WHEREAS, Third party payor contracting is one of the most cited reasons for employed physicians electing not to form their own practice.
WHEREAS, Established physicians currently in a specific insurance network who elect to form a new practice are often denied entry into that same network under the premise that the network is full and not accepting new physicians.
WHEREAS, Similarly, established physicians currently in a specific insurance network who elect to form a new practice (if offered a contract at all) are often offered entry into the network at substantially inferior terms.
WHEREAS, The economic reality of being unable to obtain third party payor contracts for new practices has the effect of restricting competition.
WHEREAS, This inability to obtain third party payor contracts for same physician / new practice scenarios negatively affects patient care by forcing patients to choose between seeing their same physician and paying higher out of network costs or transitioning to a new physician in their network.
WHEREAS, Third party payor contracts with providers have a transition period whereby if either party terminates the contract without cause, the current terms of the contract stay in force during a certain period while patients who desire to stay in network can be transitioned to other providers.
WHEREAS, These provisions do not extend to the same physician who has formed a new practice entity.
RESOLVED, That the FMA support legislation or administrative rules that would allow existing in network providers to operate under the same terms of their current contract when transitioning to a new practice for a period of not less than six months.