Frequently Asked Questions

General FAQs

Financial FAQs

Legal FAQs

Functional FAQs

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General FAQs

How can UPA help me improve patient care?

UPA is partnering with several companies to provide patient care improvement initiatives to our physician membership. Member physicians will have low cost access to these initiatives and will be able to utilize them according to their individual practice needs.

Is UPA limited to Arizona?

Presently UPA is limited to Arizona. However with time, UPA intends to expand throughout the country.

Why is this model better than previous models that have come along and ultimately disappointed?

  • UPA is a single group; and therefore has huge growth potential.
  • Unlike any other single group model, UPA works hard to provide a great degree of autonomy for its physician members.  UPA is inexpensive to join, and easy to leave. Prior practice structures do not have to be shut down.
  • UPA was created and is being coordinated by a single committed individual who is accountable and available (602 818 0128) to all UPA members; this structure allows for the highest possible degree of efficiency.
  • UPA has been designed as a multispecialty group to maximize our ability to gain strength in numbers, and because there are so many interests physicians of different specialties have in common.
  • UPA has been designed to allow for many different divisions and committees. Physicians within UPA may form divisions or committees based on any single specialty, issue or concern. Examples include your current group as a division, single specialty committees, single concern committees (like establishing a Physical Therapy Center or an MRI Facility.) The potential list is endless; limited only by physician member time and creativity. The UPA structure legally allows physician members to directly discuss all such topics, including associated business concerns.

What are the main driving forces behind the creation of UPA?

  • A belief that physicians acting in a transparent and cooperative environment can create positive changes (not only for physicians, but also for our patients and for society at large).
  • A prolonged analysis of the steps that are required to address the problems in the status quo and create a solution, resulting in the conviction that this is achievable.
  • A feeling that the status quo needs changes - See our Ideal Member Profile

Don't physicians already have a voice (e.g. medical associations)?

No. Practicing physicians have been effectively sidelined from moderate to large scale healthcare concerns because we are legally hindered from talking about mutual business concerns. Without being able to discuss business concerns, our present voice as a profession is impotent.

Is UPA trying to "squeeze out" other physicians in the local competitive marketplace?

No. UPA is designed in order to bring interested physicians together. UPA is inclusive; all qualified physicians of all specialties who wish to work cooperatively with fellow physicians are welcome. A fundamental guiding belief of UPA is that a significant part of our state and national healthcare problems stems from our profession's lack of representation. UPA seeks to become the medical profession's voice. Accordingly, UPA does not seek to become the strongest physician competitor within the physician marketplace; but rather, we seek to become a strong physician competitor within the healthcare marketplace. Hence, UPA has been designed to be inclusive and flexible, to allow its physicians to be highly autonomous, to join inexpensively, and to leave easily; all characteristics to generate strength in numbers.

What are the protections against having too much central power?

The principal's intent is to run UPA as a physician democracy, understanding that democracy is sometimes inefficient, and agility in a competitive market place is oftentimes advantageous. Substantial protections against central power exist within this structure: ease of exit for all members, low cost to join, relatively low cost to obtain an equity position, and the creation of a formal board of directors with quarterly meetings when UPA reaches 20 physicians. However, the greatest protection against central power is the principal's absolute awareness that if the principal is deficient in any significant way, or if UPA does not provide value to its members, physicians will either leave or not join UPA, and the principal's substantial investment and effort to date will have been wasted.

What is the upside of the UPA group model for me if I join?

By joining UPA, you will immediately gain access to UPA data on reimbursement rates, allowing you to see where you stand in the spectrum. The UPA rate negotiation service continues to gather new data, re-engage payors, and attempt to improve the rates that UPA members receive. As the UPA membership base grows, so does UPA's negotiating clout.

UPA members also enjoy the benefits of UPA's Patient Care Improvement Initiatives, and access to a forum where you can voice your concerns about physician issues affecting you today.

UPA delivers all these benefits while offering low personal cost, low personal risk, "relative" ease of entry, ease of exit, and the ability to retain substantial autonomy so that you may choose to practice how, where and with whom you want.

What is the down side of the UPA group model for me if I join?

It requires individual physicians to do something with which they are uncomfortable – that is, bill under a tax ID number that is not solely their own. This in turn results in some changes in the way they do business (i.e. - all members must use the same payroll service, provide the same benefit plan and retirement plan for all employees); so some will be hesitant to join. Some physicians contemplating joining will fear losing their unfettered autonomy in a single group.

Financial FAQs

Will I get better reimbursement rates as a UPA member?

