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Contracting for outpatient surgical services.

R J Pristave1, S Becker

  • 1Ross & Hardies, Chicago, IL, USA.

Managed Care Quarterly
|December 4, 1995
PubMed
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Managed care entities select outpatient surgical providers based on various factors. This review offers guidance on pricing, marketing, and business/legal aspects of managed care contracting for surgery centers.

Area of Science:

  • Health Services Research
  • Healthcare Management
  • Surgical Care Delivery

Background:

  • Managed care organizations (MCOs) increasingly influence provider selection for outpatient surgical services.
  • Understanding the decision-making process of MCOs is crucial for outpatient surgery centers (OSCs).
  • Contracting between MCOs and OSCs involves complex business and legal considerations.

Purpose of the Study:

  • To review factors influencing MCOs' selection of outpatient surgical providers.
  • To provide practical guidance for OSCs on service pricing and marketing strategies.
  • To offer an overview of business and legal issues in managed care contracting.

Main Methods:

  • Literature review of factors impacting MCO provider choice.

Related Experiment Videos

  • Analysis of pricing and marketing strategies for OSCs.
  • Examination of business and legal frameworks for managed care contracts.

    • Main Results:

    • Key factors influencing MCOs include cost-effectiveness, quality metrics, and network adequacy.
    • OSCs should tailor pricing and marketing to demonstrate value and meet MCO requirements.
    • Successful contracting necessitates a thorough understanding of regulatory compliance and negotiation tactics.

    Conclusions:

    • Strategic alignment with MCO priorities is essential for OSCs seeking partnerships.
    • Effective pricing, marketing, and legal counsel enhance contracting success for outpatient surgical services.
    • This review provides a framework for navigating the complexities of managed care contracting in surgical care.