A Risky Transition
The practice's payer mix is roughly divided into thirds among Medicaid, Blue Cross, and a mix of other commercial payers. "We are fiercely independent, but not completely isolated," she says, explaining that the practice is part of a larger IPA affiliated with Boston Children's Hospital. The IPA negotiates payer contracts with the Blues plan and a couple of other commercial payers. Performance Pediatrics is incentivized financially to meet certain quality measures, such as regular wellness exams and flu shots. McAllister may see fewer patients than his peers in larger groups, but in turn, he has to do more work himself, such as taking his own vital signs and giving his own shots. DiDomenico handles all the billing. "My husband doesn't enjoy the business side of health care," she says. "His passion is primary care and keeping kids healthy. He loves it, but if he didn't have me in the back room pushing buttons, he would have to be employed by somebody."
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