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Once a favored technique for specialists, contact capitation has fallen out of favor, primarily because there isn't enough money going to physicians. Here's how to make contact capitation work.
Is there money in capitation? You bet. This Data Insight shows that the multispecialty groups with the highest revenue and charges are those with the greatest percentage of capitation.
Capitation can be successful if hospitals, physicians, and payers share risk to align financial incentives to control costs. Payers need to help hospitals that accept risk to achieve success under managed care agreements. Many failures in hospital capitation might be preventable if hospitals improve internal operations and commit themselves to making the changes necessary for successful risk-based payment.
Data Insight: What characteristics are common to better performing medical groups? For one, they are more likely to have a higher percentage of capitation revenue. Get all the details, plus one expert's view of the reinsurance market and prospects for capitation in today's economic climate.
In the following analysis, the authors examine the capitated payment approaches for long-term care (LTC) services of five programs: the Program of All-Inclusive Care for the Elderly (PACE), the Arizona Long-Term Care System (ALTCS), the Texas STAR + PLUS, the Minnesota Senior Health Option (MSHO), and the Monroe County Continuing Care Networks (CCNs) in New York. The authors describe key aspects in the design of these programs, with an emphasis on Medicaid reimbursement, and discuss differences and commonalities in the approaches taken by the programs in setting capitation rates.
For the future survival of the rural hospitals in the U.S., there is a need to make sound financial decisions. The Activity Based Cost Accounting (ABC) provides more accurate and detailed cost information to make an informed capital investment decision taking into consideration all the costs and revenue reimbursement from third party payors. The paper analyzes, evaluates and compares two scenarios of acquiring capital equipment and attempts to show the importance of utilizing the ABC method in making a sound financial decision as compared to the traditional cost method.
To give physicians in their capitated medical groups an incentive to provide high-quality care, the Missouri Blues began a pilot program in the mid-1990s to reward doctors who met various quality benchmarks. Under the plan, doctors could earn an additional 4% of their capitated income if they made targets in the areas of childhood immunizations, retinal exams for patients with diabetes, and hospital admissions for both child and adult asthmatics. The incentives have been a smash success--here are the details.
A new study shows that physicians in capitated contracts spend less time with patients but offer more preventive care and health counseling, a finding that debunks the myth that quality care is sacrificed under capitation.
"This article examines the role of human capital and labor market characteristics in explaining geographical and individual differentials in socioeconomic outcomes of Puerto Rican women [in the United States]. The better socioeconomic performance of Puerto Ricans outside the Northeast can be in part related to their larger amount of human capital. Labor market characteristics also play a role, but their effects are generally small. Net of other characteristics, Northeast residence reduces labor force participation, increases female headship, but reduces welfare use. Of all groups examined, recent migrants from Puerto Rico located in the Northeast show the poorest socioeconomic outcomes."
"Evidence on labor immigration and capital inflows to three high labor-immigration economies (Australia, Canada, the United States) is examined over periods ranging from 1820-1870 through to 1991. Data show a close association between capital flows and immigration, although causality implications are ambiguous. For the United States, the relation between factor flows is more complex than for the other countries, but flows to the United States have influenced those to smaller economies. All three nations have been subjected to common immigrant push factors through to 1930-1950 but, since World War II, linkages between factor flows have altered. Post-World War II U.S. immigration restrictions have become more important as a global determinant of labor flows, with factor flow policymaking becoming increasingly internationally interdependent."
Hospice services received by Medicare risk-based health maintenance organization (HMO) enrollees are paid on a non-capitated basis, creating financial incentives for HMOs to encourage their terminally ill patients to elect hospice. Using Medicare administrative records for 1998, we found that hospice enrollment in the last month of life was significantly higher among HMO enrollees than among beneficiaries in fee-for-service (FFS). However, low mortality rates among HMO enrollees produced similar population-based rates of hospice use in the HMO and FFS sectors. Simulations showed that including hospice care under capitation payments in July 1998 would have produced very small savings for Medicare.
