Illinois State Medical Society

For Physicians

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Member Benefits

Continuing Medical Education

Credentialing

Licensure

HIPAA

Medical Legal Library

Hassle Factor Log

Organization Resource Guide

Hassle Factor Program

ISMS agrees to be your business associate for this matter. View the ISMS business associate agreement.

Name:
Address:
City:
State:
Zip:
Phone:
Fax:
E-mail:
Is this your residence or office information:	Residence Office
Name of Group:
Primary Hospital Affiliation:

Survey Questions

1) How do the current states of Medicare and Medicaid reimbursement rates affect your practice: (check all that apply)

No new Medicare patients
Reduce number of Medicare patients
No new Medicaid patients
Reduce number of Medicaid patients
No change

2) The medical liability crisis is having far reaching effects on the provision of health care in Illinois. How has the crisis affected your practice? (check all that apply)

Reduce or eliminate high-risk services
Relocate practice to community with lower premiums
Consider early retirement
Change practice: join group practice, become an employed physician, etc.
Change career fields
No change

3) How do current private sector payments affect your practice: (check all that apply)

Withdrawing from network (HMO, PPO, etc.)
Renegotiating contract with managed care entity
No change

4) To what extent are the following issues having an impact upon your practice?

	No Impact	Some Impact	Major Impact
Federal reimbursement
State reimbursement
Private sector reimbursement
Managed care contract concerns
Operating overhead (office administration, payroll, health insurance, rent, etc.)
Medical liability insurance

ISMS
20 North Michigan Avenue, Suite 700
Chicago, IL 60602
Fax: (312) 782-2023

It's as easy as that! Questions? Contact us at info@isms.org or toll-free at 800.782.4767.