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Medical Practice Strategies:  Systems Based Practice - Business Laws Ethics

Janet Lerman, J.D.

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CME Test - Class 3
Relevant Terms
What is PCP
Capitation & PCPs
MCOs & PCPs
PCP Services
Networks
Opportunities
Considerations
Required Reading
Suggested Readings
New News Class 3

 

For CME Test - Class 3 - Click Here

Class Description - Class 3

PRIMARY CARE PHYSICIANS

Primary Care Physicians ("PCP") are a key link in the systems-based practice. This class will examine more closely how capitated payment effects the Primary Care Physician, illustrate some potential opportunities Primary Care Physicians face in the systems-based practice, and examine some primary care physician's perspectives of in the systems-based practice.  This class will also identify some specific questions that Primary Care Physicians should ask themselves as they form networks or consider joining them. 

This class shows Primary Care Physicians the importance to consider costs and benefits of tests and treatments, not order unnecessary tests, and the reasons to adhere to established patient care pathways.  In addition, Primary Care Physicians will be reminded to identify system causes of medical error; anticipate and respond to patient care problems; adhere to protocols that ensure patient safety; and accept input from the patient care team.  Also, Primary Care Physicians will review the necessity to obtain consultation when needed; communicate with other providers; resolve differences in treatment plans; reconcile contradictory advice; assure patient awareness of available options; make appropriate referrals; assist with arrangements and follow up to ensure appropriate care.

Class 3 Topics:    PRIMARY CARE PHYSICIANS

I. WHAT IS A PRIMARY CARE PHYSICIAN

II. HOW CAPITATED PAYMENT AFFECTS PRIMARY CARE PHYSICIANS

III. FROM A MANAGED CARE PERSPECTIVE, ISSUES TO CONSIDER FOR PRIMARY CARE PHYSICIANS

IV. PRIMARY CARE PHYSICIAN?S MIX OF SERVICES PROVIDED IN A MANAGED CARE ENVIRONMENT

    A.    Hospitalists

    B.    Physician Assistants, Nurse Practitioners and Others

    C.    Alternative Care

V. HOW NETWORKS EFFECT PRIMARY CARE PHYSICIANS

VI. OPPORTUNITIES FOR PHYSICIAN ORGANIZATIONS UNDER MANAGED CARE

Key Objectives

bullet1.     Analyze how systems-based practice effects Primary Care Physicians.

 

bullet2.     Distinguish how capitated payments effect Primary Care Physicians.

 

bullet3.     Synthesize trends involving Primary Care Physicians.

Review 

bullet1.    Examine scope of care issues for Primary Care Physicians under systems-based practice, including gatekeeper issues, hospitalist issues, and wellness plans.

 

bullet2.     Analyze economic/ financial issues for Primary Care Physicians under systems-based practice, distinguishing the effect modes of payment such as capitated payments from fee-for service and discounted-fee-for-service has on Primary Care Physicians.

 

bullet3.     Analyze business issues for Primary Care Physicians under systems-based practice, including: (a) office management issues such as making the most out of staff, telemedicine, Internet, and technology; (b) Physician Assistants or Physician Extenders; (c) Alternative Care such as chiropractic, acupuncture, massage therapy, etc., (d) Patient Satisfaction issues.

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