Contracting Resources and Evaluation

Health insurance payer policies

In alignment with its goals to alleviate administrative burden and assist physicians during contract negotiations, and in response to Resolution B-4 “Physician and Physician Assistant Recredentialing,” the Washington State Medical Association has compiled carrier policies via links in one place for the convenience of physicians. Please note that these policies are maintained and provided by the carriers themselves, most of whom require additional log-in information before the individual policies or provider manuals may be viewed.

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Payer contract evaluations

Physicians often overlook the need to carefully review all facets of the payer or network sponsor who is submitting a contract. The WSMA Contract Evaluation Service provides information based on an analysis of specific contracts submitted individually by physicians. Please note this service takes 4 - 6 weeks. To request a contract evaluation, please contact Tierney Edwards, JD, associate director of legal and federal affairs at tee@wsma.org, or call (206) 441-9762 or toll-free (800) 552-0612.

Commercial exchange plans – network adequacy key questions to consider
The Office of the Insurance Commissioner will begin applying newly adopted rules regarding network adequacy to commercial health insurance plans that will become effective Jan. 1, 2015.

OIC approved the rules despite comments the WSMA submitted raising concerns that the rules as proposed would decrease access to care for Washington patients and fail to ensure good-faith negotiations between insurance carriers and physicians.

Health insurers will seek to finalize their provider networks across the state for 2015, and may be in contact with you regarding your participation. Read the WSMA’s Key Questions to Consider to learn what to look for when negotiating your contract.

Model health insurance physician contract

Payer matrix provision descriptions and scoring guide

Payer contract evaluation

Employment contract evaluation

Physicians need to review and understand all of the terms of any employment agreement they are considering entering into. The WSMA Legal Resource Center provides a checklist for physicians to use when reviewing an employment contract (see below). In most cases, however, physicians are advised to seek independent legal counsel to review their employment agreements. Even if the physician does not utilize an attorney for actual negotiation of an employment contract, an attorney can provide insight into the terms of the contract, and can provide suggestions for alternate language the physician can use, if needed, when discussing the contract with his/her potential employer. The WSMA can also provide members with referrals to a number of other attorneys experienced in employment matters. For further information please contact Denny Maher, JD, MD, director of legal affairs at (206) 956-3640, toll-free at (800) 552-0612 or dpm@wsma.org

Frequently Asked Questions: Non-compete clauses
Employment contracts frequently include non-compete and non-solicitation clauses. While a physician seeking employment will want to avoid signing an unduly restrictive provision, a physician employing other people will want to protect legitimate business interests and the good will of the practice. This concise WSMA FAQ will explain when these clauses are legal and what to consider when you evaluate them.

Contracts and physicians: The good, the bad & the things to never ignore 
Non-compete clauses are frequently part of employment contracts in Washington state. This WSMA Reports (Jan. 2015) article explains important considerations for any physician considering an employment contract, with a particular focus on non-compete clauses.

Red flags in physician employment contracting 
Physicians need to be prepared when they negotiate with an employer regarding a job. In particular, physicians must be able, and willing, to identify potential “red flags” during negotiations that might provide insight into the future employment relationship. Read the WSMA’s helpful explanation of the red flags you should be aware of anytime you consider signing an employment contract.

Employment contract checklist
A checklist of terms and conditions that are commonly found in employment contracts so that all parties know what terms need to be clarified and agreed to before the agreement is executed. WSMA does not advocate how provisions ought to be written nor espouse a policy position on employment issues.

AMA annotated model physician-hospital employment contract
The American Medical Association has published a valuable resource for physicians who wish to evaluate an employment contract with a hospital. This publication provides a wealth of background information regarding issues which physicians need to consider before even reviewing a proposed hospital employment contract. The document then walks through the terms included in a typical hospital employment contract and provides analysis of important sections and examples of sample language. This is a detailed and comprehensive look at what a physician may expect to see in a hospital employment agreement and should be a “must read” for those entering into employment with a hospital.

Additional contract resources

To assist physicians negotiating the terms of their employment contracts, the WSMA has compiled this list of other resources that offer additional guidance.