It's best to carve those services out of the contract. But there can be problems with other services that primary care practices refer to specialists. But in the capitation world, consulting rheumatology means giving the family physician an opinion on how to handle her, not taking over the patient. Generally, if you can do the service, it's best to keep the premium for it. Know how the plan is faring.
Many plans have cash flow problems.
Most independent practice associations are operating in a pre-bankruptcy state most of the time, for example. Payments may slow down, be reduced or stop altogether. But your contract obligation to provide care for the patients will not end. So it's a good idea to know the organization with which you are, in effect, going into business. Find out what you can about a plan's financial stability from colleagues who have dealt with the plan before.