Physician Group Rejects HMO, IPA Models

The Traditional Practice Alliance, a six-year-old, Sacramento-based physicians' organization, has rejected HMOs and IPAs in favor of a system that instead draws its business from fee-for-service and self-paying patients, American Medical News reports. Calling itself "the polar opposite of managed care," TPA consists of a "loose network" of 52 primary care physicians and specialists who "gradually" phased out their HMO contracts once they joined the group. Member physicians treat patients from Medicare, PPOs and point-of-service plans that allows members to see out-of-network members. The group also treats some uninsured patients, who "often" receive a discount. The group "prides itself on having no rules" -- no medical necessity determinations, no minimum or maximum number of patients to see per day and no physician profiles. Physicians pay a $300 yearly fee to belong to the group. Dr. Hillis Warren, head of TPA, attributes his group's ability to survive and grow in California's "highly penetrated" managed care market to physicians' "growing dissatisfaction with their once-vaunted managed care system." In addition, at least 25 IPAs statewide failed over the past year, leading to "frustration" among doctors formerly associated with the organizations. Warren said, "The independent practice association is really the opposite of independent. ... [Members] have to do pretty much what the IPAs and HMOs tell them to do." Despite TPA's current success, Warren said that the group has a "niche market" that can only support a limited number of doctors. But Warren's concept of "a loose federation of physicians who work outside HMOs" has spread across the state, and chapters exist in San Diego, Orange County and the East Bay area (Page, American Medical News, 1/15 issue).