UPA will provide a degree of strength in numbers which you will not be able to provide in your individual practice. UPA will be better able to negotiate with moderate to large scale healthcare companies (like insurance companies) as we develop greater strength with our growing membership base, and as we address reimbursement rate issues on a regular basis. UPA provides a legal mechanism by which practicing physicians can work together and discuss all concerns relevant to improving patient care, including business concerns. Every time a new UPA member joins, all UPA members gain access to additional data that helps us understand our current reimbursement rates better, and respond appropriately. While we cannot know with certainty how entities over which we have no control (like insurance companies) will respond to UPA, the power of the UPA single group model is that physicians can discuss all issues directly with one another and decide together how they wish to respond.

What if insurance companies decide to lower rates?

There are enough changes occurring within healthcare in this country now that no single entity can control all variables. We should all expect that at some point some insurance company will attempt to lower our rates. The challenge will be to determine what is the best position for us as individuals to be in at that point. UPA suggests that if physicians can stand together to deal with such occurrences, we will be best positioned to continue to care for our patients and our fellow citizens. UPA is endeavoring to provide such an environment in which physicians can stand together to best care for our fellow citizens.

Who will do my billing and collecting?

Billing is treated differently from collecting. Billing (and the process of working claims) may be performed by whomever you wish as long as the statutory requirement is fulfilled (i.e. after a transition period every physician member must conduct 75% of his/her medical practice through UPA, billing under the UPA tax ID number). When multiple physicians bill under a single tax ID number, insurance companies send all remitted funds to only a single location, an occurrence which seems intended to keep physicians separate and which poses some reconciliation challenges. In UPA’s case, collections from insurance companies go to a lock box at Wells Fargo Bank. That lock box is professionally reconciled by a division of UPA designed for this purpose.  This division is called United Physicians of Arizona Management Systems, LLC (UPAMS), and has been designed in association with Doctors Solutions, Inc. What differentiates UPA within the marketplace is that UPAMS has developed proprietary software which enables the accurate reconciliation of funds when multiple physicians under multiple different systems bill under the single tax ID number. For those physicians who wish to perform their own billing under the UPA tax ID number and work their own claims, the cost to distribute those funds appropriately is 0.5%. For those physicians who wish to have UPA coordinate full practice management services (through UPAMS or one of UPA’s contracted providers), the fee for those services would be specialty specific and would be no greater than either the fee you are currently paying, or 8% of collections, and that there would be no additional collections reconciliation fee. (For practice management companies interested in becoming UPA contracted providers, please Contact Us here.) UPA believes that when physicians can maintain control of their own billing, more physicians will join, and we all will generate greater strength in numbers. UPA is confident that these modest costs can be paid for by our enhanced ability to negotiate together. 

How will funds generated from my work flow through UPA - such that I get them?

Every physician member must bill under the UPA tax ID number. The funds which are generated from those services go to a single address, which in UPA's case is directly into an account at Wells Fargo Bank. A division of UPA, United Physicians of Arizona Management Services. LLC (UPAMS) has been developed in association with Doctors Solutions, Inc. to reconcile those funds and distribute them professionally - to the penny. There is a real cost to accurately reconcile all funds collected under the UPA tax ID number, for which UPAMS charges 0.5%. That cost may be offset if:

  1. Some physicians request full practice management services from UPAMS or a UPA contracted provider (in which case no additional collections reconciliation fee is charged),
  2. Your present practice management company chooses to become a UPA contracted provider (in which case no additional collections reconciliation fee is charged), or
  3. UPA - through its increasing strength in numbers - may achieve an increase in reimbursement rates greater than your practice can alone.

Once funds are reconciled, those funds are electronically transferred to a divisional Wells Fargo bank account which is set up for every division which joins UPA.  As President of UPAMS, Tess Kelso-Bans is individually responsible for the accurate reconciliation of all funds collected under the UPA tax ID number. [Recognizing the importance of this issue, the founder of UPA promises to be available to all physician members, and can be reached at any time by personal cell phone, (602) 818-0128.]  UPA is proud to refer prospective physicians to the appropriate individual for further review of specific processes involved in collections reconciliation (e.g. the specific handling of EOBs, 835s, 837s, electronic funds transfer account vs. lockbox concerns).  For such review, please Contact Us.

Who pays for the retirement plan, payroll service and our employees' benefits?

Each division is responsible for financing its own divisional costs. UPA already has a retirement plan, payroll service and an employee benefits plan in place; so there are no further charges to create such plans. The legal requirement is that all UPA members and employees use the same plan. As UPA grows, we intend to use our strength in numbers to obtain and maintain the best possible plans at the best possible cost for our members and their staff. The costs associated with these charges will be borne by each division directly – just as they now are. UPA will not mark up these costs or profit from them. Rather, they will simply be passed on. So although one could consider these a cost of joining UPA, these costs will offset costs that you are now paying internally.

