7266 Federal Register / Vol. 75, No. 32 / Thursday, February 18, 2010 / Notices 

1The comment must be accompanied by an 

explicit request for confidential treatment, 

including the factual and legal basis for the request, 

and must identify the specific portions of the 

comment to be withheld from the public record. 

The request will be granted or denied by the 

Commission’s General Counsel, consistent with 

applicable law and the public interest. See FTC 

Rule 4.9(c), 16 CFR 4.9(c). 

under the Shipping Act of 1984. 

Interested parties may submit comments 

on the agreements to the Secretary, 

Federal Maritime Commission, 

Washington, DC 20573, within ten days 

of the date this notice appears in the 

Federal Register. Copies of the 

agreements are available through the 

Commission’s Web site (http:// 

www.fmc.gov) or by contacting the 

Office of Agreements at (202) 523–5793 

or tradeanalysis@fmc.gov. 

Agreement No.: 011426–047. 

Title: West Coast of South America 

Discussion Agreement. 

Parties: A.P. Moller-Maersk A/S; APL 

Co. Pte Ltd.; Compania Chilena de 

Navigacion Interoceanica, S.A.; 

Compania Sud Americana de Vapores, 

S.A.; Frontier Liner Services, Inc.; 

Hamburg-Su ̈d; King Ocean Services 

Limited, Inc.; Mediterranean Shipping 

Company, SA; Seaboard Marine Ltd.; 

South Pacific Shipping Company, Ltd.; 

and Trinity Shipping Line. 

Filing Party: Wayne R. Rohde, Esq.; 

Sher & Blackwell LLP; 1850 M Street, 

NW.; Suite 900; Washington, DC 20036. 

Synopsis: The amendment deletes the 

geographic sections of the Agreement, 

adds new authority for the parties to 

form committees, and restates the 

Agreement. 

Dated: February 12, 2010. 

By order of the Federal Maritime 

Commission. 

Rachel E. Dickon, 

Assistant Secretary. 

[FR Doc. 2010–3065 Filed 2–17–10; 8:45 am] 

BILLING CODE P 

FEDERAL TRADE COMMISSION 

[File No. 061 0172] 

Roaring Fork Valley Physicians I.P.A.; 

Analysis of the Agreement Containing 

Consent Order to Aid Public Comment 

AGENCY: Federal Trade Commission. 

ACTION: Proposed Consent Agreement. 

SUMMARY: The consent agreement in this 

matter settles alleged violations of 

federal law prohibiting unfair or 

deceptive acts or practices or unfair 

methods of competition. The attached 

Analysis to Aid Public Comment 

describes both the allegations in the 

draft complaint and the terms of the 

consent order — embodied in the 

consent agreement — that would settle 

these allegations. 

DATES: Comments must be received on 

or before March 5, 2010. 

ADDRESSES: Interested parties are 

invited to submit written comments 

electronically or in paper form. 

Comments should refer to ‘‘Roaring Fork 

Valley, File No. 061 0172’’ to facilitate 

the organization of comments. Please 

note that your comment — including 

your name and your state — will be 

placed on the public record of this 

proceeding, including on the publicly 

accessible FTC website, at (http:// 

www.ftc.gov/os/publiccomments.shtm). 

Because comments will be made 

public, they should not include any 

sensitive personal information, such as 

an individual’s Social Security Number; 

date of birth; driver’s license number or 

other state identification number, or 

foreign country equivalent; passport 

number; financial account number; or 

credit or debit card number. Comments 

also should not include any sensitive 

health information, such as medical 

records or other individually 

identifiable health information. In 

addition, comments should not include 

any ‘‘[t]rade secret or any commercial or 

financial information which is obtained 

from any person and which is privileged 

or confidential. . . .,’’ as provided in 

Section 6(f) of the FTC Act, 15 U.S.C. 

