provisions.”

A report issued this month by the Medical Society of the State of New York’s subcommittee on health system reform called collective bargaining for physicians “a necessity in any health system.”

“This is perhaps the most propitious way to level the playing field vis-a-vis the managed care industry,” the committee stated in the report.

The committee said the bills would provide “patient protection from the ability of the industry to unilaterally change its contracts and methods of doing business.”

“Collective bargaining can be used to assure sufficiency of reimbursement to practicing physicians,” according to the committee.

While doctors believe teaming up could result in fairer reimbursement rates, critics including hospital groups argue it could lead to higher costs for consumers. Insurers forced to pay physicians more could jack up premiums.

“There’s been a lot of downward pressure on physician rates. I don’t know if making their pay adequate would raise insurance premiums,” said Dr. Charles Rothberg, the society’s commissioner of government affairs. “They might just have to [adjust] the distribution of payments. “

If doctors are able to negotiate contracts collectively, Rothberg said they might obtain better terms in other respects.

“The reasons for collective bargaining is not solely rates,” Rothberg said. “It’s provisions of the contracts.”

The Senate bill indicates provisions that could be negotiated to improve care in addition to payments to physicians. These provisions include eliminating excessively long wait times for obtaining preauthorization and preventing health plans from making major changes without physician consent.