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5 Cards in this Set

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  • Back
How a Capitated Medical Group Evaluates its Success
 Compute revenue they would have earned under a Ffs system
 Compare this with the capitation income.
Practice Management: Ways Providers can Manage and Reduce their Capitation Risk (Prepaid Risk)
 Control Utilization
 Control referral costs
 Transfer Risk
 Control Utilization
 Minimize emergency room use by having expanded clinic hours
 Perform outpatient instead of inpatient
 Avoid duplication of tests
 Use prospective, concurrent, and retrospective UR
 Develop an information system
 track each physician’s performance, cost, etc.
 Control referral costs
 Refer patients to the most cost-effective hospital
 negotiate discounted fees with the referral physicians
 purchase specialist time (“on a retainer basis”).
 ban secondary referrals
 Only use referrals for specified diagnoses.
 add specialists to the staff.
 Transfer Risk
 Purchase stop-loss
 Subcontract with umbrella groups for more capital
 use risk-sharing with the HMO