AMA offers models for two contracts you will like

The model contracts provide physicians with information on how to approach managed care and employment situations.

Editorial. Aug. 28, 2000.

In the complicated and often confusing contractual world in which today's physicians find themselves practicing, relationships with managed care organizations, physician groups and other entities that provide payment have become a fact of life. The terms of these agreements can determine not only the physician's professional and financial success, but also, and more important, the kind of care he or she is able to provide for patients.

Two new publications of the American Medical Association now are available to provide assistance.

How to get the model contracts

The first is the AMA's Model Managed Care Contract, designed by the Association's Private Sector Advocacy Group to provide a reasonable alternative to the one-sided contracts offered by some managed care organizations, often on a take-it-or-leave-it basis. The 81-page document is an update of the original contract developed in 1997 and contains information addressing the evolution of managed care over the past four years. This includes the increasing use of "all products" provisions by MCOs, the "renting" of physician discounts to third parties through so-called silent PPOs, and the growing prevalence of downcoding and bundling of claims.

The importance of careful, line-by-line scrutiny of these documents cannot be overstated. For example, the difference between a liberal and narrow definition of "medically necessary" or "emergency services" may mean the difference between an MCO's approving a payment for a patient procedure or refusing reimbursement. As the model points out, each physician also should demand copies of the MCO's policies and procedures that may be "incorporated by reference" into a contract, and review them just as carefully as the contract itself; many patient care issues may be embedded in this material, which may be considered a part of the contract.

The second new document, developed by the AMA Office of General Counsel, is the 118-page Annotated Model Physician Employment Agreement. This model was written as a resource for physicians who want to be better prepared to negotiate an employment contract with a group practice, multispecialty group practice, medical faculty practice plan, hospital or other institution. It is designed to assist both potential physician employees and groups of physicians who are employing physicians. These trends obviously are increasing throughout all segments of medicine and are of particular relevance to physicians just entering practice.

As is the case with the Model Managed Care Contract, the model employment agreement is not a substitute for legal advice, but it provides a description of basic contract terms typically found in employment agreements, with explanations, recommended language and alternative provisions. Also included is a detailed summary of the tax implications of compensation and benefit packages, a description of the distinctions between employee status and independent contractor status, and a compilation of pertinent state laws. The issues in these contracts involve complex legal relationships, but they also go to the pragmatic heart of working relationships that affect how the physician conducts his or her day-to-day practice.

The new AMA publications should be a welcome guide to thousands of physicians -- and their attorneys -- as they attempt to navigate the often-dangerous waters of today's health care environment.

Anyone considering signing a contract should review and understand that document. Provisions in the contract that frequently are glossed over during initial negotiations may find new and startling dimensions when a subsequent controversy requires interpretation or clarification.

ADDITIONAL INFORMATION:

How to get the model contracts

The AMA's "Annotated Model Physician Employment Agreement" is available online (in pdf) to AMA members only (http://www.ama-assn.org/ama1/x-ama/upload/mm/395/2003employ.pdf).

The hard-copy version can be obtained by calling (312) 464-4076. AMA members can order one copy free of charge (additional copies are $20). The price for nonmembers is $30.

The AMA's "Model Managed Care Contract" is available online to members and nonmembers alike (http://www.ama-assn.org/ama/no-index/legislation-advocacy/9559.shtml).