Editorial: vision and eye care carve-outs under managed care: what's in it for primary care physicians and their patients?
Tighter budgets mean that fewer health care dollars are available for the primary care physician (PCP) to manage. At the same time, specialists are clamoring for patients whose referral visits are financed from risk pools most likely the responsibility of the PCP. The physician case manager is caught between the pressures of patient and specialist. In fact, some specialists are now advocating carve-outs, which is the removal of certain services--and PCP funding management--from the general medical services capitation paid to the PCP that are directed to a separately contracted group or network. Do carve-outs make sense for patient care, for economics, and for the PCP? We maintain that for comprehensive and integrated vision and eye care services under the management and leadership of ophthalmologist-physicians, carve-outs makes clear and compelling sense. It is one carve-out within managed care where significant savings can be realized without sacrificing quality or patient satisfaction and without compromising the PCP. PCPs and ophthalmologists can work cooperatively to address their own needs and desires while not losing sight of their shared primary objective--giving their patients the best care.
Durfee
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Weber
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D002204:Capitation Fee; D005139:Eyeglasses / Q000191:economics*; D018588:Fee-for-Service Plans; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration*; D009885:Ophthalmology / Q000191:economics*; D010361:Patients; D010821:Physicians, Family; D014481:United States; D014787:Vision Tests / Q000191:economics*