Case Study Aetna Contract

I have completed a preliminary review of the Aetna contract as requested. I have four areas of concern I would like to briefly discuss. I believe all warrant further scrutiny.

Under the participating provider staff privilege clause, Orlberg would be required to offer privileges to qualified providers from outside the current medical staff. These providers may be from near-by hospitals and direct competitors to Orlberg’s current medical staff. In addition, this potentially could lead to a conflict with Orlberg’s current exclusive provider arrangements.

I am concerned that in section 2.10.4 that payment for an admission ends when Aetna determines the day of discharge. This may conflict with physician judgment and lead to uncompensated