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At least 253 records · Page 14Linked to original sources
PubMed1996

The effect of capitated and fee-for-service remuneration on physician decision making in gynecology.

OBJECTIVE: To evaluate the variations in physician behavior leading to performance of gynecologic surgical procedures related to fee-for-service and capitation reimbursement systems. METHODS: This study compared the physician practice utilization of surgical services for fee-for-service and capitated contract reimbursement systems within a gynecology clinic. Attending gynecologists were reimbursed on a fee-for-service basis for all surgical services performed during a 6-month interval; subsequently, the same physicians were reimbursed on a capitated basis for 6 months and received a fixed payment for the clinical and surgical services provided. RESULTS: Three thousand seven hundred eighty consecutive outpatient gynecology visits were evaluated at the university gynecology clinic during 1994. We found a 15% overall decrease in the number of surgical procedures that were performed during the capitated reimbursement period compared with the fee-for-service time interval. The procedure most responsible for the reduction of surgical services was elective sterilization by laparoscopy, which underwent a statistically significant decrease (P < .01). CONCLUSION: The remuneration system in our review seemed to affect physician decision making for only the most elective procedures, whereas physicians maintained similar practice patterns for more severe conditions. Fee-for-service seems to encourage, whereas capitation seems to discourage, gynecologist from performing elective procedures.

Adult↗
PubMed2001

The future of capitation: the physician role in managing change in practice.

Capitation-based reimbursement significantly influences the practice of medicine. As physicians, we need to assure that payment models do not jeopardize the care we provide when we accept higher levels of personal financial risk. In this paper, we review the literature relevant to capitation, consider the interaction of financial incentives with physician and medical risk, and conclude that primary care physicians need to work to assure that capitated systems incorporate checks and balances which protect both patients and providers. We offer the following proposals for individuals and groups considering capitated contracts: (1) reimbursement for primary care physicians should recognize both individual patient encounters and the administrative work of patient care management; (2) reimbursement for subspecialists should recognize both access to subspecialty knowledge and expertise as well as patient care encounters, but in some situations, subspecialists may provide the majority of care to individual patients and will be reimbursed as primary care providers; (3) groups of physicians should accept financial risk for patient care only if they have the tools and resources to manage the care; (4) physicians sharing risk for patient care should meet regularly to discuss care and resource management; and (5) physicians must disclose the financial relationships they have with health plans and medical care organizations, and engage patients and communities in discussions about resource allocation. As a payment model, capitation offers opportunities for primary care physicians to influence the future of health care by improving the management of resources at a local level.

Capitation Fee↗
PubMed1995

The growth of medical groups paid through capitation in California.

BACKGROUND: In California, it is common for health maintenance organizations (HMOs) to contract with large medical groups that are paid through capitation and are responsible for managing a full spectrum of medical services. METHODS: We studied six large medical groups in California--Bristol Park Medical, Friendly Hills HealthCare Network, HealthCare Partners Medical Group, Mullikin Medical Centers, Palo Alto Medical Foundation, and San Jose Medical Group--that are paid through capitation and that are growing as a result of contracts with managed-care organizations. We conducted interviews and obtained data on factors such as patient enrollment, capitation and other revenue, numbers of days spent by enrollees in the hospital, and numbers of visits to physicians per enrollee. RESULTS: Between 1990 and 1994, the number of HMO enrollees whose care was paid for through capitation in the six medical groups increased by 91 percent, from 398,359 to 759,474. In 1994, the mean number of hospital days per 1000 HMO enrollees ranged from 120 to 149 for non-Medicare patients and from 643 to 936 days for Medicare patients. By comparison, in 1993 the mean numbers of hospital days per 1000 HMO enrollees not covered by Medicare were 232 for California and 297 for the United States; for HMO enrollees covered by Medicare, the numbers were 1337 for California and 1698 for the United States. In 1994, the average annual number of visits to physicians for HMO patients in the six groups not covered by Medicare ranged from 3.1 to 3.9; for Medicare patients, it ranged from 7.2 to 9.3; these rates were slightly lower than statewide and national rates. Four of the groups have sold their assets (such as facilities, supplies, equipment, and patients' charts) to outside investors; the physicians remain employed by physician-owned professional corporations. CONCLUSIONS: Medical groups paid through capitation offer a model for the status of physicians in managed-care systems that differs from the employee status offered by staff-model HMOs and the subcontractor status offered by HMOs that negotiate directly with individual physicians. Despite their growth, such medical groups in California face substantial challenges, such as obtaining the financial assets necessary to sustain rapid growth.

