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Risk-Based Reimbursement
For your Dropbox
assignment, a primary care physician is often reimbursed by Health
Maintenance Organizations (HMOs) via capitation, fee-for-service,
relative value scale, or salary. Capitation is considered as a risk
based compensation.
In an effort to understand the intricacies
involved with physician reimbursement, particularly in an era of health
care reform, identify and interview an expert in the field, such as:
- Hospital Administrator
- Managed Care Organization (MCO) executive
- Health care Consultant
- Legal Professional
Assumption: MCOs use risk-based reimbursement for primary care physicians.
Ask the following questions in the interview:
- What kind of risk do the MCOs assess?
- Does risk-based compensation limit the freedom of primary care physicians in any way in terms of patient care? Why or why not?
- How does the capitation model of reimbursement work? Do physicians generally prefer one model over the other? Why or why not?
- Why do HMOs prefer the prepaid, monthly premium?
- Is pay-for-performance a better model than existing models of compensation? Are there limitations to it as well?
Feel free to add additional follow-up questions for depth and clarification as you see fit.
Create a 4- to 5-page report in Microsoft
Word document, analyzing the responses provided (which should be
included as part of the report) using the evidence from the literature
to help support or refute the responses provided.
Support your responses with examples.
Cite any sources in APA format.
Submission Details
Name your document SU_HCM4025_W5_A2_LastName_FirstInitial.doc.
Submit your document to the W5 Assignment 2 Dropbox by Tuesday, August 2, 2016.
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