[Federal Register Volume 61, Number 164 (Thursday, August 22, 1996)]
[Notices]
[Pages 43380-43384]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-21432]


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DEPARTMENT OF JUSTICE

Antitrust Division
[Civil Action No. 96-389-BMZ]


United States v. Woman's Hospital Foundation and Woman's 
Physician Health Organization; Public Comments and United States' 
Response to Public Comments

    Pursuant to the Antitrust Procedures and Penalties Act, 15 U.S.C. 
16(b)-(h), the United States publishes below the comments received on 
the proposed Final Judgment in United States v. Woman's Hospital 
Foundation and Woman's Physician Health Organization, Civil Action 96-
389-BMZ, United States District Court for the Middle District of 
Louisiana, together with the response of the United States to the 
comments.
    Copies of the response and the public comments are available on 
request for inspection and copying in Room 200 of the U.S. Department 
of Justice, Antitrust Division, 325 7th Street, NW., Washington, DC 
20530, and for inspection at the Office of the Clerk of the United 
States District Court for the Middle District of Louisiana, United 
States Courthouse, 777 Florida Street, Suite 208, Baton Rouge, 
Louisiana 70801.
Rebecca P. Dick,
Deputy Director of Operations, Antitrust Division.

United States' Response to Public Comments

    Pursuant to the requirements of the Antitrust Procedures and 
Penalties Act (commonly referred to as the ``Tunney Act''), 15 U.S.C. 
16(b)-(h), the United States hereby responds to public comments 
regarding the Consent Decree proposed to settle this proceeding in the 
public interest. The United States received several comments from a 
single source, General Health, Inc. (``General Health''). General 
Health does not oppose entry of the Consent Decree. Rather, one of its 
comments points out an inadvertent mistake in the language of the 
Decree which has been corrected to reflect the original intent of the 
parties. (A revised Final Judgment will be filed shortly with the Court 
as an attachment to a motion for entry of the Judgment.) General 
Health's two other comments suggest additional prophylactic relief. 
After careful consideration of these comments, the United States 
concludes that the additional relief suggested by General Health is not 
necessary because the proposed Consent Decree, as amended, will provide 
an effective and appropriate remedy for the antitrust violations 
alleged in the Complaint. Once the public comments and this Response 
have been published in the Federal Register, pursuant to 15 U.S.C. 
16(d), the United States will move the Court to enter the Consent 
Decree.
    On April 23, 1996, the United States filed a Complaint alleging 
that Defendants Woman's Hospital Foundation and Woman's Physician 
Health Organization (``WPHO'') violated sections 1 and 2 of the Sherman 
Act, 15 U.S.C. 1, 2. At the same time, the United States filed a 
proposed Consent Decree, a Stipulation signed by all parties agreeing 
to entry of the Decree following compliance with the Tunney Act, and a 
Competitive Impact Statement (``CIS''). On May 6, 1996, the United 
States filed a Notice of Amendment of Competitive Impact Statement and 
an Amended Competitive Impact Statement.
    Pursuant to the Tunney Act, on May 3, 1996, the Defendants filed 
the required description of certain written and oral communications 
made on their behalf. A summary of the terms of the proposed Decree and 
the CIS and directions for the submission of written comments were 
published in the Washington Post for seven consecutive days, from April 
28, through May 4, 1996, and in the Baton Rouge Advocate from April 30, 
through May 7, 1996. The proposed Consent Decree and the CIS were 
published in the Federal Register on May 10, 1996. 61 FR 21,489 (1996).
    The 60-day period for public comments began on May 10, 1996, and 
expired on July 9, 1996. General Health submitted several comments; the 
United States is filing them as attachments to this Response. The 
United States has concluded that the Consent Decree, as amended, 
reasonably, adequately, and appropriately addresses the harm alleged in 
the Complaint. Therefore, following publication of the comments and 
this Response, the United States will move this Court to hold that 
entry of the proposed Consent Decree, as amended, is in the public 
interest.

