An IPA (Independent Physician Association) represents independent physicians who want to avoid the politics and noise of more extensive health care facilities but want to provide personalized care for their patients with access to the best resources to improve the quality of care.
Independent physician associations, also known as independent practitioner associations, are created by groups of doctors that join together to contract with Health Maintenance Organizations (HMOs), Accountable Care Organizations (ACOs), and Management Care Organizations (MCOs).
Medical practices that want to give quality care but need additional resources and experience to be at the forefront of value-based care are attracted to an IPA. IPAs allow providers to participate in risk contracts even if they lack administrative resources to do so.
It can involve collaboration among primary care physicians, other specialties, or both. They can also cover a defined local area (most common) or several geographical regions. An IPA may also organize as a Clinically Integrated Network (CIN) to improve patient care, decrease healthcare costs, and adapt to the value-based market.
HMOs or other managed care plans contract with IPAs, and those IPAs in turn contract with independent healthcare providers to provide members with care at a discount or a uniform fee.
In its traditional form, an IPA includes all specialties. Still, an IPA can be exclusively for primary care, could consist of one type of service, or could involve a group of providers of other benefits as well, such as food banks, homeless shelters, and substance abuse treatment centers.
Since IPAs are self-supporting entities and are not involved with large medical corporations, physicians have full authority to their own offices and practices.
The practitioner can tend to patients inside or outside an affiliated health maintenance organization (HMO). Healthcare providers receive compensation based on a per-patient fee schedule or discounted fee schedule. Therefore, regardless of how many times their patients go in, they still get paid.
The IPA and HMO contract defines the responsibilities of the IPA as it pertains to complying with government and industry regulations and allowing patients to access physicians. Each physician has a similar agreement with the IPA. In the absence of these contracts, IPA physicians will not receive payment for services provided to HMO patients.
IPAs are not allowed to negotiate with insurance companies on behalf of providers' other insurance reimbursements under the Federal Trade Commission Act despite a perception that they have established to improve compensation rates. IPA can only negotiate for members for services contracted on a capitation basis.
The following are some benefits possible from properly functioning IPAs:
As well as IPA benefits, there are potential drawbacks. Being a member of an IPA will not remove a care provider from their duties as an administrator within a medical practice.
Some IPAs may also not be run efficiently due to rapid growth, low levels of management experience, or rapid changes in technology.
Additionally, IPAs can encounter antitrust concerns since they represent competing healthcare providers.
Practitioners considering establishing or participating in an IPA should study the following principles:
Although IPAs can help manage costs and improve care, they are not a panacea for the medical system. As they have advantages, so do they have disadvantages.