The future of capitation: the physician role in managing change in practice

Journal of General Internal Medicine
J D GoodsonH P Selker

Abstract

Capitation-based reimbursement significantly influences the practice of medicine. As physicians, we need to assure that payment models do not jeopardize the care we provide when we accept higher levels of personal financial risk. In this paper, we review the literature relevant to capitation, consider the interaction of financial incentives with physician and medical risk, and conclude that primary care physicians need to work to assure that capitated systems incorporate checks and balances which protect both patients and providers. We offer the following proposals for individuals and groups considering capitated contracts: (1) reimbursement for primary care physicians should recognize both individual patient encounters and the administrative work of patient care management; (2) reimbursement for subspecialists should recognize both access to subspecialty knowledge and expertise as well as patient care encounters, but in some situations, subspecialists may provide the majority of care to individual patients and will be reimbursed as primary care providers; (3) groups of physicians should accept financial risk for patient care only if they have the tools and resources to manage the care; (4) physicians sharing risk for patient c...Continue Reading

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Citations

Mar 16, 2007·Journal of General Internal Medicine·Allan H GorollLaurence B Gardner
Oct 3, 2008·Journal of General Internal Medicine·Elmer D AbboElbert S Huang
May 15, 2010·Journal of General Internal Medicine·Robert A Berenson, Eugene C Rich
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Dec 19, 2013·Journal of Preventive Medicine and Public Health = Yebang Ŭihakhoe Chi·Kimyoung HanKihong Chun
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Jun 20, 2015·The American Journal of Emergency Medicine·Leah FeazelNicholas M Mohr
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Jun 21, 2018·Journal of Oncology Practice·Michael Kolodziej
Mar 21, 2002·Journal of General Internal Medicine·Steven D Pearson, Tracey Hyams
May 7, 2021·Health Policy and Planning·Emma GhazaryanKrishna D Rao

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