California↗
PubMed2000

When sick patients switch primary care physicians: the impact on AMCs participating in capitation.

Patients facing catastrophic illness often desire choice when selecting specialist physicians and will sometimes request specialists at academic medical centers (AMCs). Under capitated payment systems, community primary care physician (PCP) gatekeepers have an incentive to refer patients to local specialists with whom they regularly collaborate rather than to AMC specialists, who generally are more expensive and with whom they may not have working relationships. As a result of the financial pressures of capitation and the desire to work with familiar specialists, some PCPs in community-based risk-sharing groups are reluctant to refer sick patients in capitated health plans to AMC-affiliated specialists. Forced to choose between their existing primary care relationships and their desired specialists, some patients are terminating their existing primary care relationships to enroll with PCPs affiliated with the AMCs to which they wish to be referred. The authors' observations at their AMC indicate that most of the patients leaving their PCPs in the community do so to gain access to oncology and surgical specialty services. The shifting of sick patients in capitated health plans to AMC-affiliated PCPs creates a financial burden for both AMCs and their affiliated physicians. Health plans and AMCs must cooperate in developing a solution; for example, risk-adjust each risk unit's capitation payment based on the health status and disease burden of its population. The authors propose strategies aimed at enabling patients to have access to AMC tertiary care services while ensuring that the cost of caring for the sickest patients is not borne solely by AMC risk groups. They conclude that it is in the best interests of all concerned to modify the current counterproductive incentives that promote the problems they have described.

Academic Medical Centers↗
PubMed1984

Capitation payment for pharmacy services. II. Impact on costs.

Four areas of cost were analyzed in the expanded capitation drug program: total program costs; drug costs, escrow account distribution, and administrative costs. Total program costs were, on average, 9% higher under capitation. Drug costs, however, were 3% lower than under fee-for-service (FFS) reimbursement. This discrepancy is probably because pharmacists were not at financial risk under the program, the capitation rates were higher than intended, there were many emergency claims, and other aspects of the research environment. Although administrative costs were large, almost two thirds of the development cost was for one-time work, which could be transferred to another state at little or no expense. One third of the total administrative costs can be attributed to complying with regulations of the Health Care Financing Administration. Significant refinement of the present capitation model may be necessary before this financing innovation is used elsewhere. Modifications might include limiting the system to nursing home patients, placing pharmacists at partial financial risk, restricting participation to pharmacies that service a large number of Medicaid eligibles, and basing capitation rates in part on the drug use behavior of cash-paying patients.

Capitation Fee↗
PubMed2006

Vascularized capitate transposition for advanced Kienböck disease: application of 40 cases and their anatomy.

Based on anatomic study, the vascularized capitate transposition to replace excised necrotic lunate was designed and applied in 40 cases of advanced Kienböck disease. It includes excision of the necrotic lunate and proximal shift of the vascularized capitate. The blood supply of the transposed capitate is provided by the dorsal branch of the anterior interosseous artery. Bone union occurred radiographically, and no postoperative capitate necrosis occurred in all cases after 6 weeks. Twenty-three cases were followed up for 1 year. No residual wrist pain existed in the range of motion, but limited residual wrist pain existed in labor work. The arc of motion ranged on average from 35 degrees of flexion to 45 degrees of extension. The grip power of the affected hand reached on average 70% compared with the contralateral. The authors conclude the vascularized capitate transposition is a reliable alternative for advanced Kienböck disease.

Adolescent↗
PubMed2001

Capitation and risk adjustment in health care financing: an international progress report.

In every system of health care, capitation payments have become the accepted tool used by health care purchasers in much of the developed world to determine prospective budgets. The policy prescription of capitation is perceived to address both equity objectives (of great importance in publicly funded systems of health care) and efficiency objectives (the dominant concern in competitive insurance markets). An examination of the current state of the art in 20 countries outside the United States in which health care capitation has been implemented confirms that capitation has assumed central importance within diverse systems of health care. In practice, however, the setting of capitation payments has been heavily constrained to date by poor data availability and unsatisfactory analytic methodology.

Australia↗
PubMed1996

Evaluating the impacts of human capital stocks and accumulation on economic growth: some new evidence.

"Various hypotheses have been put forward in recent years concerning the contribution of human capital to economic growth. This paper argues that school enrolment rates--by far the most commonly used human capital measure in growth regressions attempting to test these hypotheses--conflate human capital stock and accumulation effects and lead to misinterpretations of the role of labour force growth. An alternative education-related human capital measure is constructed which is capable of distinguishing between stocks and flows. Applying this measure to samples of developed and less developed countries during the 1960-85 period suggests not only that there are important growth effects associated both with 'initial' stocks of, and subsequent growth in, human capital, but also that this new measure out-performs the simple school enrolment rates used in previous analyses."

