The risks of joining a super group

June 10, 2012

Joining a super group has its perks, but it's not all smooth sailing. Learn about the potential problems you could face if you decide to leave it.

Key Points

Super groups are in vogue as physicians do their best to reduce costs and enhance revenues. A super group essentially is a collection of previously separate competitors who have joined a single legal entity to achieve certain advantages.

Another plus? Gaining leverage in managed-care contracting. Twenty groups of five physicians each cannot contract with a payer with "one voice" due to antitrust restrictions, but a single group of 100 doctors can.

THINK ABOUT THE RISKS

Physicians join super groups with promise and hope. Clearly, they are a good idea, especially if the doctors have solid operations. That said, physicians who rush to form them rarely consider the risks associated with departing the group. But they should.

When you join a super group, you stop billing through your old practice and partnership agreement, and start billing through a new group that is a limited liability company (LLC). The LLC has tax ID and Medicare group numbers and enters into lots of managed-care payer agreements.

PARTING POSES PROBLEMS

So what's the risk? When you leave a super group, you must confront some difficult facts.

It will take months to get a new Medicare provider number. If you haven't billed through your old entity for a while, that number is gone. Until you obtain a new number, revenues associated with Medicare patients are lost.

It can take as long as 6 months, sometimes longer, to get on insurance plans, which means you will be considered "out of network." This situation exposes your patients to higher costs and may affect referral patterns. This issue alone can be crippling to anyone who leaves a super group.

Leaving also can mean you no longer have access to electronic health records and patient scheduling and billing. The inability to obtain information that would enable you to get back on your feet can be devastating.

In addition, noncompete clauses can play a role in how you get back in business. You may believe that going solo is not as good as being part of a larger practice. But what if the super group imposes a restriction that prevents you from being part of another group? Such a restriction is common and often harmful because a doctor's only option may be to join another group.