Frequently Asked Questions
Does Pediatric Partners have an alliance with an ACO (Accountable Care Organization)?
Yes. Pediatric Partners is striving to become the pediatric solution to adult ACOs by providing exceptional pediatric quality care to health plans or health care purchasers. These partnerships are carried out through network agreements with the Children’s Health Pediatric Alliance, a physician-led ACO and one of the first of its kind in the nation. Pediatric Alliance positions member practices to be leaders in the new health care environment.
What is the relationship between Pediatric Partners and Children’s Health?
Pediatric Partners is a Texas non-profit corporation, and is part of the Children’s Health System of Texas.
What does Children’s Health have to gain by helping establish Pediatric Partners?
Children’s Health has evolved from a standalone hospital to an integrated health care system, leading an effort to positively transform the health care for children in the Dallas area and beyond. Children’s Health has identified the importance of an integrated provider network and understands that, if it is successful, there will be fewer unnecessary visits to the Emergency Department, fewer avoidable inpatient admissions and the acuity level of patients in the hospital will increase. This is part of Children’s Health initiative to create a system where the right care is provided by the right provider at the right place. Children’s Health believes this approach is the right approach for our children and their families. Children’s Health is at a critical juncture in its more than 100-year history – whether to progressively change and support health care transformation or to resist change and continue business as usual. Business as usual is not an option for Children’s Health, and the effort to partner and collaborate with community providers will create a win for all parties, including community physicians, the patient/family and Children’s Health.
How much is the monthly membership fee?
Per the Physician Participation Agreement, the current administrative fee (“Participation Fee”) is $125 for Primary Care Physician and $100 for Specialist Physician. The monthly membership fee is due the first business day of each month. The fee pays for the provider’s access to the network’s benefits, including use of the nurse advice line, patient satisfaction surveys, and more.
How do I join Pediatric Partners?
Reach out to us at email@example.com. A Pediatric Partners representative will be happy to answer your questions about provider membership.
Is Pediatric Partners an IPA (Independent Practice Association) or a CIN (Clinically Integrated Network)?
Pediatric Partners is a clinically integrated network of over 300 physicians. It is by definition, a network of independent physicians that is self-governed, and dedicated to providing coordinated care that is safe, timely, effective, efficient and patient-focused. Pediatric Partners’ members will be held accountable to clinical metrics and best practice standards set by the group. Pediatric Partners focuses on care coordination and quality. An IPA is simply a group of physicians who come together to contract with managed care plans and other payers.
Receipt and Use of PHI by Pediatric Partners
Children’s Health Pediatric Partners (“Pediatric Partners”) is a nonprofit affiliate of Children’s Health System of North Texas that provides clinical integration and data analytics services for certain physicians who sign Physician Participation Agreements with Pediatric Partners. In connection with the provision of those services, Pediatric Partners will be receiving protected health information (“PHI”) as defined in the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated there under (collectively, “HIPAA”). Therefore, the Physician Participation Agreements all contain a HIPAA-compliant business associate agreement (“BAA”) that recognizes Pediatric Partners’ status as a business associate of the practices and requires Pediatric Partners to appropriately protect the PHI.
What if I don’t want to be in Pediatric Partners anymore? Can I leave?
Yes. If a physician decides to leave the network, he or she simply must provide 90 days’ written notice.
What if I have a better contract through another IPA in the area? Do I have to join a contract through Pediatric Partners?
No. Pediatric Partners does not require that each physician participates in a contract. Pediatric Partners is a “nonexclusive” network in which members can “opt in” or “opt out” of network contracts. It is expected that Pediatric Partners physicians may decide to participate in more than one network. However, we aim to demonstrate great value to our members.
Will I be required to change my EMR system to EPIC if I join the network? What if I don’t have an EMR; will I be required to get one?
No, you will not be required to transition to Epic if you join the network, or be forced to purchase a particular EMR system once you’ve joined. It is beneficial and highly recommended for current members to use an EMR. In May 2015, the board of directors of Pediatric Partners resolved that all new members are required to use an EMR platform. The decision was based on the desire to ensure that we created the best opportunity to evidence standards of clinical integration.