Contracting for professional service agreements.

A review of several professional service agreements (PSA) of managed care organizations which contract with gynecologic oncologists in the Southern California area demonstrates several distinct patterns of practice restrictions and financial benefits which can help guide the physician who is considering signing such an agreement. These contracts must be evaluated in a manner similar to any business transaction as they are legally binding and can enhance or adversely impact one's clinical practice. Their advantages include increased numbers of referrals resulting in higher practice income; however, their disadvantages include practice restrictions which can adversely impact office overhead, practice efficiency, and the ability to deliver quality medical care. General guidelines to physicians evaluating a PSA include (1) avoiding "hold harmless" clauses, (2) avoiding contracts which tie enrollment in one plan to others, (3) the need to enter any verbal agreements by managed care administrators into the contract language, and (4) avoidance of actions which might be construed as being in violation of antitrust activities. Furthermore, physicians must avoid contracts which will result in the uncontrolled growth of a practice beyond its capabilities for expansion.