I. Background

    Woman's Hospital Foundation owns and operates Woman's Hospital, a 
facility with 149 staffed acute care beds. Woman's Hospital provides a 
range of care, including inpatient, outpatient, and home health 
services, to women and infants in the Baton Rouge area. It is the 
dominant provider of private inpatient obstetrical care in Baton Rouge.
    In the late 1980's, competition among doctors for participation in 
managed care plans created the opportunity for the entry of other Baton 
Rouge area

[[Page 43381]]

hospitals into the market for inpatient obstetrical care. Woman's 
Hospital viewed the new entrants, particularly the Health Center, owned 
by General Health, as a serious competitive threat because General 
Health also owned the Gulf South Health Plans, Inc. (``Gulf South''), 
the largest managed care plan in Baton Rouge.
    In June 1992, in an effort to stave off competition from the new 
Health Center, Woman's Hospital entered into negotiations with General 
Health offering to continue contracting at discounted hospital rates 
with Gulf South in return for General Health's agreement not to provide 
inpatient obstetrical services for the next 5 to 7 years. Woman's 
Hospital eventually retreated from this particular attempt to foreclose 
competition from the Health Center.
    In 1993, Woman's Hospital made another effort to prevent new 
entrants from becoming significant competitors. Woman's Hospital formed 
an economic alliance with its medical staff in the form of defendant 
WPHO, a physician hospital organization. WPHO's purpose was to 
establish a minimum physician fee schedule and serve as a joint 
bargaining agent on behalf of Woman's Hospital and participating 
doctors with managed care payers. Through WPHO, Woman's Hospital hoped 
to assure the continued ``loyalty'' of its medical staff. Nearly every 
OB/GYN on Woman's Hospital's medical staff joined WPHO. The physicians' 
agreement with WPHO authorized it to contract with managed care plans 
on behalf of doctors at or above a minimum fee schedule. WPHO did not 
develop utilization review standards, and the agreement to limit price 
competition was not reasonably necessary to further any efforts by WPHO 
to encourage physicians to practice more cost effectively.
    Defendants and WPHO physicians collectively obtained higher fees 
for OB/GYNs, deprived managed care plans of the ability to selectively 
contract with OB/GYNs, and prevented the development of competition for 
inpatient obstetrical services.
    These actions, along with the additional conduct alleged in the 
Complaint, violated Sections 1 and 2 of the Sherman Act.

II. Response to Public Comments

    The comments on the Consent Decree are from a single source, 
General Health, whose relationship with Woman's Hospital is discussed 
above. General Health does not object to the entry of the proposed 
Decree, rather its comments suggest changes or additions to the relief 
set forth. Each of General Health's comments is discussed separately 
below.
    1. General Health's first comment refers to the language used in 
the definition of ``qualified managed care plan'' (``QMCP''). General 
Health proposes that the last phrase of Section II (G)(1)(b) be amended 
to add the underscored word ``or'' as follows: ``so long as Woman's 
Hospital or WPHO and they do not own an interest in another physician 
network * * *.'' (``They'' refers to any single physician or single 
pre-existing physician practice group.) The rationale for the proposed 
change is to make clear that the prohibition against ownership in 
another physician network applies to any physician network in which 
Woman's Hospital and ``they'' or WPHO and ``they'' are involved, rather 
than only to physician networks in which all three entities are 
involved. The United States discussed this comment with Defendants' 
counsel who concurs that the proposed change actually clarifies the 
original intent of the parties.
    2. General Health's second comment suggests adding two provisions 
