Physician-led independent practice associations (IPAs) are supposed to be more physician-friendly than managed care organizations, at least in theory. But that may not be the case for IPAs in highly competitive markets. According to a recent study of 53 physician-led IPAs in California, IPAs there share many of the business practices of managed care organizations, even some of the most unpopular ones. In particular, the survey found that roughly half of the IPAs had terminated a physician contract in the previous year. Sixty-four percent cited concerns with quality of care as the reason for termination, 41 percent cited "conflicts over IPA policies" and 27 percent cited "excessively costly practice."

California IPAs' reasons for terminating physician contracts

Source: Grumbach K, Coffman J, Vranizan K, Blick N, O'Neil EH. Independent Practice Association Physician Groups in California. Health Affairs. 1998;17(3):227-237.