American Podiatry Association

Bureau of Competition
FEDERAL "I"RAIBE 	COMMlSSlON
WASHINGTON, 0.G. 20580
Werner 	Strupp, 	Esq,
S i n r d 	and 	T a s h
2206 	Wisconsin Avenue,
Washington, 	D,C. 	28007
Dear 	M E , 	Strupp:
Thank 	you 	fot your 	letter dated 	February 9 , 	1984, 	i n 	which
you 	ask, on behalf 	of t h e 	m e r i c a n Podiatry Association 	("APA"),
whether Fi,IA peex 	review cornittees may 	refer 	to a 	publicly-
a v a i l a b l e 	national medicare profile 	sf fees, 	published 	by 	t h e
H e a l t h 	Care 	Financing 	Administgation 	["HCFA"), 	as 	a n 	a i d 	i n .
determining 	whether 	a disputed 	f e e 	is 	"reasonable," 	Vau 	s t a t e
t h a t 	peep 	review cornittees do n o t 	i n t e n d 	for 	HCFADs fee 	profiles
ta become 	t h e 	exclusive measuring 	d e v i c e sf a 	fee" 	'"reason-
ableness", 	t h a t 	t h e 	profile 	of 	fees will 	not be distributed 	to
APJ 	component 	ssciety members, 	and 	t h a t 	third-party 	payers 	and
8 other 	intermediaries will be 	aware 	t h a t 	peer 	review 	coreunittees
have 	t h e 	fee profile 	available 	to 	them,
I$ is my 	opinion t h a t 	use of 	MCFADs medicare 	fee 	profile 	by
- 	component 	society peer 	review eomittees as a 	reference a i d 	i n
d e t e r m i n i n g 	w h e t h e r 	a disputed 	fee 	is 	"reasonable," 	in 	accordance
w i t h 	APA Guidelines, would 	n o t 	appear 	tea violate 	t h e 	antitrust
laws, 	provided 	the cornittees do 	not 'use the 	f e e 	profile to
r e s t r a i n 	price competition 	or 	to discourage the 	use of 	innovative
or 	efficiency-enhancing procedures by 	~ d i a t r i s t s , Tf peer
review e o m i t t e e s 	were 	$0 use 	the fee profile 	to facilitate an
agreement among podiatrists to price their 	services 	in aceordance
with 	the published 	rates, however, their eanduee 	might 	constitute
u n l a w f u l price-fixing,
1 hope 	t h a t 	t h i s 	information 	is h e l p f u l ,
S i n c e r e l y ,
A r t h u r 	N, 	Lerner
Assistant Director

Ax th u s Lerner , Esquire
Federal Trade Cannnissioo
B*seau of 	&qetieisa
Washington, 	D.C, 	20580
Dear kk. Ler~ler:
The undersigned is g e n e r a l counsel of the Annerican P o d i a t r y Association
(MA), l o c a t e d at 20 Chevy Chase Cirspe, M . W , , 	Wash%ngton, B,C,
A s you a r e aware, 	t h e Connnission:s 	Bureau of 	Competition, 	on August 	18,
1983, i s s u e d an a d v i s o r y o p i n i o n l e e t e r t o M A and one of 	its component 	s t a t e
8 a s s o c i a t i o n ' s 	t h e P o d i a t r y S o c i e t y of, V i r g i n i a , 	The opinion r e l a t e d 	t o t h e
resumption of peer 	review by APA and g t s components i n m a t t e r s concerning
p o d i a t r i s t ' s 	fees, d e t e m i n a t i o n s of 	k d i c a ~m c e s s i t y and q u a l i t y of 	care,
i
Since r e c e i p t of 	t h e o p i n i o n , 	a q u e s t i o n has a r i s e n r e g a r d i n g t h e p r o c e s s
f S
by which pees review c o r n i t b e e s ressfGe d i s p u t e s concerning ""usuaLqq",usto-
maryWdor "seasonable'Vfees. 	Ln accordance w i t h t h e MA g u i d e l i n e s , 	t h e con--.
c l u s i o n s reached by peer review c o r n i t t e e s a r e based on t h e i r own p r o f e s s i o n a l
e m e r i e n c e s , 	Such conclusions a r e us,uallg expressed 	i n p o s i t i v e o r n e g a t i v e
terms, 	%,e. t h a t 	a p a r t i c u l a r 	f e e d s w , o r does n o t , 	f a l l w i t h i n t h e range o f
u s u a l , 	cussolaary and reasonabxe 	f e e s f o r the s e r v i c e performed., 	The q u e s t i o n
t h a t h a s been posed 	is whether 	in arr/iving 	a t 	its d e t e r m i n a t i o n , a committee
m y r e f e r 	t o t h e n a t i o n a l medicare p r o f i l e of fees, 	published 	by t h e Wealth
Care Financing Administration, 	U,S, ~ k p a r b m e n tof 	H e a l t h and Human S e r v i c e s ,
A s the tern i n d i c a t e s , 	t h e n a t i o n a l p r o f i l e 	is a cornpendim of f e e s
charged t o rnedicare b e n e f i c i a r i e s 	f o i : p a r t i c u l a r procedures, 	The c o r n i t t e e s ,
if they were t o use 	t h e s e d a t a , 	w u l d employ them as an a i d i n reaching t h e
r e q u i r e d c o w l u s i o n . 	The p r o f i l e would not become an e x c l u s i v e measuring
d e v i c e , 	nor would 	it b e p u b l i c i z e d or:d i s t r i b u t e d 	t o 	t h e a s s o c i a t i o n member-
s h i p , 	However, 	t h i r d p a r t y 	i n s u r a n c e c a r r i e r s , 	o r o t h e r 	i n t e r m e d i a r i e s would
g e n e r a l l y be aware thas pees review c o r n i t s e e s have 	t h e aforementioned 	i n f s r -
rnation 	a v a i l a b l e t o 	them- 	Ira a l l o t h 9 r 	r e s p e c t s , 	t h e program m u l d 	f u n c t i o n
In che nranner p r e v i o u s l y d e s c r i b e d .

Arthur Lerner , Esquire
It would be greatly appreciated, 	if you could provide us w l t k . y s u s o p i n i o n
regarding t h e foregoing proposed praeedure,
Very t r u l y yours,