title: How can vascular surgery survive capitated care?
abstract: The basic differences between fee-for-service and capitated care are characterized and how they are likely to impact the practicing vascular surgeon are explored. Likely practice scenarios under capitated care are given. If the potential problems associated with using primary care "gate keeper" physicians materialize, secondary "carveouts" by vascular specialists may prove feasible. The alternative, particularly in large patient care consortiums, is to educate gatekeepers with efficient management algorythms in exchange for appropriate referrals. In spite of demonstrable flaws and abuses, capitated, managed care is likely to persist in some form, as an effective way to control spiraling health care costs. Therefore, vascular surgeons need to be prepared to compete under such systems. The major keys to success are efficient use of diagnostic tests, applying conservative, cost conscious indications for intervention, and efficient use of hospital resources (judged by lengths of stay in the intensive care unit and hospital and readmissions under the same diagnosis). In addition to developing better practice profiles, in these and standard mortality and morbity parameters, vascular surgeons need to create or join an efficient practice environment, with a minimum number of efficient personnel and teaching and research costs tightly controlled. To negotiate contracts effectively, vascular surgeons must know their costs, of delivering care on a per capita basis in their environment, adjusted for specific (eg, working or retired) patient populations. Outcomes and cost comparisons and other management research must vie for attention with new technology and basic research.
authors.affiliation: University of Colorado School of Medicine 80498, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Rutherford
mesh_terms: D002204:Capitation Fee; D003363:Cost Control; D017048:Health Care Costs; D006801:Humans; D008329:Managed Care Programs / Q000191:economics* / Q000639:trends; D016345:Medicare Part B / Q000191:economics; D012017:Referral and Consultation; D014481:United States; D014652:Vascular Diseases / Q000191:economics / Q000628:therapy; D014656:Vascular Surgical Procedures / Q000191:economics* / Q000639:trends