The 'Fulcrum for Quality'. The physics of provider reform: six key variables to achieve 'MEDQIC'.
As health care providers move from a fee-for-service, revenue-driven system to total capitation, the need to focus on achieving the most efficient delivery of quality integrated care will be paramount to survival. The energy to survive a totally capitated reimbursement system will depend on the degree that a provider is able to evolve from a revenue-driven to a quality-driven organizational culture. This evolution is going to be very difficult for many health care providers who are committed to a managing money mentality rather than a managing quality mentality to achieve the "bottom line" and regard human resources as expendable and quality as unmeasureable rhetoric. The "Fulcrum for Quality" demonstrates how six key variables change when moving from a fee-for-service to a capitated reimbursement system: reimbursement methodology, utilization, operational expenses, information systems, management and communication. In a fee-for-service system, providers experience minimal restrictions on the revenue limits they could achieve. Consequently, inefficiencies and poor quality had little to do with a provider's ability to increase profits. Under a totally capitated system that limits revenue, providers will experience that quality and efficiencies directly affect profits. The "Fulcrum for Quality" discusses the transformation of the six key variables and the changes a medical practice manager will need to make in order to achieve the most efficient delivery of quality integrated care.
King
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RD
Medi-Call of St. Louis Inc., Kirkwood, MO, USA.
D002204:Capitation Fee; D003142:Communication; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D017598:Efficiency, Organizational; D018588:Fee-for-Service Plans; D017048:Health Care Costs; D007256:Information Systems / Q000706:statistics & numerical data; D015279:Organizational Culture; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012051:Reimbursement Mechanisms; D014481:United States; D014600:Utilization Review