The Reporter: June 1997, Vol.8, No.3
EXTRA! A Special Supplement to the Health Sciences Reporter
Your Questions Answered

Governing Boards Columbia-Cornell Care has established its governing boards. An operating board and two policy boards are made up of representatives from Columbia and Cornell with equal representation from both schools as well as members from each school's local community physicians organization. Columbia's members are: Operating Board for Columbia-Cornell Care, L.L.C. and MSO Inc. Faculty physicians John Driscoll, MD, Richard Levine, MD, Henry Lodge, MD, Eric Rose, MD, Peter Schiff, PhD/MD, Joseph Tenenbaum, MD CEO of Columbia Physician Organization (CPPN) Myron Weisfeldt, MD CMO of Columbia-Cornell Care, L.L.C. James Lieberman, MD CMO of Columbia Physician Organization (CPPN) Seth Feltheimer, MD (acting) Dean of P&S Herbert Pardes, MD Vice dean Thomas Morris, MD Co-CEO of Columbia-Cornell Care, L.L.C. Myron Weisfeldt, MD (acting) Administrative representative Kathleen O'Donnell COO of CPPN (non-voting member) Michele Burr Policy Board Members for Columbia-Cornell Care, L.L.C. Two Columbia-affiliated physicians Michael Wechsler, MD, James Reiffel, MD One department chair Eric Rose, MD CEO of local physician organization (CPPN) Myron Weisfeldt, MD Co-CEO of CCC Myron Weisfeldt, MD (acting) Dean of P&S Herbert Pardes, MD President of Columbia or designee George Rupp, PhD Three trustees Stephen Friedman, Henry L. King, Clyde Wu, MD Policy Board Members for Columbia-Cornell Care MSO Inc. Two Columbia-affiliated physicians Welton Gersony, MD, Jeffrey Newhouse, MD One department chair Michael Shelanski, MD/PhD CEO of local physician organization (CPPN) Myron Weisfeldt, MD Co-CEO of CCC Myron Weisfeldt, MD (acting) Dean of P&S Herbert Pardes, MD President of Columbia or designee George Rupp, PhD Three trustees David J. Stern, Alfred Lerner, Marylin B. Levitt, DSW

Q: How do I join Columbia-Cornell Care?
A: To join CCC, a Columbia faculty physician must be a member of the Columbia Presbyterian Physician Network (CPPN). All members of CPPN will receive a CCC participating faculty physician agreement. Each CPPN physician member will be asked to select one or more participation categories, complete the agreement, and return it to CPPN.

Q: What is the term?
A: The term is one year, with automatic annual renewal. The agreement may be terminated at any time, in accordance with CCC policies, upon 90 days written notice, contingent upon fulfillment of patient care obligations under existing contracts including medically appropriate transfer of care of enrolled patients for contracted plans.

Q: What are the different categories of participation?
A: Participants can sign up for one or more of the following categories: (A) information, education, and marketing services only; (B) managed care contracts over 170 percent of Medicare rates; (C) managed care contracts between 135 percent and 170 percent of Medicare rates; (D) managed care contracts between 100 percent and 135 percent of Medicare rates; (E) managed care contracts between 80 percent and 100 percent of Medicare rates; (F) risk arrangements. All participating physicians will have the opportunity to change their participation category periodically in accordance with CCC policies to be developed by the Operating Board.

Q: Do I have to participate in all the contracts offered within my category of participation?
A: Participating physicians will have the ability to opt out of participating in individual contracts within their categories of participation by giving written notice to CCC as outlined in the participating faculty physician agreement.

Q: What does it mean to physicians to "Appoint CCC as their exclusive contracting agent"?
A: Physicians in all categories except "A" (information, education, and marketing) shall agree that CCC is their exclusive contracting agent in accordance with right of first opportunity and other policies developed by the Operating Board. When a physician signs the CCC agreement, the physician agrees that CCC will be the physician's exclusive negotiating agent with managed care payors. CCC will notify physicians within 30 days of receiving notice of a potential contract whether or not it will pursue the opportunity. The spirit of this agreement is that in order to provide CCC with as much negotiating leverage as possible with payors, CCC needs the ability to negotiate for a short term (120 days) exclusively. After that 120-day period, CCC will no longer be exclusive and the physician will be free to pursue a given opportunity independently. Appointment of CCC as the physician's exclusive contracting agent refers to new contracts as well as renewed, extended, or amended existing contracts.

