Exiting an IPA: A Neurosurgeon’s Journey to Independence

Provider Situation

Dr. Christopher, a highly respected neurosurgeon with over 20 years of experience, had been a member of the Washington Neurosurgical Associates (WNA) – a dominant Independent Physician Association (IPA) in the region. Despite his excellent reputation and consistently high patient satisfaction ratings, he felt constrained by the IPA’s policies and reimbursement structures.

WNA held a significant market share, with contracts spanning multiple major insurance networks. While this provided broad patient access, it also meant that individual providers had limited autonomy in negotiating their own contracts or setting their own terms.

Furthermore, as a large IPA, WNA’s reimbursement rates were often lower than what an independent practitioner could potentially command, especially for a highly skilled specialist like Dr. Christopher. This disparity in compensation was a growing source of frustration.

Seeking greater control over his practice and the ability to negotiate more favorable reimbursement rates, the doctor made the decision to leave WNA and establish his own independent practice. However, he recognized that exiting such a prominent IPA would not be a simple task, and he would need guidance to navigate the complexities of the process.

*Names changed for privacy reasons

The Challenge

While seeking greater autonomy and better reimbursement rates, Dr. Christopher faced obstacles common to many providers looking to leave an IPA:

• The IPA held a significant market share, making it difficult to establish direct contracts with insurance companies.
• Some networks were “closed,” requiring creative solutions to gain entry
• Initial contract rates offered were often lower than those provided by the IPA