MCOs - hosp too much AWP(Any Willing Provider Laws of a pt...

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Selective Contracting : Can choose any doc you want, but the health plan will provide diff amounts depending on who you choose NOT A RIGHT for phys to get to practice in a health care plan as a preferred provider Procompetitive -> Health plans insert competition into the system by forcing docs to bargain or start their own health plan --> The courts would agree No competition if all docs were allowed in a plan Contracts can be terminated Termination with Cause - one party breaches the contract Termination without Cause - Can leave at any time with 60 days written notice (either party) Hidden Incentive -> to reduce costs and terminate contracts Some states have made it illegal for health plans to terminate a contract without cause when there really is a cause (she refers to specialists too often, puts her pts in the
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Unformatted text preview: hosp too much) AWP (Any Willing Provider) Laws- of a pt has a health plan and the health plan makes selective contracts with some providers but not others and those providers give a discount to become a preferred provider --> pt can go to any phys that is willing to give the same discount and the health plan has to pay the provider at the same discounted rate--> Destroys the bargaining process • Phys have no incentive to stay in a contract as a preferred provider Financial Incentives to Provide Less Care Federal statute prohibits hosps from paying docs to reduce level of services for Medicare and Medicaid pts, but not other health plans (they can give docs those same incentives)...
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