Slicing the pie.
Case rate contracts take the onus of dividing payment from the insurer and places it on the provider. There are a number of methods which can be used to respond to this challenge. One method which has a number of significant advantages is the floating conversion factor reimbursement method. It is based on a very simple concept, is transparent and delivers the market reality of the plan performance directly to participating physicians, without any convoluted calculations or cushions in between. A withhold can be added to this method, though it is unnecessary. A profit/loss sharing plan with the hospital can be helpful in completing the alignment of incentives.
Standish
J D
JD
Cardiovascular Division, University of Virginia, Charlottesville 22908, USA.
D019090:Case Management / Q000191:economics*; D003284:Contract Services / Q000191:economics*; D018588:Fee-for-Service Plans; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D012052:Reimbursement, Incentive; D014481:United States