How much can I put away each year toward my retirement?

Within the UPA retirement plan, there are three components – safe harbor, 401K, and profit sharing plan. In 2009, a total of roughly $45,000 per year per physician could be contributed to this plan. All funds which are billed through the UPA tax ID# can only be put towards the UPA retirement account. For more information, UPA will refer you to Patrick Funke of Nirvana, our plan's financial advisor.

Is UPA a for-profit company?

Yes.

How does UPA make its money?

UPA generates revenue for the umbrella organization only from administrative fees received as follows:

  • Physicians who enter the evaluation phase of membership sign the letter of intent and pay $1 per month for the first years' administrative fee of $12.
  • The administrative fee for physicians who enter the value phase of membership is $25 per month.  This fee reflects UPA’s cost of credentialing physicians on insurance contracts. This fee increases only if UPA demonstrates an increase in physician revenue (by improving physicians' reimbursement rates or decreasing overhead costs), and only after giving physicians 30 days' notice. If physician revenue increases, UPA retains less than half of the increase, up to a maximum of $500 per physician per month.
  • For those physicians who enter the equity phase of membership, the administrative fee is $500 per physician per month.

All other revenues are distributed to the appropriate division providing services (e.g. the physician doing his/her medical work).
All other fees are simply costs that must be run through UPA for statutory reasons but will offset costs which are already paid elsewhere (e.g. staff payroll).

Does everyone in our group have to join UPA, or can some doctors choose to join individually?

UPA has been designed to allow for the greatest autonomy for its physician members which is legally permissible. While UPA invites all qualified physicians to join, we recognize that different members of single groups will have different interests - so single members of any group may join UPA without the entire group being obligated to do so. However, there are statutory requirements which may vary from group to group for which each individual will need to meet with their own attorney to determine what is legally permissible within their own setting. From the UPA perspective, all qualified physicians who wish to work cooperatively with their fellow physicians are welcome. The LLC structure of UPA has been intentionally designed to allow for maximal flexibility in accommodating all interested physicians.

What are the legal documents I'll have to go through in order to join?

To enter Evaluation Phase -

  • Letter of Intent

To enter the Value member and Equity Phases –

  • The "4-in-1" agreement which consists of:
    • Employee agreement – to formalize legal arrangement between UPA and physician member
    • Division Operation Memorandum – to specify how each division works
    • Facilities Lease Agreement – to allow UPA to work in your space
    • Stark Memorandum of Understanding – to insure that all members comply with all relevant laws

To bill under the UPA tax ID#:

  • Board certification
  • Vicarious Liability Insurance
  • United Physicians of Arizona Management Services agreement

Thereafter, the Annual Compliance Certification

How can prospective physicians be sure that after joining UPA the company won't simply be sold out from under them?

The UPA Operating Agreement has been amended to:

  • assure the principal's 10 year commitment to UPA; and
  • provide the physician membership base with a Right of First Refusal with any sale.

The Operating Agreement addresses the rights of physician members, and is available for review by equity members.

Functional FAQs

What does it mean to submit 75% of our total claims through UPA?

When billing charges, the UPA tax ID# must be printed on the standard HCFA form for at least 75% of the total charges that every member physician submits. This is the statutory requirement to constitute a single group practice. While it is perfectly acceptable for 100% of one's claims to be submitted through the UPA tax ID#, the legal requirement is 75%. In order to attract the greatest number of physicians, UPA was designed to allow for the greatest autonomy for its physician members which is legally permissible; hence UPA's requirement is 75%.

What specifically will UPA do that warrants my hassle and expense to join?

See - Membership Benefits.

What does UPA "provide"?

Physician Advocacy Services via:

  • Data (acquisition, analysis, distribution) services
  • Contract and rate negotiation services
  • Patient Care Improvement Initiatives

Why does UPA “provide” Patient Care Improvement Initiatives?

Improving patient care is the right thing to do. Physicians working together in a single medical group recognize that patient welfare is a valuable part of the business of healthcare.  UPA is well aware of the benefits of providing a patient care improvement focus to its physician members and their patient base.

How much loss of autonomy is there?

The loss of physician autonomy in a single group model is not a legal requirement. UPA has been designed to attract the greatest number of physicians possible – so allowing the greatest autonomy which is legally permissible is a fundamental principal of UPA.

Only the statutory requirements are UPA requirements.

See - Membership Requirements.

How do I join UPA?

See – Take the Next Step

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