to the proposed Decree. First, General Health would add a prohibition 
against Woman's Hospital and WPHO participating in ``any agreement 
relating to prices, terms, or conditions upon which physician services 
are provided to patients'' except in connection with a QMCP or 
messenger model. Second, General Health would add a provisions 
enjoining consenting physicians from participating in ``any agreement 
relating to the prices, terms or conditions upon which Woman's Hospital 
provides hospital services to patients'' except in connection with a 
QMCP or messenger model. The rationale asserted for these proposed 
changes is that the Final Judgment will not prevent the defendants and 
consenting physicians from ``informally'' engaging in the same types of 
anticompetitive conduct alleged in the Complaint.
    The United States believes that the Court should enter the proposed 
Consent Decree without these additions. The proposed ``addition'' to 
the injunctive relief against Woman's Hospital and WPHO neither differs 
substantively from, nor adds to, the relief already provided. Contrary 
to General Health's contention, the proposed Final Judgment does not 
permit Woman's Hospital and WPHO to engage in ``informal'' 
anticompetitive conduct. Specifically, Section IV(A)(1) enjoins Woman's 
Hospital and WPHO from ``directly, or through any agent, organization 
or other third party, expressing views on, or conveying information on, 
competing physicians' prices or other terms and conditions, or 
negotiating on behalf of competing physicians.'' Any attempt by Woman's 
Hospital or WPHO informally to enter into an agreement relating to 
prices or other terms and conditions for the provision of competing 
physicians' services would violate this Section of the proposed Decree.
    General Health's suggestion to prohibit consenting physicians from 
participating in agreements involving Woman's Hospital's fees would add 
a substantive provision that is inappropriate and unnecessary. This 
additional injunctive relief would prevent a single consenting 
physician from participating in a managed care plan controlled solely 
by another area hospital for the purpose of competing with other 
managed care companies simply because Woman's Hospital was also 
participating in the other hospital's plan. Such circumstances do not 
necessarily raise competitive concerns. In fact, to the extent that 
formation of such a plan offers consumers additional choice in the 
marketplace, its formation could be procompetitive.
    Moreover, the allegations in the Complaint directed at physicians 
involve agreements among competing physicians concerning the prices 
charged for physician services. The United States has not alleged any 
anticompetitive conduct resulting from an agreement by physicians 
regarding the fees charged for Woman's Hospital services. The 
injunctive relief against consenting physicians in Section IV(B)(2) 
provides appropriate and adequate relief by prohibiting them from 
``participating in or facilitating any agreement among competing 
physicians on fees or other terms and conditions for physician 
services, including the willingness of physicians to contract on any 
terms with particular payers or to use facilities competing with 
Woman's Hospital's facilities * * *.'' In sum, the proposed Decree 
provides appropriate and adequate relief for the violations alleged in 
the Complaint.
    3. General Health's third comment suggests that any network 
operated by Defendants based on a messenger model should be subject to 
the 30% physician participation limitation placed on a QMCP and the 
requirement of prior written approval for its formation from the 
Department of Justice.
    These additional limitations are inappropriate. The messenger model 
in the proposed Consent Decree uses an agent or third party to 
facilitate the transfer of information concerning prices and other 
competitively sensitive information between individual physicians and 
purchasers of physician

