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Essay / Research Paper Abstract
A 7 page paper assessing payment options. Alpha Internal Medicine Physician group (AIMPG) has agreed to become a provider organization for a local health maintenance organization (HMO). AIMPG is not financially successful at present and anticipates salvation in the form of association with the HMO. The task before it now is to determine what payment structure would be most beneficial: fee for service; bundled service; or capitation payments. The paper concludes that fee for service is the most advantageous, followed by capitation. The practice should avoid bundling. Includes one table. Bibliography lists 4 sources.
Page Count:
7 pages (~225 words per page)
File: CC6_KShlthCrHMOpay.rtf
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Unformatted sample text from the term paper:
Medicine Physician group (AIMPG) has agreed to become a provider organization for a local health maintenance organization (HMO). AIMPG is not financially successful at present and anticipates salvation in
the form of association with the HMO. The task before it now is to determine what payment structure would be most beneficial: fee for service; bundled service; or capitation
payments. Fee For Service The fee for service approach enables the practice to be paid for each service provided for the HMOs members.
The fee paid likely will be discounted, of course, but the practice can expect to be paid for every service it provides. This is not the case with
other payment plans. Risk. Being paid for individual services provided to individual patients constitutes the manner in which medical practices operated in
the past, and it is the easiest form of payment to visualize. The total of services A, B and C provided to Patient 1 is what the physician bills
and provides the basis for payment for those services. Even though the physicians fees likely will be discounted - perhaps substantially - fee for service operates according to this
same basic framework. If specific fees are determined contractually and the HMO remains solvent, then there is little risk associated with this payment structure.
Forecasting for Budget Development. The fee for service payment structure also is the easiest to deal with in forecasting for budget development. Forecasts can continue to
be based on numbers of patients, numbers and types of procedures and numbers of consultations with patients. All of former processes remain under this payment structure; only the amounts
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