AMA, PPO group offer contracting guide

The two associations have developed a tool kit to help doctors make decisions about working with a preferred provider organization.

By Emily Berry — Posted June 2, 2009

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More than two-thirds of insured Americans are enrolled in PPOs, so deciding whether to be part of one is an important decision for a physician.

The American Medical Association and the American Assn. of Preferred Provider Organizations are offering help with that decision through a contracting tool kit. The resource is designed to walk physicians through the responsibilities of a PPO, particularly what the payer and physician organizations must and should disclose; how to assess what an agreement will mean to your practice; and an explanation of how a rental network or "silent PPO" works.

Karen Greenrose, RN, president and CEO of the AAPPO, said she hopes the tool kit will help physicians understand how the physician network works. "There's finally the first contracting guidelines where, as an organization, we're saying, 'This is how you contract with providers.' And the AMA is saying to physicians, 'These are the things you need to be aware of when contracting.' And it's exactly the same message," Greenrose said.

AMA Board of Trustees member Cecil B. Wilson, MD, an internist from Winter Park, Fla., said it's important for a physician to evaluate whether signing a PPO contract will benefit the practice, even if it seems the practice has no negotiating power.

"There may be things in that contract that make you say, 'even if this is a big part of our market, this isn't something we want to be part of,' " Dr. Wilson said. "It's a way of holding insurance plans to more accountability."

The tool kit is available on the AMA Web site (link).

The same resource also is available from the AAPPO (link).

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