Magazine article Medical Economics

Having Won Its Battle, a California IPA Loses the War

Magazine article Medical Economics

Having Won Its Battle, a California IPA Loses the War

Article excerpt

For several years now, the North Lake Tahoe Medical Group (an IPA) has managed to prevent HMOs from getting a foothold in California's Lake Tahoe Basin. Naturally, that drew regulatory attention, and recently the association agreed to settle FTC charges that it kept managed care at bay by conspiring with its members.

From the time the IPA was formed in 1994, a clause in its participation agreement required doctors to contract with payers only through the IPA. When Blue Shield of California tried to establish an HMO in the area, the IPA decided that its members would contract only on a fee-for-service basis. The IPA then developed its own minimum fee schedule and tried to force Blue Shield to accept it.

When Blue Shield wouldn't, the IPA encouraged its members who were participating providers in other Blue Shield plans to drop out-and many did. Since the IPA's membership represents a large majority of physicians in both the North and South Lake Tahoe areas, the Blues had to accept the IPA's reimbursement rates or stay out. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.