[[Page 43382]]

services. The critical feature of a properly devised and operated 
messenger model, as defined by the Decree, is that individual providers 
make their own separate decisions about whether to accept or reject a 
purchaser's proposal, independent of the other physicians' decisions 
and without any influence by the messenger. Thus, the messenger model 
in the Decree already contains adequate safeguards against its being 
used as a vehicle for organizing a physician boycott. As explained in 
the CIS, the messenger may not coordinate individual providers' 
responses to a particular proposal, disseminate to physicians the 
messenger's or other physician's views or intentions concerning the 
proposal, act as an agent for collective negotiation and agreement, or 
otherwise serve to facilitate collusive behavior. CIS at 18.
    Because a QMCP, in contrast to a messenger model, allows for some 
collective decision-making among competing physicians, including 
agreements among competitors on the prices for their services, a QMCP 
presents a greater risk of collusive behavior. For this reason, in the 
circumstances of this case, the proposed Decree requires that 
defendants obtain prior approval from the Department of Justice to 
operate a QMCP and limits physician ownership participation to no more 
than 30% in any relevant market.

III. The Legal Standard Governing the Court's Public Interest 
Determination

    The Tunney Act directs the Court to determine whether entry of the 
proposed Decree ``is in the public interest.'' 15 U.S.C. Sec. 16(e). In 
making that determination, ``the court's function is not to determine 
whether the resulting array of rights and liabilities is one that will 
best serve society, but only to confirm the resulting settlement is 
within the reaches of the public interest.'' United States v. Western 
Elec. Co., 993 F.2d 1572, 1576 (D.C. Cir.), cert. denied, 114 S. Ct. 
487 (1993) (internal quotation and citation omitted).\1\
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    \1\ The Western Electric decision concerned a consensual 
modification of an existing antitrust decree. The Court of Appeals 
assumed that the Tunney Act was applicable.
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    The Court should evaluate the relief set forth in the Decree in 
light of the claims alleged in the Complaint and should enter the 
Decree if it falls within the Government's ``rather broad discretion to 
settle with the defendant within the reaches of the public interest.'' 
United States v. Microsoft Corp., 56 F.3d 1448, 1461 (D.C. Cir. 1995).
    The Court is not ``to make de novo determination of facts and 
issues.'' Western Elec., 993 F.2d at 1577. Rather, ``[t]he balancing of 
competing social and political interests affected by a proposed 
antitrust decree must be left, in the first instance, to the discretion 
of the Attorney General.'' Id. (internal quotation and citation omitted 
throughout). In particular, the Court must defer to the Department's 
assessment of likely competitive consequences, which it may reject 
``only if it has exceptional confidence that adverse antitrust 
consequences will result--perhaps akin to the confidence that would 
justify a court in overturning the predictive judgments of an 
administrative agency.'' Id \2\
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    \2\ The Tunney Act does not give a court authority to impose 
different terms on the parties. See, e.g., United States v. American 
Tel. & Tel. Co., 552 F. Supp. 131, 153 n.95 (D.D.C. 1982), aff'd sub 
nom. Maryland v. United States, 460 U.S. 1001 (1983) (Mem.); accord 
H.R. Rep. No. 1463, 93d Cong., 2d Sess. 8 (1974). A court, of 
course, may condition entry of a decree on the parties' agreement to 
a different bargain, see, e.g., AT&T, 552 F. Supp. at 225, but if 
the parties do not agree to such terms, the court's only choices are 
to enter the decree the parties proposed or to leave the parties to 
litigate.
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    The Tunney Act does not empower the Court to reject the remedies in 
the proposed Decree based on the belief that ``other remedies were 
preferable.'' Microsoft, 56 F.2d at 1460. To a great extent it is the 
realities and uncertainties of litigation that constrain the role of 
courts in Tunney Act proceedings. See United States v. Gillette Co., 
406 F. Supp. 713, 715-16 (D. Mass. 1975). As Judge Greene has observed:

    If courts acting under the Tunney Act disapproved proposed 
consent decrees merely because they did not contain the exact relief 
which the court would have imposed after a finding of liability, 
defendants would have no incentive to consent to judgment and this 
element of compromise would be destroyed. The consent decree would 
thus as a practical matter be eliminated as an antitrust enforcement 
tool, despite Congress' directive that it be preserved.

United States v. American Tel. & Tel. Co., 552 F. Supp. 131, 151 
(D.D.C. 1982), aff'd sub nom., Maryland v. United States, 460 U.S. 1001 
(1983) (Mem.). Indeed, where, as here, the Consent Decree comes before 
the Court at the time the Complaint is filed, ``the district judge must 
be even more deferential to the government's predictions as to the 
effect of the proposed remedies * * *.'' Microsoft, 56 F.3d at 1461.

IV. Conclusion

    As required by the Tunney Act, the United States will publish the 
public comments and this Response in the Federal Register. After such 
publication, the United States will notify this Court and move for 
entry of the proposed Consent Decree based on this Court's 
determination that the Decree is in the public interest.

    Respectfully submitted,
Mark J. Botti, Pamela C. Girardi,
U.S. Department of Justice, Antitrust Division, Liberty Place--Suite 
400, 325 7th St., N.W., Washington, D.C. 20530, (202) 307-0827.
L.J. Hymel,
United States Attorney.
    By: ____________
John J. Gaupp LBN # 14976,
Assistant United States Attorney, 777 Florida St., Suite 208, Baton 
Rouge, LA 70801, (504) 389-0443, Local Counsel.
June 25, 1996
Pam Girardi
United States Department of Justice
Health Care Task Force
Room 434
325 7th St., N.W.
Washington, D.C. 20530

    Dear Ms. Girardi: As we discussed over the phone last week, we 
would like to comment, on behalf of our client General Health, Inc., 
on the Department's proposed consent order with Woman's Hospital and 
Woman's Physician Hospital Organization. We will formally submit our 
comments before the comment period expires on July 9th. However, I 
have attached a draft of our comments for your information, and to 
facilitate an informal discussion of our proposed comments. I would 
appreciate having an opportunity to discuss our comments with you 
before we formally submit them. I can be reached at (202) 861-1888. 
Thank you very much for your consideration.

    Sincerely,
Michael R. Bissegger

II.

