For CME Test - Class 4 - Click Here
SPECIALISTS
The last class explained how Primary Care Physicians acting as "Gatekeeper" are in control of the patient’s 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 managed care, 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 MCO’s
Class 4 Topics: SPECIALISTS
I. HOW MANAGED CARE EFFECTS SPECIALISTS
V. CHART COMPARING SPECIALISTS UNDER A FEE FOR SERVICE SYSTEM AND MANAGED CARE SYSTEM
Key Objectives
 | 1. Analyze how managed care effects Specialists. |
| 2. Summarize how gatekeeper effects Specialists. |
| 3. Describe variable compensation programs in sharing both the risks and rewards of health care delivery. |
Review
| 1. Synthesize how managed care effects Specialists, include analyzing carve-outs. |
See: Mark Hagland, "What We’ve Learned About Carving Out Health Care," Medical Economics (January 1, 2000). Margaret Ann Cross, "Slicing it Thin: Carveouts Seek Cost Savings, But Challenges Remain," Modern Physician (November 1, 1999).
| 2. 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 focused factories and contact capitation would effect
Specialists.
See: Christine H. Markham, "New Focus For Community Hospitals: Neuro Centers," Health Care Strategic Management (March, 2000): 20 - 23. Ed Egger, "Contact Capitation Helps Control Specialists’ Costs," Health Care Strategic Management (June, 1999): 20 - 23. Jeffrey M. Alexander, J.D., "Managed Care Contracting for Specialists,"1999 HFM Resource Guide: 6 - 10. Regina Herzlinger, "Market-Driven, Focused Healthcare: The Role of Managers," Frontiers of Health Services Management 16:3: 3-12. |
| 3. Describe two reasons incentive pay would be used as part of the Specialist’s compensation. |
See: Frank Cliff and Jon Brunsberg, "Using Contact Capitation to Align Payment Incentives Among Specialists; Physician Compensation," Healthcare Financial Management (October 1, 1999).