Class Description - Class 4
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
Class 4 Topics: SPECIALISTS
I. HOW MANAGED CARE
B. Survival Tips
III. UNIFORM BILLING
IV. EMERGING TRENDS
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
|1. Analyze how managed care effects
|2. Summarize how gatekeeper effects
|3. Describe variable compensation programs in
sharing both the risks and rewards of health care delivery.|
|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
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).
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topic for class 4 CME
Test - Class 4