Payment & Delivery Models

Strengthen the practice through collaboration


Strengthen Your Practice (PDF) is a resource designed to help physicians, legislators, attorneys and others identify many of the benefits and limitations of several potential collaboration arrangements. The manual comprises four parts.

Business planning

Part I discusses the reasons driving physician collaboration.  Part I also describes key considerations that physicians should consider before embarking on an integrative project.

The Merger Model

Part II describes elements of fully integrated physician practice mergers.

  • The merger model means the consolidation of separate physician practices into one medical group in which participating physicians have a complete unity of interest. The merged firm controls all of the resources of the combined practices so that none of the participating physicians compete with one another.
  • At the same time, physicians who have merged their practices may still enjoy some degree of independence, e.g., (1) remain in their local practice settings, (2) oversee many day-to-day practice operations and staffing decisions and (3) be rewarded based on individual productivity. 
  • Learn more about the flexibility of this model and general requirements for fully integrated practice mergers.

Partial Integration Models

Part III explains how physicians can partially integrate their practices as a way to collaborate, and in some cases, collectively negotiate fees lawfully under the antitrust laws.

  • Independent physicians can partially integrate financially by pooling resources and taking on risk for the costs of the services that they provide.
  • Independent physicians can partially integrate clinically by jointly implementing an active and ongoing program to evaluate and modify practice patterns of the physician participants to create a high degree of practice interdependence.
  • Learn more about 2 types of collaborative integration models—and potential antitrust issues.

Antitrust Issues

Part IV contains antitrust issues including:

  • The relevant antitrust concerns that may be raised when physicians seek to jointly negotiate fees and a description of the current law on the subject.
  • Information on antitrust pitfalls and a description of the circumstances in which physicians are sufficiently integrated to permit joint fee negotiations under antitrust laws.

For further information regarding this guidance or other AMA antitrust activities, contact Wes Cleveland at (312) 464-5000 or by email at [email protected] and Henry Allen at (312) 464-5000 or by email at [email protected].

The purpose of this resource is strictly informational and/or educational. This resource does not create an attorney-client relationship between the American Medical Association and the reader. The AMA is not providing legal advice in this resource. The reader should consult appropriately qualified legal counsel regarding applicability of or compliance with federal and state laws and regulations including antitrust compliance.