46(f), and Commission Rule 4.10(a)(2), 

16 CFR 4.10(a)(2). Comments containing 

material for which confidential 

treatment is requested must be filed in 

paper form, must be clearly labeled 

‘‘Confidential,’’ and must comply with 

FTC Rule 4.9(c), 16 CFR 4.9(c).1

Because paper mail addressed to the 

FTC is subject to delay due to 

heightened security screening, please 

consider submitting your comments in 

electronic form. Comments filed in 

electronic form should be submitted by 

using the following weblink: (https:// 

public.commentworks.com/ftc/ 

roaringforkconsent) and following the 

instructions on the web-based form. To 

ensure that the Commission considers 

an electronic comment, you must file it 

on the web-based form at the weblink: 

(https://public.commentworks.com/ftc/ 

roaringforkconsent.) If this Notice 

appears at (http://www.regulations.gov/ 

search/index.jsp), you may also file an 

electronic comment through that 

website. The Commission will consider 

all comments that regulations.gov 

forwards to it. You may also visit the 

FTC website at (http://www.ftc.gov/) to 

read the Notice and the news release 

describing it. 

A comment filed in paper form 

should include the ‘‘Roaring Fork 

Valley, File No. 061 0172’’ reference 

both in the text and on the envelope, 

and should be mailed or delivered to the 

following address: Federal Trade 

Commission, Office of the Secretary, 

Room H-135 (Annex D), 600 

Pennsylvania Avenue, NW, Washington, 

DC 20580. The FTC is requesting that 

any comment filed in paper form be sent 

by courier or overnight service, if 

possible, because U.S. postal mail in the 

Washington area and at the Commission 

is subject to delay due to heightened 

security precautions. 

The Federal Trade Commission Act 

(‘‘FTC Act’’) and other laws the 

Commission administers permit the 

collection of public comments to 

consider and use in this proceeding as 

appropriate. The Commission will 

consider all timely and responsive 

public comments that it receives, 

whether filed in paper or electronic 

form. Comments received will be 

available to the public on the FTC 

website, to the extent practicable, at 

(http://www.ftc.gov/os/ 

publiccomments.shtm). As a matter of 

discretion, the Commission makes every 

effort to remove home contact 

information for individuals from the 

public comments it receives before 

placing those comments on the FTC 

website. More information, including 

routine uses permitted by the Privacy 

Act, may be found in the FTC’s privacy 

policy, at (http://www.ftc.gov/ftc/ 

privacy.shtm). 

FOR FURTHER INFORMATION CONTACT: 

Constance M. Salemi (202-326-2643), 

Bureau of Competition, 600 

Pennsylvania Avenue, NW, Washington, 

D.C. 20580. 

SUPPLEMENTARY INFORMATION: Pursuant 

to section 6(f) of the Federal Trade 

Commission Act, 38 Stat. 721, 15 U.S.C. 

46(f), and § 2.34 the Commission Rules 

of Practice, 16 CFR 2.34, notice is 

hereby given that the above-captioned 

consent agreement containing a consent 

order to cease and desist, having been 

filed with and accepted, subject to final 

approval, by the Commission, has been 

placed on the public record for a period 

of thirty (30) days. The following 

Analysis to Aid Public Comment 

describes the terms of the consent 

agreement, and the allegations in the 

complaint. An electronic copy of the 

full text of the consent agreement 

package can be obtained from the FTC 

Home Page (for February 3, 2010), on 

the World Wide Web, at (http:// 

www.ftc.gov/os/actions.shtm). A paper 

copy can be obtained from the FTC 

Public Reference Room, Room 130-H, 

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Federal Register / Vol. 75, No. 32 / Thursday, February 18, 2010 / Notices 7267 

600 Pennsylvania Avenue, NW, 

Washington, D.C. 20580, either in 

person or by calling (202) 326-2222. 

Public comments are invited, and may 

be filed with the Commission in either 

paper or electronic form. All comments 

should be filed as prescribed in the 

ADDRESSES section above, and must be 

received on or before the date specified 

in the DATES section. 

Analysis of Agreement Containing 

Consent Order to Aid Public Comment 

The Federal Trade Commission has 

accepted, subject to final approval, an 

agreement containing a proposed 

consent order (‘‘proposed order’’) with 

Roaring Fork Valley Physicians I.P.A., 

Inc., (‘‘RFV’’). The agreement settles 

charges by the Federal Trade 

Commission that RFV violated Section 5 

of the Federal Trade Commission Act, 

15 U.S.C. § 45, by, among other things, 

orchestrating and implementing pricerelated agreements and concerted 

refusals to deal among competing 

physician members of RFV to maintain 

and raise the price at which RFV’s 

physician members contract with 

payers. 

