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Terminating physicians from managed care organizations.

P K O'Hare1

  • 1McDermott, Will & Emery, Washington, DC, USA.

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|December 8, 1997
PubMed
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Physician contract termination by managed care organizations faces new challenges. New laws grant physicians more hearing rights, making contract termination more complex and costly for organizations.

Area of Science:

  • Healthcare law
  • Managed care policy
  • Physician contracting

Background:

  • Managed care organizations (MCOs) commonly terminate physician contracts.
  • Physician contract termination procedures are evolving.
  • Legal and legislative landscapes are shifting.

Purpose of the Study:

  • To analyze recent legal and legislative changes impacting physician contract termination.
  • To inform managed care organizations about new physician rights.
  • To advise on adapting termination processes.

Main Methods:

  • Review of state and federal legal and legislative developments.
  • Analysis of physician hearing rights in contract termination.
  • Assessment of potential impacts on MCOs.

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Main Results:

  • Physicians now have increased rights to hearings during termination.
  • Contract termination processes are expected to become more difficult.
  • Termination is likely to incur higher costs for MCOs.

Conclusions:

  • MCOs must monitor state legislative activity regarding termination.
  • Existing termination standards require reevaluation.
  • Anticipating evolving standards is crucial for MCOs.