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Understanding PSHPs
By Dr. David Edward Marcinko; MBA CMP™
[Publisher-in-Chief]
Capitation or Per Member / Per Month [PM/PM] fixed medical reimbursement models offer some of the same advantages to Point of Service Health Plans [PSHPs] as they do to HMOs. But, they are often more risky for the doctor or healthcare provider.
The main reason for the discrepancy is medical risk acceptance without considering the PSHP peculiarities.
For example, these plans, unlike HMOs, may allow out-of-network services and PSHP managers and providers must then pay the unmanaged outside contractors in addition to the discounted in-service physicians. This care therefore is an unknown future liability.
Of course, re-insurance is useful, but these plans tend to be chronically short of capital and, as a result, should expect higher operating costs than traditional HMOs.
Assessment
And so, what has been your experience with PSHPs; as either patient or provide?
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
- PRACTICES: www.BusinessofMedicalPractice.com
- HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
- CLINICS: http://www.crcpress.com/product/isbn/9781439879900
- ADVISORS: www.CertifiedMedicalPlanner.org
- FINANCE: Financial Planning for Physicians and Advisors
- INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
- Dictionary of Health Economics and Finance
- Dictionary of Health Information Technology and Security
- Dictionary of Health Insurance and Managed Care
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