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Economic credentialing moves from the hospital to managed care
1Loyola University Chicago, School of Law, Institute for Health Law, IL, USA.
Journal of Health Care Finance
|January 1, 1995
Summary
Economic credentialing uses financial criteria for medical staff privileges, evolving with managed care. Law and legislation are key for physicians in selective contracting, especially concerning the American Medical Association's Patient Protection Act.
Area of Science:
- Healthcare Administration
- Medical Law
- Health Economics
Background:
- Economic credentialing involves applying financial criteria to medical staff appointments and privileges.
- This practice is increasingly relevant in both hospital settings and evolving managed care environments.
Purpose of the Study:
- To explore the concept and implications of economic credentialing.
- To analyze the legal and political issues surrounding economic credentialing in hospitals.
- To examine the future evolution of economic credentialing within managed care settings.
Main Methods:
- Conceptual analysis of economic credentialing.
- Review of legal and legislative frameworks impacting physician contracting.
- Examination of organized medicine's strategies for protecting physician interests.
Main Results:
- Economic credentialing presents significant legal and political challenges in hospitals.
- Managed care settings will see further evolution of economic credentialing practices.
- Legislation, such as the American Medical Association's Patient Protection Act, plays a crucial role in physician protection during selective contracting.
Conclusions:
- Economic credentialing is a complex issue with legal and financial implications for medical staff.
- Physicians and organized medicine must leverage legal and legislative tools to navigate selective contracting.
- Understanding "any willing provider" provisions is essential for protecting physician interests in managed care.