According to the state, the merger could have lessened competition by limiting competition among the surgeons, increasing the likelihood of collusion among them, and helped them to resist efforts by managed care companies to negotiate reduced rates. To settle the suit, the surgeons, who together perform over 80 percent of the cardiac surgery at Maine Medical Center, have agreed to a resolution whereby at the option of managed care companies, the
surgeons will be reimbursed at the rates paid by managed care companies to cardiac surgeons practicing on a fee-for-service basis in Boston. The Boston market for cardiac surgery is considered to be highly competitive. Specifically, the surgeons: (1) will not sign an exclusive cardiothoracic surgery contract with any hospital; and (2) will not refuse to participate in a fee-for-service contract that pays at or above a Resource-Based Relative Value Scale (RBRVS) fee schedule similar to that used in the Medicare program. The cardiac group is not required to deal with managed care plans that are not financially sound or that violate good quality or ethical practices.