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Medical Practice Strategies:  Systems Based Practice - Business Laws Ethics

Janet Lerman, J.D.

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CME Test - Class 4
Relevant terms
Specialists
Point-of-Service
Billing
Trends
Comparisons
Risk Sharing Pools
Compensation
Considerations
Required Readings
Suggested Readings
New News Class 4

 

For CME Test - Class 4 - Click Here

Class Description - Class 4

SPECIALISTS  

The last class explained how Primary Care Physicians acting as "Gatekeeper" are in control of the patientís continuum of care. Taking that logic one step further, means Primary Care Physicians can decide whether or not to use Specialists.

This class will examine how systems-based practice, and specifically gatekeepers, effects specialists and reasons why some specialists were seeking retraining into primary care, especially during the late 1990s. This class will examine point-of-service plans and uniform billing system. Also, this class will go into more detail about risk sharing pools, a potential source of funds to pay specialists for their services rendered to managed care patients. This class will look at how variable incentive compensation methods are increasingly being used by various entities.

Class 4 Topics:    SPECIALISTS

I. HOW MANAGED CARE EFFECTS SPECIALISTS

    A.    Carve-outs

    B.    Survival Tips

II. POINT-OF-SERVICE

III. UNIFORM BILLING SYSTEM

IV. EMERGING TRENDS

    A.    Disease Management

    B.    Focused Factories

V. CHART COMPARING SPECIALISTS UNDER A FEE FOR SERVICE SYSTEM AND MANAGED CARE SYSTEM

VI. RISK SHARING POOLS

VII. HOW VARIABLE COMPENSATION PROGRAMS IN SHARING BOTH THE RISKS AND REWARDS OF HEALTH CARE DELIVERY EFFECTS SPECIALISTS

    A.    Contact Capitation

    B.    Contract Issues

 

Key Objectives

bullet1.     Analyze how systems-based practice effects Specialists.

 

bullet2.     Summarize how gatekeeper effects Specialists.

 

bullet3.     Describe variable compensation programs in sharing both the risks and rewards of health care delivery.

Review 

bullet1.    Synthesize how systems-based practice effects Specialists, include analyzing carve-outs.

 

bullet2.     Describe in detail how healthcare moving in the direction of outpatient, group practice, capitated settings would effect Specialists.  Also, analyze in detail how healthcare moving in the direction of centers of excellence and pay for performance would effect Specialists.

 

bullet3.     Describe two reasons incentive pay would be used as part of the Specialistís compensation.

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