Characteristics of eye care practices with managed care contracts.
OBJECTIVE
To describe the variation in practice structure, financial arrangements, and utilization and quality management systems for eye care practices with managed care contracts.


METHODS
Cross-sectional survey of 88 group and 56 solo eye care practices that contract with 6 health plans affiliated with a national managed care organization. The survey contained modules on practice structure, financial arrangements, utilization management, and quality management. The survey response rate was 85%.


RESULTS
Group practices with both ophthalmologists and optometrists were triple the size of ophthalmology-only groups, and 5 times the size of optometry-only groups. Fee-for-service payments were the primary source of group practice revenues, although 60% of groups derived some revenues from capitation payments. Group practices paid their physicians almost exclusively with fee-for-service payments or salary arrangements, with minimal capitation at the individual level. Almost no practices used both capitation and bonuses to compensate providers. Most practices received practice profiles and three fourths were subject to utilization review, which mainly consisted of preauthorization for procedures, tests, or referrals. Nearly all practices used clinical guidelines, protocols, or pathways in managing patients with diabetic retinopathy or glaucoma. Further, nearly all group practices used computerized information systems to assist in delivering care, and most had provider education programs.


CONCLUSIONS
Managed care has affected the way eye care providers organize, finance, and deliver healthcare. In general, our findings paint an optimistic picture of eye care practices that contract with managed care organizations. Few practices bear substantial financial risk, and nearly all practices use quality management tools that could help to improve the quality of care.
Solomon
Matthew D
MD
RAND Health Program, Santa Monica, Calif 90401, USA.
Lee
Paul P
PP
Mangione
Carol M
CM
Kapur
Kanika
K
Adams
John L
JL
Wickstrom
Steven L
SL
Escarce
José J
JJ
D002204:Capitation Fee; D003284:Contract Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005376:Financial Management; D006123:Group Practice / Q000458:organization & administration; D019538:Health Care Surveys; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D009885:Ophthalmology / Q000191:economics / Q000458:organization & administration*; D009907:Optometry / Q000191:economics / Q000458:organization & administration*; D011216:Practice Management, Medical / Q000145:classification* / Q000191:economics / Q000458:organization & administration; D011331:Private Practice / Q000458:organization & administration; D017749:Total Quality Management; D014481:United States; D014600:Utilization Review