Washington, D.C., May 19, 2009 – To help physicians, preferred provider networks (PPNs) and payers develop a common understanding during contacting discussions, the American Association of Preferred Provider Organizations (AAPPO) and the American Medical Association (AMA) partnered to develop an educational guide, available today. The “Provider Contracting Toolkit” is designed to create a common ground for discussions between physicians, PPNs and payers by fostering a better understanding of contractual agreements and diminish the potential for problems or misunderstandings that arise after the contract is executed.
“With more than 69 percent of Americans enrolled in PPOs, our industry needs to do all we can to ensure that all parties understand the contracting process for preferred provider networks,” said Karen Greenrose, president and CEO of AAPPO. “AAPPO believes that continued collaboration with AMA will enhance communication among our members and providers.”
“No physician should sign a health plan agreement without a thorough understanding of the implications for their practice,” said AMA Board Member Cecil B. Wilson, M.D. “The new toolkit will help physicians get straight answers and useful information up front during the contract negotiation process, which can help establish a fairer and more balanced business relationship over the course of the contract.”
Physicians are often solicited to participate in PPNs, and clarity and transparency in the contract agreements are the foundation for a fair, long-term business relationship. Given the focus on provider contracting at the state legislative level, as well as the desire of both the PPNs and physicians to work together to ensure transparent and fair contracts, the new toolkit will serve as an educational resource so that both parties better understand the process.
The toolkit provides quick reference documents on several key issues that arise during the contracting process, including:
- Responsibilities of PPNs/Payers.
- Physicians Contracting with PPNs.
- Assessing Network Value.
- Primary/Secondary Network Matrix.
- Understanding Silent PPOs.
The toolkit is available in hard copy, or can be accessed online at AAPPO and AMA Web sites.
The toolkit is not intended to be a source of legal advice. An experienced counsel should be sought for assistance in negotiations. Additionally, some states have laws regulating PPNs. Contact the local state medical association for more information on the laws in a specific state.
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About the American Association of Preferred Provider Organizations (AAPPO)
Founded in 1983, AAPPO (www.aappo.org) is the leading national association of preferred provider organizations (PPOs). PPOs put control for medical decisions in the hands of the physician and patient, resulting in easy access to the right care, provided by the right doctor, at the right time. AAPPO creates a forum for discussion and dissemination of PPO best practices.
About the American Medical Association (AMA)
The AMA helps doctors help patients by uniting physicians nationwide to work on the most important professional, public health and advocacy issues in medicine. Working together, the AMA's quarter of a million physician and medical student members are playing an active role in shaping the future of medicine. For more information on the AMA, please visit
www.ama-assn.org.
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