IPA Part 3: Messenger Model

Dr. Wolfe is the Chairman of the Board for EyeAssure, an Optometric Independent Physician Association and a wholly owned subsidiary of the Nebraska Optometric Association.

Before we get started on this weeks post, if you have not read Parts 1 and 2 on IPAs, you can find them here:

 

We left off last week with the following thoughts:

Clinical Integration Advantage:

  • The ability to negotiate fees on behalf of the IPA members.

Clinical Integration Challenges:

  • Developing and funding effective programs that will control the cost of care and increase the quality of that care.

  • Mitigating the risk if quality measures do not reduce the overall cost of care.

 

This week I will describe a Messenger Model IPA (MM-IPA) and what this entity is legally allowed to do and also what they are required to do.

In the eyes of most providers, the immediate disadvantage of a MM-IPA is that they cannot explicitly negotiate fees of a contract with a payer.

The reason that fees can not be negotiated explicitly under a messenger model is discussed in Part 2 of this series but it has mainly to do with anti-trust laws.

However, all other aspects of a contract (except for fees) can be negotiated by a MM-IPA. These provisions could include (non-exhaustive list):

  • Reimbursement method

  • As an example if a payer was reimbursing the provider via paper check 1 time per month, the IPA could negotiate that a weekly electronic funds transfer be used to transfer payment directly to the provider. This may be an advantage to the provider since the accounts receivable could be reduced.

  • Covered Services

  • If there were certain services that were not being reimbursed by a payer (IE. topography, anterior segment photography, pachymetry, etc) this could be a provision that the MM-IPA could negotiate on behalf of their members.

  • Discounts on Non-covered services

  • If a payer requires a specific discount on services that are not covered by the payer, the MM-IPA could negotiate this provision to be lowered or eliminated.

  • Choice of laboratory

  • If a payer requires a specific spectacle or contact lens laboratory to be utilized by a provider, this can be a provision that is negotiated by the MM-IPA

  • Copay

  • If the MM-IPA can show that primary care services are more cost effective when they are provided to patients by an optometrist rather than an ophthalmologist the MM-IPA can utilize that data to negotiate to have the patient copay to the see the OD member of the MM-IPA be less than to see an OMD.

 

The bottom line:

The disadvantage of a Messenger Model IPA is the inability to explicitly negotiate fees on behalf of their members. The main advantage is that there are many other provisions that can be negotiated that can be an advantage to the member doctors who may be happy with current fee levels but would like other enhancements to contracts which make business easier or make it more attractive for patients to seek out optometrists for their primary eye care needs.

I hope this series was helpful in showing you the different ways that IPAs can benefit both payers and physicians.

Have a great week - Chris