their adoption, and they have a compelling interest in achieving more efficient and value-driven health care services. The federal government also appropriates substantial funds for the education and training of health care providers, and it has an understandable interest in ensuring that the ever-expanding skills and abilities acquired by graduates of these programs are fully utilized for the benefit of the American public.

In particular, the Federal Trade Commission (FTC) has a long history of targeting anticompetitive conduct in health care markets, including restrictions on the business practices of health care providers, as well as policies that could act as a barrier to entry for new competitors in the market. The FTC has responded specifically to potential policies that might be viewed predominantly as guild protection rather than consumer protection, for example, taking antitrust actions against the American Medical Association (AMA) for policies restricting access to clinical psychologists to cases referred by a physician and for ethical prohibitions on collaborating with chiropractors, podiatrists, and osteopathic physicians. In 2008, the FTC evaluated proposed laws in Massachusetts, Illinois, and Kentucky, finding that several provisions could be considered anticompetitive, including limits on advertising, differential cost sharing, more stringent physician supervision requirements, restrictions on clinic locations and physical configurations or proximity to other commercial ventures, and limits on the scope of professional services that can be provided that are not applicable to professionals with similar credentials who practice in similar “limited care settings” (for example, urgent care centers) (DeSanti et al., 2010; Ohlhausen et al., 2007, 2008). Likewise, the FTC initiated an administrative complaint against the North Carolina Board of Dental Examiners in June 2010 (FTC, 2010). The Board had prohibited nondentists from providing teeth-whitening services. The FTC alleged that by doing this the Board had hindered competition and made it more difficult and costly for consumers in the state to obtain this service.

As a payer and administrator of health insurance coverage for federal employees, the Office of Personnel Management (OPM) and the Federal Employees Health Benefits program have a responsibility to promote and ensure employee/subscriber access to the widest choice of competent, cost-effective health care providers. Principles of equity would suggest that this subscriber choice would be promoted by policies ensuring that full, evidence-based practice is permitted for all providers regardless of geographic location.

Finally, the Centers for Medicare and Medicaid Services (CMS) has the responsibility to promulgate rules and policies that promote access of Medicare and Medicaid beneficiaries to appropriate care. CMS therefore should ensure that its rules and polices reflect the evolving practice abilities of licensed providers, rather than relying on dated definitions drafted at a time when physicians were the only authorized providers of a wide array of health care services.



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