Physician reimbursement in Medicare risk contracting.
The Medicare population remains largely unmanaged despite its increasing cost burden. With a few notable exceptions, health maintenance organizations (HMOs) have historically avoided serving this expensive segment. In many cases, the inability to control costs results from failing to understand the importance of specialist reimbursement mechanisms. This article examines the importance of these mechanisms and describes how to successfully capitate specialty physicians in a Medicare risk program. The article also includes a case study on a successful capitation agreement between an HMO and a specialty group.
Levine Healthcare Group, Nederland, CO.
R H
RH
Levine
J A
JA
Wilson
D000368:Aged; D002204:Capitation Fee; D003284:Contract Services / Q000191:economics; D004470:Economics, Medical; D006279:Health Maintenance Organizations / Q000191:economics*; D006801:Humans; D016345:Medicare Part B / Q000191:economics / Q000458:organization & administration*; D009516:New Mexico; D011907:Rate Setting and Review; D012051:Reimbursement Mechanisms / Q000191:economics; D013038:Specialization; D014481:United States