In many parts of the country, a few giant health insurance companies dominate the health care market place. When physicians attempt to negotiate patient care issues with these health plans, they are at a severe disadvantage. The AAOS works to promote legal mechanisms to allow physicians to engage in group negotiations in order to compete in the managed care environment and to continue to be their patient's advocate.
Under current antitrust law, the only way physicians can bargain collectively is in the context of an employment relationship, as defined by the National Labor Relations Act (NLRA). Unless they are part of an integrated group practice, self-employed physicians cannot bargain collectively with insurers or other payers. Doing so might be considered a violation of the federal antitrust laws, that potentially carries criminal penalties and the possibility of treble damages. Under federal antitrust laws, physicians who are not students or employed are viewed as competitors and therefore, they cannot agree on the prices they will charge for their services.
Under the "State action doctrine" (promulgated by US Supreme Court case law) a state may not simply authorized private parties to violate antitrust law. Subsequently, it is limited what a state "joint negotiation" law can actually accomplish. Despite this, some states have passed some sort of joint negotiation law, and AAOS monitors activity that would allow for greater joint negotiation power by physicians when dealing with payors.