The "MD Hawkeye" software program from Doctor-Driven Systems helps capitated groups manage costs, reduce utilization, and improve quality measurements. See how one capitated group saved more than $100,000 on one project.
Capitated groups continue to make basic mistakes in managing contracts, although a growing number are learning from their blunders, according to a leading consultant who shares her list of top problem areas under capitation--and what to do about them.
The Supreme Court recently decided that the death penalty as it applies to persons with mental retardation is not a violation of constitutional protection from cruel and unusual punishment as long as juries consider the convicted person's disabilities during trial proceedings. Advocates for persons with mental retardation have argued that because their disability reduces culpability in capital offenses, the death penalty is always inappropriate. In this paper we argued that the latter position makes unwarranted categorical assumptions about mental retardation, fails to consider the individualized and situation-specific determinants of culpability for a capital offense, and undermines the very assumptions required to restore respect and value for citizens with mental retardation as participants in society.
The ability to achieve reductions in health care costs is determined in part by physician payment mechanisms. This study observes the response to a change in the reimbursement mechanism by a group of physicians who participated in a fee-for-service plan and then formed an IPA using capitation payment for primary care physicians and a reduced fee schedule for specialists. Patient benefits were similar under the two plans. Analyses of data for a group of continuous enrollees show that the change in the physician payment mechanism was associated with a reduction in hospitalizations but increases in length of hospital stay and number of ambulatory visits. These increases may have occurred because capitation for primary care physicians and a reduced fee schedule for specialists led to a greater number of referrals with no incentive in place for reductions in length of stay for specialty admissions.
BACKGROUND: The purpose of this study was to determine the annual incidence rates of non-work-related traumatic fractures and dislocations (excluding head and facial injuries) referred for orthopaedic services in a large population enrolled under a capitated insurance contract. METHODS: The number of fractures and dislocations that were referred for orthopaedic services were recorded prospectively from among an average of 135,333 persons per year who were enrolled under a capitated insurance contract during the three-year study period. These data were used to determine the gender-specific and age-specific incidence rates of fractures and dislocations referred for orthopaedic services. RESULTS: A total of 3440 fractures and 422 dislocations were referred for orthopaedic services during the three-year study period. The incidence rate of fractures referred for orthopaedic services was 8.47 per 1000 member-years, with a significantly (p < 0.0001) higher rate among males. Members between the ages of ten and fourteen years had the highest rate of fractures referred for orthopaedic services (21.52 per 1000 member-years). The lifetime risk of a traumatic fracture referred for orthopaedic services to the age of sixty-five years was one in two for both males and females. The incidence rate of dislocations referred for orthopaedic services was 1.04 per 1000 member-years, which did not differ significantly (p = 0.75) between genders. Members between the ages of fifteen and nineteen years had the highest rate of dislocations referred for orthopaedic services (2.75 per 1000 member-years). The lifetime risk of a traumatic dislocation referred for orthopaedic services to the age of sixty-five years was one in sixteen for both male and female members. CONCLUSIONS: Young males had the highest rate of traumatic fractures referred for orthopaedic services. Adolescents of both genders had high rates of traumatic dislocations referred for orthopaedic services. The lifetime risk of a non-work-related fracture referred for orthopaedic services to the age of sixty-five years is approximately equal to that of coronary artery disease.
Not-for-profit healthcare organizations have four basic sources of capital: internal sources, philanthropy, asset sales, and external sources. External sources, in particular, offer a wealth of options that are important for such organizations--especially those facing significant capital shortfalls--to consider. External sources include bond offerings and nontraditional offerings, such as receivables financing, off-balance-sheet options, real estate investment trusts, and subordinated securities.
A comprehensive capital plan can help organizations achieve long-term goals. In contrast to previous planning methods that were largely department-driven and spanned three-year increments, this approach maintains a strategic focus and identifies and prioritizes major capital requirements over a 10-year planning horizon.