August 30, 2007
Acting Chief, Litigation I Section
United States Department of Justice
1401 H Street, N.W. Suite 4000
Washington, D.C. 20530
The purpose of this letter is to comment on the Impact Statement and Consent
Decree pending from the Department of Justice toward the Federation of
Physicians and Dentists (Federation) and its effects on the Cincinnati OB-GYNS
that employ their services.
I believe the Utah State Orthopedic Society (USOS) has a germane example in
regard to the appropriate use of the Federation and the "messenger model". While
the use of the "messenger model" in the state of Utah among Orthopedist has an
approximate 8 - 9 year history its presence in Utah became more formal S years
ago when the Federation of Physicians and Dentist helped the USOS organize
itself into a functioning society that supplies meaningful information and
education to it members, via a representing Board of Councilors and an annual
The history the USOS has had with the Federation of Physicians and Dentists has
been nothing. but professional and extremely cognizant of the legal operating
parameters of the "messenger model". The USOS from the beginning was
counseled and has operated under the clear understanding from the Federation
that the "messenger model" is intended only to provide efficiencies in the
contracting process by allowing. representation from a "messenger" dedicated to
such activities rather than a physician trying to practice medicine and trying to
negotiate such contracts simultaneously. While a "messenger" may legally
represent several competing orthopedists or their practices it is clear that the
"messenger" can never negotiate or represent physicians collectively; all of the
negotiations must be kept confidential on an individual decision-making level.
The Federation has always operated in Utah in this fashion.
The USOS has
nature but never
as a tool to
or position in the
Utah market. As
a physician, my
ability to balance
a busy patient
Speaking as an
practitioner I can
only do so many
things in a single
day. I admittedly
disadvantaged when it comes to my negotiations with the insurance industry
through the proper use of the "messenger model" have become at least somewhat more
educated in making rational decisions for my practice. I believe this education has had the
effect of making the physician and insurance markets in the state of Utah more competitive,
From our experience in Utah I can only presume that the activities in Cincinnati have been
handled in a similar fashion by the Federation. I hope the use of the "messenger model"
through out the country is managed legally by those that employ it. I also hope that where the
"messenger model" is being used appropriately that it will be protected by the Department of
Justice for the benefit of physicians and patients that realize such an important benefit from
From a Utah perspective I would judge that monopoly power is not held with the physicians
but rather with the insurers and one system in particular. We trust that the Department of
Justice is carefully monitoring this side of the medical industry and the powerful, potentially
controlling, organizations that exist in it as well.
I hope you find this information helpful, thank you for your consideration.
Vernon J. Cooley, M.D.
President, Utah State Orthopedic
Executive Director, Utah State Orthopedic Society
Vernon J. Cooley,
Terry I. Finlayson, M.D.
E. Marc Mariani,
Mark C. Wankier
Dean Walker, M.D.
Paul Winterton, M.D.
and Legislative Oversight
Kade C. Hunisman, M.D.
Timonthy C. Beals, M.D.
Third Party Relations
Reed Fogg, M.D.
Marketing & Public
Michael C. Holmstrom,
Education & CME
Douglas T. Hutchinson,
University of Utah
John S. Bradley