Developed Countries↗
PubMed2005

Capitals, assets, and resources: some critical issues.

This paper explores the potential of Bourdieu's approach to capital as a way of understanding class dynamics in contemporary capitalism. Recent rethinking of class analysis has sought to move beyond what Rosemary Crompton (1998) calls the 'employment aggregate approach', one which involves categorizing people into class groups according to whether they have certain attributes (e.g. occupations). Instead, recent contributions by Pierre Bourdieu, Erik Wright, Aage Sorensen, and Charles Tilly have concentrated on understanding the mechanisms that produce class inequalities. Concepts such as assets, capitals and resources (CARs) are often used to explain how class inequalities are produced, but there remain ambiguities and differences in how such terms are understood. This paper identifies problems faced both by game theoretical Marxism and by the rational choice approach of Goldthorpe in developing an adequate approach to CARs. It then turns to critically consider how elements of Bourdieu's approach, where his concept of capital is related to those of habitus and field, might overcome these weaknesses. Our rendering of his arguments leads us to conclude that our understanding of CARs might be enriched by considering how capital is distinctive not in terms of distinct relations of exploitation, but through its potential to accumulate and to be converted to other resources. This focus, we suggest, sidesteps otherwise intractable problems in CAR based approaches.

Capitalism↗
PubMed1978

The inclusion of capitation reimbursement in solo practice.

Capitation reimbursement has been an integral part of prepaid group practices in both medicine and dentistry, and claims have been made for its ability to influence the delivery of services favorably. Experts have suggested that if capitation is implemented, more preventive care will be provided, more diagnostic services will be provided, there will be better continuity of care, utilization of high-cost services will be reduced, and clinical outcome will be improved. This study focused on the dominant mode of practice in dentistry, the general, solo practitioner, to determine if these contentions held. A sample of 245 patients whose care was paid for by a capitation mechanism was matched to a sample of 245 similar patients whose care was paid for on a standard fee-for-service basis--all from three dentists' practices. All services in all years of care for each patient were analyzed. It was determined that the rate of restorations was lower, while rates of diagnostic testing and prophylaxis were higher for capitation patients. Continuity was also better under capitation, but rates of extractions were virtually identical for the two groups.

Capitation Fee↗
PubMed1996

Effect of conversion from a fee-for-service plan to a capitation reimbursement system on a circumscribed outpatient radiology practice of 20,000 persons.

PURPOSE: To assess the effect of a capitation reimbursement plan with attendant changes in service arrangements on the utilization of radiologic services, financially on the payer, and on the satisfaction of patients and referring physicians. MATERIALS AND METHODS: Outpatient radiologic services for a defined population of 20,000 company employees and their dependents were converted from a point-of-service managed care plan to a capitation payment plan. Under the capitation plan, nonemergent outpatient diagnostic imaging was performed at a newly constructed imaging center staffed by general radiologists. All cross-sectional images and certain projectional studies were also over-read (read again after the initial reading by local radiologists) by subspecialists. Utilization data obtained before and after the conversion were analyzed. The financial effect on the employer and the satisfaction of patients and physicians were also assessed. RESULTS: Quality imaging services were provided under the capitation plan with financial savings by the employer. Use was higher for cross-sectional imaging, especially magnetic resonance imaging studies, and was lower for nonmammographic plain radiography. Consumer satisfaction was high. CONCLUSION: Under certain conditions, conversion to a capitation system for imaging can lead to improved quality of care and decreased overall health-care costs.

Ambulatory Care↗
PubMedDate not supplied

Effects of capitation payment for pharmacy services on pharmacist-dispensing and physician-prescribing behavior: I. Prescription quantity and dose analysis.

This paper evaluates changes in quantities and appropriateness of dosages and quantities of prescription in capitation and control pharmacies. The data indicate that, under capitation, changes were made in the quantities of ingredients so that the quantities dispensed were significantly different from those prescribed. However, the number of such modifications to prescriptions was small, and the reader is cautioned against drawing broad conclusions. The analysis, then, considers changes in days' supply of prescription ingredients during the study period. There were significantly increases in the average day's supply of prescription ingredients for maintenance drugs dispensed under the capitation reimbursement scheme; however, no such differences were observed for non-maintenance drugs. Appropriateness of the dosages and quantities of prescriptions were then compared for capitation and fee-for-service pharmacies for the study period, and no significant differences were found. Thus, it is concluded that although capitation was associated with increases in the average days' supply of ingredients dispensed for maintenance prescriptions, such changes did not adversely affect the quality of drug therapy as measured by two sets of criteria.

