How does it work in the Practice?
What do you need to look for in a practice as it relates to managed care support?
You need to identify the resources that are dedicated to the total managed care process. Does the practice have a department that supports the majority of the managed care functions? Exhibit C describes a comprehensive managed care process within a practice.
Not all of the functions have to be organized in one dept. but they need to exist somewhere within the practice. It should be clear which departments are responsible for which functions. Most practices of any size (7 to 10 physicians) have a dedicated person for the contracting function. However, many times one can negotiate a great physician contract, but if there is no support for the other functions, the contract will fail.
Can I expect to treat managed care patients immediately after I join the practice?
This is a very important question. If you do not have a state license and if you are not credentialled by the healthplans, it may take from 3 to 12 months before you can begin to see certain managed care patients. Each market is different, but most MCOs require a physician to possess active hospital privileges prior to beginning the MCO credentialing process. You should request from the practice a credentialing timeline that outlines practice credentialing, state licensure, hospital credentailing and MCO credentialing. Exhibit D is an example of a credentialing timeline and process. Different practices and markets vary so the timeline may be shorter or longer, but the process should be generally the same.
In summary, it is essential that each of the departments which manage these functions have strong leadership with individuals who understand the managed care market and how these functions directly impact the total managed care process for the practice. All of the functions need to exist within the practice and there should be clear managerial accountability for each function.
About the Author:
Wesley D. Millican, MBA, CEO and Physician Talent Officer of CareerPhysician Advisors, LP, and CareerPhysician, LLC, provides comprehensive talent solutions for academic children’s hospitals, colleges of medicine and academic medical centers across the nation. He possesses a longstanding passion for career development of all young physicians and serves as a go to career resource for training program directors and their residents and fellows. In continuing his commitment to the “future of medicine”, Mr. Millican speaks nationally at residency and fellowship programs. His Launch Your Career® Series is a proven resource for today’s residents and fellows and has served as a go to resource for program directors over the last 15 years.