The proposed order has been placed 

on the public record for 30 days to 

receive comments from interested 

persons. Comments received during this 

period will become part of the public 

record. After 30 days, the Commission 

will review the agreement and the 

comments received, and will decide 

whether it should withdraw from the 

agreement or make the proposed order 

final. 

The purpose of this analysis is to 

facilitate public comment on the 

proposed order. The analysis is not 

intended to constitute an official 

interpretation of the agreement and 

proposed order or to modify their terms 

in any way. Further, the proposed order 

has been entered into for settlement 

purposes only and does not constitute 

an admission by the proposed 

respondent that it violated the law or 

that the facts alleged in the complaint 

(other than jurisdictional facts) are true. 

The Complaint 

The allegations of the complaint are 

summarized below. 

RFV is a type of organization 

commonly referred to in the health care 

industry as an ‘‘independent practice 

association’’ because its members 

consist of independent physicians in 

solo and small group practices. RFV is 

controlled by and organized in 

substantial part for the pecuniary 

benefit of its approximately 85 

physician members. RFV is located in 

Garfield County, Colorado. 

The complaint alleges that since at 

least 2003 RFV, although purporting to 

use a messenger model, negotiated 

price-related terms on behalf of its 

members for the purpose of increasing 

and maintaining the rates for services 

provided by RFV’s otherwise competing 

physician members. RFV increased rates 

by demanding that payers include 

automatic annual cost of living 

adjustments (COLAs) in their contracts. 

RFV held lengthy bargaining sessions 

with payers to pressure them into 

including COLAs and other terms in 

their contracts. To protect the automatic 

increases, RFV refused to messenger 

contracts with Medicare-based rates 

because of their potential to decline. 

RFV feared Medicare-based rates would 

decline over time. 

The complaint also alleges that since 

at least 2003 RFV and its members 

engaged in concerted refusals to deal 

with payers except upon the 

collectively-agreed upon contract terms 

demanded during negotiations. RFV 

organized concerted refusals to deal by 

requiring payers contracting with RFV 

to persuade 80 percent of all RFV 

members and 50 percent of each RFV 

specialty (‘‘80/50 rule’’) to accept their 

contracts. After a payer satisfied the 80/ 

50 rule, RFV signed, administered and 

bound all the members to the payer’s 

contract. RFV refused to messenger the 

contract of a payer who failed to satisfy 

the 80/50 rule. RFV reinforced the 80/ 

50 rule by refusing to provide 

unsuccessful payers with the identity of 

the members willing to accept their 

contracts. RFV’s refusal prevented the 

unsuccessful payers from contracting 

directly with individual physicians 

willing to accept the proposed contract 

terms. RFV also reinforced its concerted 

refusals to deal by encouraging members 

to only use the IPA for their contracting. 

RFV targeted its concerted refusals at 

national payers and warned members 

against contracting with them. Most 

national payers attempting to contract 

with RFV could not satisfy the 80/50 

rule. RFV members did not engage in 

any efficiency-enhancing integration of 

their practices sufficient to justify the 

collectively negotiation or the concerted 

refusals to deal. Accordingly, the 

complaint alleges that RFV violated 

Section 5 of the FTC Act. 

The Proposed Order 

The proposed order is designed to 

remedy the illegal conduct charged in 

the complaint and prevent its 

recurrence. It is similar to recent 

consent orders that the Commission has 

issued to settle charges that physician 

groups engaged in unlawful agreements 

to raise fees they receive from health 

plans. 

The proposed order’s specific 

provisions are as follows: 

Paragraph II.A prohibits RFV from 

entering into or facilitating any 

agreement between or among any 

physicians: (1) to negotiate with payers 

on any physician’s behalf; (2) to deal, 

refuse to deal, or threaten to refuse to 

deal with payers; (3) on any terms on 

which a physician is willing to deal 

with any payer; or (4) not to deal 

individually with any payer, or not to 

deal with any payer other than through 

RFV. 