Definitions

    (C) ``Qualified managed care plan'' means an organization that is 
owned, in whole or in part, by either or both of the defendants, offers 
a provider panel and satisfies each of the following criteria:
    (1) Its owners or not-for-profit members (``members'') who compete 
with other owners or members or with subcontracting physicians 
participating in the plan, (a) [NO CHANGE] and (b) in combination with 
the owners and members of all other physician networks in which Woman's 
Hospital, WPHO or any of them who own an interest constitute no more 
than 30% of the physicians in any relevant physician market, except 
that it may include any single physician, or any single preexisting 
physician practice group for each relevant physician market, so long as 
Woman's Hospital or WPHO and they

[[Page 43383]]

do not own an interest in another physician network;
    (2) [NO CHANGE]
    (3) [NO CHANGE]
    (4) [NO CHANGE]
    (5) [NO CHANGE]
    The organization * * * [NO CHANGE]
[RATIONALE FOR CHANGE]
    The word ``or'' (at the bottom of page 7) is needed to make it 
clear that the prohibition identified after the phrase ``so long as'' 
(at the bottom of page 7) is against any physician network in which two 
of the three parties (e.g., Woman's Hospital and the single physician 
or preexisting physician group practice, but not WPHO), rather than 
only prohibiting a physician network in which all three are involved 
(e.g., Woman's Hospital, WPHO, and a single physician or preexisting 
physician group).

IV.

Injunctive Relief

    (A) Woman's Hospital and WPHO are enjoined from:
    (7) Directly, or indirectly, entering into, or participating in, 
any agreement relating to the prices, terms, or conditions upon which 
physician services are provided to patients; unless such an agreement 
is necessary for the formation, organization, or operation of a 
qualified managed care plan or messenger model as defined herein, and 
approved in writing by the Department of Justice. Nothing in this 
paragraph IV(A)(7) prevents Woman's Hospital or WPHO from entering an 
agreement with a managed care plan or network for the provision of 
hospital services, provided that such managed care plan or network is 
not owned or controlled by Woman's Hospital, WPHO, or any consenting 
physician.
    (B) Each consenting physician is enjoined from:
    (3) Directly, or indirectly, entering into, or participating in, 
any agreement relating to the prices, terms, or conditions upon which 
Woman's Hospital provides hospital services to patients; unless such an 
agreement is necessary for the formation, organization, or operation of 
a qualified managed care plan or messenger model as defined herein, and 
approved in writing by the Department of Justice.
[RATIONALE FOR CHANGE]
    The formation of WPHO and the other acts included in the complaint 
represent the continuation of a long-standing pattern of concerted 
action among many of the physicians in the community and Woman's 
Hospital. The restrictions and limitations placed on the defendants and 
consenting physicians go a long way toward preventing future agreements 
on price, concerted refusals to deal, and other forms of 
anticompetitive concerted action undertaken through a formal agreement 
or organization such as WPHO. However, without the type of prohibition 
or fencing in provision suggested above, the defendants and consenting 
physicians will remain relatively free to informally engage in the same 
types of anticompetitive conduct as alleged in the complaint through 
other means.
    Given the fact that the defendants and consenting physicians have a 
history of coordinating their actions and have already ironed out a lot 
of the mechanics of concerted action, it would be particularly easy for 
these defendants and consenting physicians to continue their previous 
course of conduct without creating the formal agreements and 
organizational structure prohibited by the Final Order. Consequently, 
we believe it is imperative that the Final Order address the potential 
for the traditional, informal price agreements, boycotts, etc. that 
have been such a significant part of antitrust enforcement for almost a 
century.
    (D) Nothing in this Final Judgment prohibits the defendants or the 
consenting physicians from
    (1) Forming, operating, owning an interest in, or participating in 
(a) a messenger model (provided such messenger model satisfies each of 
the criteria used to define a qualified managed care plan in II.(G)), 
or (b) a qualified managed care plan, if defendants obtain prior 
written approval from the Department of Justice, which will not be 
withheld unreasonably, or
    (2) [NO CHANGE]
[RATIONALE FOR CHANGE]
    The Department's complaint alleges that the defendants engaged in 
two types of anticompetitive behavior: an agreement on price among and 
between physicians and Woman's Hospital; and an agreement among and 
between physicians and Woman's Hospital regarding with whom physicians 
would deal (only those payers willing to negotiate with WPHO), and 
would not deal (General Health's Health Center). The provisions in the 
Final Judgement relating to qualified managed care plans clearly 
address both the potential for price fixing and for collective 
agreements not to deal. However, while the messenger model provisions 
contain in the Final Judgement do apparently address the potential for 
price fixing agreements, the Final Judgement is ambiguous as to whether 
or not the messenger model provisions are subject to the limitations 
placed on qualified managed care plans that prevent or hinder the 
formation of collective agreements not to deal. Without similar 
limitations, a messenger model could be a vehicle for providers to 
collectively agree not to deal.
    The Competitive Impact Statement would apparently allow Women's 
Hospital and WPHO to use a messenger model that is not subject to the 
limitations, including the percentage of physicians that can 
participate, that are placed on the defendants' development of a 
qualified managed care plan. We believe that any negotiating 
organization developed by the defendants using the messenger model 
should be subject to the same constraints as those placed on a 
qualified managed care plan, and that the language of the Final 
Judgement and Competitive Impact Statement should be modified to make 
that limitation explicit.
    The price-fixing protections contained in the definition of the 
messenger model do not adequately protect against the messenger model 
becoming the means for boycott activity. A physician network organized 
and operating according to the messenger model defined in the Final 
Judgement is indeed, less likely to lead to price fixing behavior, but 
it is wholly inadequate to prevent or even significantly hinder 
attempts among the participants to collectively refuse to deal. For 
example, the messenger model as defined would not prohibit the 
messenger from informing participating physicians about the number of 
physicians that have agreed to participate in a given plan, as long as 
the messenger does not covey any information about prices or terms. 
Similarly, the messenger would not be prohibited from communicating to 
physicians how many other physicians were generally participating in 
the network. The messenger would also be allowed to provide physicians 
with a comparison of offers from various payers, which could easily 
become a means for conveying to physicians which payer contracts are 
favored, and which ones are not.
    Obviously, the language of the messenger model provisions could be 
modified to address the problems noted above. However, it would be 
extremely difficult to ascertain whether defendants are complying with 
the substantive protections included in the messenger model provisions. 
Ensuring or verifying compliance is particularly important given the 
fact that WPHO has already

