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How group practices can avoid managed care contracting pitfalls.

A G Gosfield1

  • 1Alice G. Gosfield and Associates, P.C., Philadelphia, PA, USA.

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|November 11, 1999
PubMed
Summary

Group practices must understand managed care contract pitfalls, focusing on negotiation positions, key terms like compensation and termination, and physician protections for unmet utilization assumptions.

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Area of Science:

  • Healthcare Administration
  • Contract Law
  • Health Economics

Background:

  • Group practices face complex negotiations with managed care organizations.
  • Understanding contract terms is crucial for financial stability and operational success.

Purpose of the Study:

  • To identify key considerations and potential pitfalls in managed care contract negotiations for group practices.
  • To provide guidance on essential contract clauses and realistic term fulfillment.

Main Methods:

  • Analysis of fundamental contract issues in managed care agreements.
  • Review of critical clauses including compensation, termination, and utilization assumptions.

Main Results:

  • Key issues include understanding negotiating positions and the business significance of terms.

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  • Compensation and termination clauses are paramount.
  • Physician protection against unmet utilization assumptions and realistic term fulfillment are vital.

    • Conclusions:

    • Group practices need to be aware of contract pitfalls and prioritize clear, well-defined, and time-limited contract terms.
    • Ensuring physician protection and realistic expectations are essential for successful managed care contracting.