Discussion 08: Regulation Overkill Discussion Topic For this discussion, please refer to the list on pages 362-363 in the text. This list presents both governmental and non-governmental agencies that oversee a real hospital (as of 1989). Discuss what this list implies by addressing each of the points below. . What effects does this reality have on the administration of the hospital? What financial impact does it have? How would it impact patient care, directly or indirectly? How would this affect health care cost and pricing? Other matters? Read also the footnote on page 384. If you were a New York hospital administrator, what affect do you think these regulatory agencies and review would have on your hospital - on your functioning as an administrator? Base your discussion on material from the text and your own experience. Cite sources when necessary. Remember to write 150 words in complete sentences. Once you have posted your initial answer to the topic and questions above, read and reply to at least two of your classmates' initial posting with a minimum of 75 words in each reply. L- HASSAN v. INDEPENDENT PRACTICE ASSOCIATES 698 F. Supp. 679 (E.D. Mich. 1988) NEWBLATT, District Judge. Before the court are defendants' Motion for Summary Judgment.... Plaintiffs Shawky Hassan and Fikria Hassan are allergists who practice through the Allergy 493 & Asthma Center, P.C., a professional corporation wholly owned by the Drs. Hassan. Defendant Independent Practice Associates, P.C., (IPA) is an organization of physicians and osteopaths who provide medical care to subscribers of Genesee Health Care, Inc., doing businesd as Health Plus of Michigan (Health Plus), a state licensed, federally qualified health maintenance organization (HMO). Plaintiffs allege... that IPA's participation in plaintiffs' separation from IPA and the group's subsequent refusal to readmit the doctors, constitute an illegal group boycott. ... IPA is the corporation through which the group of doctors that treat patients who subscribe to Health Plus practice. It is owned by the physicians who comprise the group. Health Plus, the HMO insurance contractor here, was formed by the Genesee County Medical Society in 1979. Its Board of Directors is made up of subscribers, the public and physicians. Health Plus is funded by subscribers who pay a fixed premium per month. With this money, Health Plus pays service providers, such as IPA, on a computed basis and also a fixed amount per member per month. IPA members are paid primarily on a fee-for-services basis, which the IPA determines according to a set maximum fee schedule.... Poolth Plus has experienced Ith no betonte Defendants concede that IPA exists only to serve Health Plus patients. ... Health Plus has experienced substantial growth since 1979 and its patient market share is 20 percent of the population in the area of Genesee-Lapeer-Shiawassee counties. ... There is no evidence that IPA physicians cannot also belong to other such organizations. Defendants contend that they face a competitive market. For example, they contend that the largest portion of Health Plus's membership is represented by General Motors (GM) employees. In order to obtain the GM business, defendants must compete on an annual basis by obtaining both GM and UAW approval as an authorized insurer and then, further, convince the employees to choose the Health Plus program. Thus, GM, the union, and the workers must be satisfied as to both price charged and benefits offered. ... This has resulted in actions [to cut costs such as) denying physicians' applications for membership and terminations or resignations of physicians. ... Plaintiffs joined IPA in 1979, and until October of 1981, they were the only allergy specialists to provide such service to Health Plus subscribers. In 1980, a review of billing records revealed a high incidence of lab tests performed by plaintiffs and prompted the IPA's Care, Quality and Cost Committee to request justification for those tests from plaintiff Shawky Hassan. Moreover, the Committee began setting guidelines for allergy testing which prohibited routine testing. Further, in October of 1981, an IPA survey of allergy testing procedures indicated that plaintiffs performed far more tests than two other specialists, and a review of patient charts failed to satisfy the IPA that the Hassans' level of testing was justified. Health Plus sent out a notice that subscribers could no longer see the Drs. Hassan. ... In August of 1983, the Hassans applied to IPA on behalf of their newly established Urgent Care Family Clinic to provide emergency care to IPA members. ... On January 6, 1984, all of plaintiffs' applications were denied without explanation. The Hassan Clinic lost money and, in 1985, it was closed. is