Other parts of Paragraph II reinforce 

these general prohibitions. Paragraph 

II.B prohibits RFV from facilitating 

exchanges of information between 

physicians concerning any physician’s 

willingness to deal with a payer or the 

terms or conditions, including price 

terms, on which the physician is willing 

to deal with a payer. Paragraph II.C bars 

attempts to engage in any action 

prohibited by Paragraph II.A or II.B, and 

Paragraph II.D proscribes RFV from 

inducing anyone to engage in any action 

prohibited by Paragraphs II.A through 

II.C. 

As in other Commission orders 

addressing providers’ collective conduct 

with health-care purchasers, Paragraph 

II excludes certain kinds of agreements 

from its prohibitions. First, RFV is not 

precluded from engaging in conduct 

that is reasonably necessary to form or 

participate in legitimate joint 

contracting arrangements among 

competing physicians, such as a 

‘‘qualified risk-sharing joint 

arrangement’’ or a ‘‘qualified clinicallyintegrated joint arrangement.’’ The 

arrangement, however, must not restrict 

the ability of, or facilitate the refusal of, 

physicians who participate in it to 

contract with payers outside of the 

arrangement. 

As defined in the proposed order, a 

‘‘qualified risk-sharing joint 

arrangement’’ possesses two 

characteristics. First, all physician 

participants must share substantial 

financial risks through the arrangement, 

such that the arrangement creates 

incentives for the physician participants 

jointly to control costs and improve 

quality by managing the provision of 

services. Second, any agreement 

concerning reimbursement or other 

terms or conditions of dealing must be 

reasonably necessary to obtain 

significant efficiencies through the joint 

arrangement. 

A ‘‘qualified clinically-integrated joint 

arrangement,’’ on the other hand, need 

not involve any sharing of financial risk. 

Instead, as defined in the proposed 

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7268 Federal Register / Vol. 75, No. 32 / Thursday, February 18, 2010 / Notices 

order, physician participants must 

participate in active and ongoing 

programs to evaluate and modify their 

clinical practice patterns in order to 

control costs and ensure the quality of 

services provided, and the arrangement 

must create a high degree of 

interdependence and cooperation 

among physicians. As with qualified 

risk-sharing arrangements, any 

agreement concerning price or other 

terms of dealing must be reasonably 

necessary to achieve the efficiency goals 

of the joint arrangement. 

Paragraph III, for three years, requires 

RFV to notify the Commission before it 

enters into any arrangements to act as a 

messenger or an agent on behalf of any 

physicians, with payers regarding 

contracts. Paragraph IV sets out the 

information necessary to make the 

notification complete. 

Paragraph V, for three years, requires 

RFV to notify the Commission before 

participating in contracting with health 

plans on behalf of either a qualified risksharing or a qualified clinicallyintegrated joint arrangement. Paragraph 

VI sets out the information necessary to 

satisfy the notification requirement. 

Paragraph VII imposes other 

notification obligations on RFV and 

requires the termination of certain 

contracts that were entered into 

illegally. Paragraph VII.A require RFV to 

distribute the complaint and order to (1) 

physicians who have participated in 

RFV since 2001; (2) to various past and 

current personnel of RFV; and (3) to 

payers with whom RFV has dealt since 

2001. Paragraph VII.B requires RFV, at 

any payer’s request and without 

penalty, to terminate its existing 

contracts with the payer for the 

provision of physician services. 

Paragraph VII.B allows certain contracts 

currently in effect to be extended at the 

written request of the payer no longer 

than one year from the date that the 

order becomes final. Paragraph VII.C 

requires RFV to distribute payer 

requests for contract termination to 

physicians who participate in the 

contract Paragraph VII.D requires RFV 

for three years, to provide new 

members, personnel, and payers not 

previously receiving a copy, a copy of 

the Order and the Complaint. Paragraph 

VII.D also requires RFV to publish 

annually a copy of the Order and the 

Complaint in its newsletter. 

Paragraphs VIII, IX, and X impose 

various obligations on RFV to report or 

provide access to information to the 

Commission to facilitate the monitoring 

of compliance with the order. Finally, 

Paragraph XI provides that the order 

will expire in 20 years. 

