Berman M L
Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange 92613, USA.
Gynecol Oncol. 1995 Aug;58(2):159-64. doi: 10.1006/gyno.1995.1204.
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.
对南加州地区与妇科肿瘤学家签约的几家管理式医疗组织的专业服务协议（PSA）进行审查后发现，存在几种不同的执业限制和经济利益模式，这有助于指导考虑签署此类协议的医生。这些合同必须以类似于任何商业交易的方式进行评估，因为它们具有法律约束力，可能会增强或对临床实践产生不利影响。其优点包括转诊数量增加，从而提高执业收入；然而，其缺点包括执业限制，这可能会对办公费用、执业效率以及提供优质医疗服务的能力产生不利影响。评估PSA的医生的一般指导原则包括：（1）避免“免责”条款；（2）避免将加入一个计划与其他计划挂钩的合同；（3）需要将管理式医疗管理人员的任何口头协议纳入合同语言；（4）避免可能被视为违反反垄断活动的行为。此外，医生必须避免签订会导致执业规模无节制增长、超出其扩张能力的合同。
