Membership and Participation Frequently Asked Questions

Q.  What will be the benefits to my practice if I join the CIN? 

A.  CIN membership includes a number of benefits including: 

  • access to commercial and other contracts not otherwise available; 
  • participation in a network of physicians that seeks to improve the health of its community in measurable terms by being part of the solution to spiraling healthcare costs; 
  • obtaining the tools to measure your practice’s patient care performance relative to your peers; 
  • rewarded with additional reimbursement for practices that achieve and demonstrate the value, not only the volume, of care provided 

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Q.  What are the participation requirements? 

A.  While the newly created physician-led CIN Board of Managers has the responsibility to establish specific criteria for participating members, the Board has not yet established specific criteria. However, at a minimum, participating members must satisfy certain standard credentialing requirements including, without limitation, NCQA requirements and standards, as is typical of existing managed care contracts. Participating members must also have a desire to clinically integrate his or her practice with Bethesda Health System hospitals and facilities and other providers participating in the CIN. This clinical integration is necessary to satisfy the ultimate goal and objective of the CIN, which is to provide outstanding medical care to our communities at the lowest possible cost. 

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Q.  What are the obligations expected of physicians who join the CIN?

A.  A contract will be required to participate in the CIN. The distinction between the CIN and existing payer contracting networks with which you may be familiar is two-fold. First, the CIN is physician led and governed. Not all participating providers will desire or be expected to serve on the Board of Managers or in various committees. However, the providers that do participate will be able to ensure the network operates in the best interests of all providers and patients. Second, as a clinically integrated network, providers will have access to patient information that will help improve the quality of a patient’s care across all specialties and facilities. In the future, all CIN physicians will be aligned by the same incentives around quality and costs. Over time, the benefits of referring to physicians with whom you are clinically integrated will be obvious and in the best interest of patient care. 

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Q.  Are there any entry fees or annual dues to join the CIN?

A.  Yes. There is an initial application fee of $500. Thereafter, CIN participants will be required to pay $250 annually. These fees will be utilized to support the infrastructure of the CIN including information technology. A key attribute of successful CINs is that participants have some financial contribution to the organization that they play a significant role in making successful. 

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Q.  What are the qualifications for entry into the CIN and to maintain CIN participation? 

A.  Qualifications to enter the CIN and maintain participation are: 

  • Board Certified, or become Board Certified within a specified time in practice, depending on your specialty and CIN credentialing criteria. The CIN Board will consider Board eligible (or equivalent) physicians on a case by case basis 
  • Meet the minimum credentialing requirements of the CIN 
  • Comply with CIN policy and procedures that will be forthcoming 
  • Maintain good standing including paid membership dues 

As the CIN matures, requirements to meet minimum performance on CIN endorsed quality and utilization metrics may be used in credentialing and membership decisions.

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Q.  Does the BHQA require hospital admitting privileges at a Bethesda facility?

A.  Bethesda Health Quality Alliance does not require that you have privileges at a Bethesda facility. 

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Q.  Do I have to join the CIN? 

A.  If you are a physician employed by Bethesda Health, you will become a member of the CIN. No one is required to join the CIN, and if you don’t join you can still continue with your privileges at Bethesda Health hospitals and with your individual relationships with payers. However, not being a member will limit your ability to improve the environment in which you’ll want to work; being a part of a network with common goals, and the impact you could have on improving health care in our community. 

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Q.  Can I be in another ACO or CIN and join BHQA? 

A.  It depends upon the payer program. In most cases, specialists can belong to more than one organization. In some cases, like the Medicare Shared Savings Program, physicians providing primary care services can belong to only one. BHQA plans to participate in, as well as construct, various CIN programs. If you participate in another program, we encourage you to discuss this with us. 

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Q.  Can I opt out of payer contracts? Will the CIN be a messenger model network or will providers be required to delegate contracting to the CIN?

A.  Shared savings contracts with elements of clinical integration necessitate a fully integrated network and as such will contract on behalf of all member providers. In addition to realizing the goals of clinical integration, this evolution will allow the CIN to react to contract opportunities much more quickly and efficiently. Typically, if you have a contract with a payer and you belong to the CIN, the CIN’s shared savings contract with the payer will apply to you. Shared savings contracts do not change the underlying fee for service contracts that you may have with a payer. You bill and collect as you usually would as regardless of your participation in the Bethesda Health Quality Alliance. 

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Q.  How do I join? 

A.  BHQA is accepting both Primary Care and Specialty physician members. Call us today for more information at 561-737-7733, ext. 84944.

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