[[Page 43384]]

been used as a vehicle to boycott the new Health Center. Subjecting a 
messenger model network to a 30% limit on participation, as well as to 
the other qualified managed care plan limitations, is not only the most 
effective way to prevent a boycott from being effective, but also makes 
compliance easily verifiable.\1\ Allowing defendants to operate a 
messenger model that does not require DOJ approval and does not limit 
the number of physicians who can participate, would be imprudent and 
would jeopardize the efficacy of the Final Judgment. Consequently, we 
believe that any network operated by defendants based on a messenger 
model should be subject to all the limitations placed on a qualified 
managed care plan.
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    \1\ While 30% of the physicians in a market could attempt a 
boycott, it is unlikely they would try because a boycott consisting 
of only 30% of the physicians in any relevant market would 
undoubtedly, and obviously fail.
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    A 30% participation limitation on the messenger model would also 
have a significant deterrent effect on any attempts to use the 
messenger model as a means to coordinate pricing because managed care 
plans competing with the Woman's Hospital/WPHO qualified managed care 
plan could exclude the 30% of the doctors involved in the price fix. 
Consequently, there would be little incentive for only 30% of the 
physicians to agree on prices. Therefore, the 30% participation limit 
goes a long way toward preventing such an agreement from taking place.
    If it is important to prevent both price fixing and boycott 
activity via the formation of a managed care plan, it is illogical to 
address only the price fixing potential inherent in a negotiating 
organization of physician and hospital providers. The use of the 
messenger model alone does not address the potential for such a 
negotiating organization to be the vehicle for organizing a boycott. 
Without limitations such as those placed on qualified managed care 
plans, a messenger model could be a vehicle for providers to 
collectively agree not to deal. Similarly, we cannot see any 
distinction between a messenger model and qualified managed care plan 
that justifies not requiring prior written DOJ approval for operating a 
messenger model. Consequently, we believe that the messenger model 
should be limited to participation by 30% of the physicians in any 
relevant market, and should be subject to the other restrictions placed 
on qualified managed care plans. Finally, we recommend that the 
defendants and consenting physicians also be required to obtain prior 
written approval from the DOJ before forming, operating, owning an 
interest in, or participation in a messenger model.

Certificate of Service

    I, Pamela Girardi, hereby certify that copies of the United States' 
Response to Public Comments in U.S. v. Women's Hospital Foundation and 
Woman's Physician Health Organization, Civ. No. 96-389-B-MZ were served 
on the 15th day of August 1996 by first class mail to counsel as 
follows:

John J. Miles,
Ober, Kaler, Grimes & Shriver, Fifth Floor, 1401 H Street, NW., 
Washington, DC 20005.
Toby G. Singer,
Jones, Day, Reavis & Pogue, 1450 G Street, NW., Washington, DC 20005.
Pamela C. Girardi.
[FR Doc. 96-21432 Filed 8-21-96; 8:45 am]
BILLING CODE 4410-01-M