Independent practice association

Health care in the United States
Government Health Programs
	Federal Employees Health Benefits Program; Indian Health Service; Medicaid / State Health Insurance Assistance Program (SHIP); Medicare; Prescription Assistance (SPAP); Military Health System / TRICARE; State Children's Health Insurance Program (CHIP); Program of All-Inclusive Care for the Elderly (PACE); Veterans Health Administration;
Private health coverage
	Consumer-driven health care Flexible spending account (FSA); Health Reimbursement Account; Health savings account (HSA) High-deductible health plan (HDHP); Medical savings account (MSA); ; Private Fee-For-Service (PFFS); ; Health insurance in the United States; Managed care (CCP) Exclusive provider organization (EPO); Health maintenance organization (HMO); Preferred provider organization (PPO); ; Medical underwriting;
Health care reform law
	Emergency Medical Treatment and Active Labor Act (1986); Health Insurance Portability and Accountability Act (1996); Medicare Prescription Drug, Improvement, and Modernization Act (2003); Patient Safety and Quality Improvement Act (2005); Health Information Technology for Economic and Clinical Health Act (2009); Patient Protection and Affordable Care Act (2010);
State level reform
	Dirigo Health (Maine); Massachusetts health care reform; Oregon Health Plan; SustiNet (Connecticut); Vermont health care reform;
Municipal health coverage
	Fair Share Health Care Act (Maryland); Healthy Howard (Howard Co., Maryland); Healthy San Francisco; Healthy Way LA; My Health LA;

In the United States, an independent practice association (IPA) is an association of independent physicians, or other organization that contracts with independent physicians, and provides services to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis.^[1]^[2]

Operation

An HMO or other managed care plan can contract with an IPA, which in turn contracts with independent physicians to treat members at discounted fees or on a capitation basis. The typical IPA encompasses all specialties, but an IPA can be solely for primary care or could be single specialty.^[2]

IPAs are typically formed as an LLC, S Corp, C Corp, or other stock entity. Their purpose is not to generate a profit for the shareholders although this can be done. The IPA assembles physicians in self-directed groups within a geographic region to invent and implement healthcare solutions, form collaborative efforts among physicians to implement these programs, and exert political influence upward within the medical community to effect positive change.

Despite a perception that IPAs have been formed to negotiate as a group with insurance companies in an attempt to improve rates of compensation, under the Federal Trade Commission Act, they cannot negotiate as a group with insurance companies for the physician's other insurance reimbursement. The IPA can only negotiate for the IPA members those services which are contracted on capitated members. "Messengers", specialists who are selected to represent individual practices, can be used by IPA members to review and discuss coding and compensation with health insurance companies. These professionals do not collectively bargain and can only do so if the doctors have reorganized under a single tax ID number which is not an IPA model.

Benefits and drawbacks

Benefits

Joining an IPA allows a physician to focus on providing care. Many IPAs offer management services organization (MSO) amenities including payroll, bookkeeping, benefits management, group purchasing, compliance, marketing, and online reputation management. IPAs may also offer physicians an information technology platform offering automation and/ or a connection to an Electronic Health Record (EHR) system. Additionally, IPAs structured as risk-bearing entities can give interested physicians the ability to participate in risk contracts even if they don't have the administrative staff to coordinate them. Most importantly, an IPA offers a physician strength in numbers, having dozens to thousands of physicians represented together gives a single physician the ability to participate in programs that would otherwise not be available.

Drawbacks

There are significant potential drawbacks that may be associated with IPAs as well. Joining an IPA will not relieve a physician from all of the administrative duties of running a medical practice. Also, some IPAs may not be run effectively; this can be due to rapid growth, lack of a sufficiently experience management team, or rapidly changing technology in the field. It is also possible for IPAs to face antitrust issues because they may represent competing healthcare providers.

References

↑ Margaret E. Lynch, Editor, "Health Insurance Terminology," Health Insurance Association of America, 1992, ISBN 1-879143-13-5
1 2 Peter R. Kongstvedt, "The Managed Health Care Handbook," Fourth Edition, Aspen Publishers, Inc., 2001 ISBN 0-8342-1726-0

Bibliography

American Public Policy: An Introduction 7th Edition
Essentials of Managed Care, 4th Ed, Peter Kongstvedt
De Wolf W, and A Stanten. 1995. "The Independent Practice Association". JAMA : the Journal of the American Medical Association. 274, no. 22: 1761.
Roth M. 1979. "Is an Independent Practice Association for You?" Physician's Management. 19, no. 1: 42-6.
2002. "LATE - REGULATORY PRECEDENT - The FTC OKs a Deal That Would Allow a Physician Independent Practice Association to Contract with Health Plans on Behalf of Its Competing Physicians". Modern Healthcare. 32, no. 8: 6.

External links

http://aihinc.com/

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[HIAA_Terminology-1] Margaret E. Lynch, Editor, "Health Insurance Terminology," Health Insurance Association of America, 1992, ISBN 1-879143-13-5

[Kongstvedt-2] 1 2 Peter R. Kongstvedt, "The Managed Health Care Handbook," Fourth Edition, Aspen Publishers, Inc., 2001 ISBN 0-8342-1726-0