Q: If I join CCC, can I join other organizations that do managed care contracting?

A: The Operating Board will develop a process for case-by-case review of exceptions to the general policy of exclusivity. It is recognized that some physicians provide services in communities where they may need to work with other organizations. Every attempt will be made to accommodate those relationships.

Q: Will I be guaranteed that I will be given the opportunity to participate with every payor that CCC contracts with?
A: CCC cannot guarantee that every payor will agree to contract with every physician. During contract negotiations, however, CCC will request that the payor accept all physicians in the given category that the plan's fee schedule falls into. CCC's negotiating strength increases the likelihood that physicians will have access to most, if not all, contracts within the category in which they wish to participate; but CCC cannot promise that the payors will make exceptions to their credentialing requirements. In those situations where not all physicians are included in a particular contract, and CCC (rather than the payor) must determine which physicians will be included, then CCC will work with CPPN and the Cornell Physician Organization to develop criteria and equitable methods for establishing panels for risk contracts. Panel sizing will be done locally.

Q: Will I have to pay dues to CCC?
A: No. CPPN dues will cover participation in CCC. To be a Columbia member of CCC, however, you must be a member of CPPN.

Q: If I join CCC, how will I be paid for managed care services?
A: You will be reimbursed for services as you currently are paid, either on a fee-for-service or capitated basis, depending upon the contract. The only difference is with regard to surplus sharing in risk contracting. In these instances, the local physician organizations will distribute these funds in accordance with their own procedures.

Q: Will CCC tax revenues or levy any administrative assessments?
A: No. CCC will not charge any assessments but CPPN intends to dedicate a small percentage of revenues generated by Columbia physicians in risk-based arrangements to support the administrative costs associated with managing those risk arrangements. Initially, this is projected at 3 percent beginning in year three, well below typical market charges for such services.

Q: What are risk-based arrangements?
A: Risk-based arrangements are those in which the physician has agreed to share financial risk. Examples include capitation, percentage of premium, fee-for-service to budget, specialty carveouts, or global case rate agreements. To participate in any and all of such contracts, a physician must sign up for membership in category "F." Physicians who participate in risk contracts may also be required by the payor to participate in its other lines of business.

Q: How will the surpluses (or deficits) from risk-based arrangements be distributed?
A: CPPN will establish the criteria and equitable policies for distributing surpluses or handling deficits generated by Columbia physicians participating in risk contracts. It is CPPN's goal to maximize the return of surplus dollars to the participating physicians.

Q: If I participate in risk-based arrangements, will I have any personal financial liability?
A: CCC will purchase stop-loss insurance, establish withhold reserves, and take other measures to provide the maximum protection possible for CCC and the local physician organizations from the financial risks associated with adverse selection or excess utilization of health care services. It will be CCC's Operating Board and management's responsibility to monitor closely performance on risk contracts on a timely basis. In the event that expenses exceed revenues under a given risk arrangement, the participating physicians would run the risk of receiving reduced payments for their services.
Q: Is CCC designed to promote conversion of fee-for-service medicine to managed care and risk contracts?
A: CCC is designed not only to ensure managed care readiness as penetration increases in New York, but also to support all types of faculty practice. It will provide the capability to manage risk contracts when and if that becomes a market imperative or as it becomes clear that physician reimbursement and decision making can be enhanced if the physicians manage and allocate the health care premium dollar in lieu of insurance companies or HMOs.

Q: If I join category "A" (information, education, and marketing services only), will I have access to CCC's clinical information systems? Will I be charged separately for these services?
A: There will be no additional charges for the first several years. As the clinical information systems (including electronic medical record capability, clinical pathways and protocols) are fully implemented, there will be no separate charge for full-time faculty. Depending upon the cost of maintaining those systems, part-time faculty may be asked to pay a fee for their use.

Q: If I join CCC will I be required to use its information systems?
A: To ensure effective and efficient management of risk arrangements, participants in category "F" will be required to use CCC clinical and business systems or to interface their existing systems with CCC systems at their expense. All participants in risk contracts must provide and have access to consistent data with regard to clinical pathways and protocols, referrals, utilization of services, clinical information, and claims data.

Q: If I elect not to join CCC at this time, will I be able to join in the future?
A: It is difficult to predict when and if panels will close as the market will dictate our ability to keep CCC membership open for all interested physicians. The CCC Operating Board will be responsible for determining the timing and the policies and procedures related to future participation.

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