Quote:
Originally Posted by dbussone
A capitation program typically involves the sharing of a pool of funds that are set aside throughout the year. The funds can then be distributed based on criteria established in advance. Quality of care, reduction of test usage, and decreased referral to specialists (all based on data and usually evidence based medicine) are examples.
I'm more familiar with the hospital side of capitation so it would be interesting to see if GE weighs in on the doc side.
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Our practice never got involved in any capitation plans, but I can give you an idea of how they work. The insurer will pay $x.xx per month for each enrollee, regardless of whether you see them or not. They then keep statistics on your "performance"---% of generic drugs prescribed, cost of drugs, cost of referrals, cost of radiologic exams, etc. They then compare this to all physicians in the plan, adjusted for patient demographics and underlying illnesses. As capitation got started, this information was "educational", but in the future I'm sure they will adjust payment based on this data. The problem here is that you can get destroyed by the chronic complainers and hypochondriacs who will try to make appointments every day and demand expensive testing for no reason. Like most things in life, 10% of the people can eat up 90% of the dollars very quickly. At the other end of the spectrum you'll get people who stay home and get sicker and sicker because "they don't want to bother you", or "they were waiting for their next regular appointment" I guess it takes all kinds.