Capitation Fee↗
PubMed1997

Managed care, capitation, and the future of nephrology.

Within the next decade, it is predicted that more than 90% of the United States population will receive its health insurance through managed care. Capitation will be the reimbursement mechanism to health care providers as the major way of controlling costs. Currently, managed care has had little experience with capitation payments for chronically ill patients, who consume large financial and physical resources. The end-stage renal disease (ESRD) population represents a vulnerable group of patients, and their care may be compromised in a capitated environment. Nephrologists will need to serve as advocates for ESRD patients through a mechanism of quality of care, driven by a continuous quality improvement model. Cost-effective delivery of care will occur as nephrologists join together to form Independent Practice Associations (IPAs). In this article, the role of a nephrologist in a capitated environment is outlined in detail, and background for the basis of managed care growth is provided as a framework for understanding the change in our health care delivery system. After formation of a nephrology IPA, there will most likely be a linkage with a management service organization (MSO). A business plan driven by the highest principles will allow nephrologists to work together as a cohesive force in accepting global risk capitated contracts. The starting point is for ESRD care, and the future includes pre-ESRD care.

Capitation Fee↗
PubMed2001

Physicians' willingness to participate in the process of lethal injection for capital punishment.

BACKGROUND: It has been found that physicians condone colleague involvement in capital punishment. Physicians' own willingness to participate has not been explored. OBJECTIVE: To examine physicians' willingness to be involved in cases of capital punishment. DESIGN: Survey exploring physicians' willingness to participate in 10 aspects of capital punishment by lethal injection, 8 of which are disallowed by the American Medical Association. SETTING: United States. PARTICIPANTS: 1000 randomly selected practicing physicians. MEASUREMENTS: Questions assessing willingness to be involved in and attitudes toward capital punishment. RESULTS: 41% of respondents indicated that they would perform at least one action disallowed by the American Medical Association; 25% would perform five or more disallowed actions. Perceived duty to society (P < 0.001), approval of the death penalty (P < 0.001), and approval of assisted suicide (P = 0.015) correlated with increased willingness to perform disallowed actions. Only 3% of respondents knew of any guidelines on this issue. CONCLUSIONS: Despite medical society policies, many physicians would be willing to be involved in the execution of adults. The medical profession needs to be better informed about the ethical issues involved in physician participation in capital punishment.

American Medical Association↗
PubMed1994

Influences on the use of capital by public hospitals.

This paper examines key influences on the volume of capital employed by public hospitals. Empirical models are constructed and analysed separately for total capital employed and for plant and equipment only, using data from 68 Victorian hospitals. Such data provide an empirical base to guide government decisions on funding capital expenditure in hospitals. The analysis finds that the proportion of hospital expenditure devoted to outpatients and teaching, and the proportion of funding derived from government all influence the level of capital utilised per inpatient. The model provided a reasonable fit for plant and equipment, but much improved data coverage and consistent valuation of land and buildings are required to adequately explain influences on total capital.

Ambulatory Care↗
PubMedDate not supplied

A capital planning model for health care organizations.

Limited capital funds in health care organizations have lead to aggressive capital acquisition campaigns. This article presents a model for a systematic, comprehensive capital planning process. The model, based on a review of the literature on capital budgeting, includes detailed recommendations on how to structure an effective capital planning process.

Canada↗
PubMed1995

The need to manage and reconcile capitation payments.

As capitation becomes a more common method of paying providers, healthcare financial managers must determine if these payments are being made correctly. The reconciliation process under capitation contracts is new for most financial managers. Standard industry conventions for payers and providers are needed to reduce the associated administrative costs for this type of payment. Recent efforts to create an American National Standards Institute (ANSI) X12 capitation payment standard have focused on provider information needs under capitated payment agreements. A solution is at hand if providers and payers can agree on a standard for reconciling capitation payments.

Capitation Fee↗
PubMed1996

Using an affordability analysis to budget capital expenditures.

A healthcare organization or system often needs to make capital expenditures to expand or renovate its facilities or to finance other important projects. It may be difficult, however, for an organization to gauge how much of its resources it can afford to commit to capital projects. To help the organization evaluate the feasibility of a capital expenditure, an analysis of financial resources should first be conducted. Using an actual healthcare system whose name has been changed to protect its identity, this article outlines how healthcare financial managers can perform an affordability analysis, based on the debt-to-capital ratio or debt service coverage, to determine the amount of resources to allocate for future capital expenditures.

Budgets↗