By direction of the Commission. 

Donald S. Clark 

Secretary. 

[FR Doc. 2010–3033 Filed 2–17–10: 7:19 am] 

BILLING CODE 6750–01–S 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

[Document Identifier: OS–0990–New] 

Agency Information Collection 

Request; 60-Day Public Comment 

Request 

AGENCY: Office of the Secretary, HHS. 

In compliance with the requirement 

of section 3506(c)(2)(A) of the 

Paperwork Reduction Act of 1995, the 

Office of the Secretary (OS), Department 

of Health and Human Services, is 

publishing the following summary of a 

proposed information collection request 

for public comment. Interested persons 

are invited to send comments regarding 

this burden estimate or any other aspect 

of this collection of information, 

including any of the following subjects: 

(1) The necessity and utility of the 

proposed information collection for the 

proper performance of the agency’s 

functions; (2) the accuracy of the 

estimated burden; (3) ways to enhance 

the quality, utility, and clarity of the 

information to be collected; and (4) the 

use of automated collection techniques 

or other forms of information 

technology to minimize the information 

collection burden. 

To obtain copies of the supporting 

statement and any related forms for the 

proposed paperwork collections 

referenced above, e-mail your request, 

including your address, phone number, 

OMB number, and OS document 

identifier, to 

Sherette.funncoleman@hhs.gov, or call 

the Reports Clearance Office on (202) 

690–6162. Written comments and 

recommendations for the proposed 

information collections must be directed 

to the OS Paperwork Clearance Officer 

at the above e-mail address within 60- 

days. 

Proposed Project: Evaluation of 

Medicare Personal Health Records 

Choice Pilot—OMB No. 0990–NEW— 

Office of the Assistant Secretary for 

Planning and Evaluation. 

Abstract: Since 2003, HHS has 

worked toward the goal of establishing 

electronic, longitudinal health records 

for Americans that can be accessed 

safely, across the Internet, and anytime 

and anywhere by patients, doctors, and 

other health care providers. In addition 

to electronic health records (EHRs), 

where health information is created, 

stored and accessed mainly by health 

care organizations and practitioners, 

personal health records (PHRs), 

electronic, patient-centered applications 

and services, are gaining increasing 

recognition and momentum. Current 

PHR business models represent broad 

and varied uses, from disease 

management to health promotion, with 

sponsors consisting of commercial 

vendors, heath plans, employers, and 

health care providers. We know very 

little about why consumers, and 

specifically Medicare beneficiaries, elect 

to use PHRs and what functionality they 

want from a PHR. Understanding these 

needs will be critical if HHS and the 

Centers for Medicare & Medicaid 

Services (CMS) are to pursue PHRs as a 

tool to empower consumers to manage 

their health and have the capability to 

link to their provider’s EHR. 

In January 2009, CMS launched a new 

program in Arizona and Utah, the 

Medicare PHR Choice Pilot (PHRC). 

This pilot encourages Medicare fee-forservice (FFS) beneficiaries to take 

advantage of the newer, more robust 

Internet-based tools for tracking their 

health and health care services. This is 

the first pilot to offer a choice of PHRs 

to Medicare FFS beneficiaries, including 

PHRs with additional functionality and 

direct data linkages for the consumers. 

Pilot participants can choose among 

GoogleHealthTM, NoMoreClipboardTM, 

PassportMDTM, and HealthTrioTM, 

competitors in the open PHR market. 

HHS’ Office of the Assistant Secretary 

for Planning and Evaluation (ASPE) has 

contracted with Mathematica Policy 

Research to conduct an evaluation of 

this pilot program, including a PHR 

enrollee user satisfaction survey to 

assess barriers, facilitators, and 

satisfaction with the PHRs. A selfadministered paper-and-pencil 

instrument will be the primary data 

collection mode for the PHRC user 

satisfaction survey, with telephone 

followup for mail nonrespondents. The 

one-time data collection field period is 

expected to be 12 weeks in Fall 2010. 

WReier-Aviles on DSKGBLS3C1PROD with NOTICES