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ASK AN ADVISOR
To Join -or- Not to Join is the Question
By Staff Reporters
A new-wave West-Coast managed care organization (MCO) wanted a multi-specialty medical group to contract with them to provide medical services to all subscribers. Compensation would be in the form of a fixed-rate capitated payment system, a.k.a. per member / per month (PM/PM).
Ask an Advisor
The medical group practice administrator reviewed their request for proposal (RFP) very carefully, but is still not sure what to do. So, allow us to “crowd-source” as we ask ME-P readers, advisors and management consultants for a solution.
Key Issues
Facts to know for an informed PM/PM capitated reimbursement decision:
- annual frequency or service-rate per 1,000 patients
- unit cost of medical services per unit-patient
- co-payment dollar amount per patient
- co-payment frequency rate per 1,000 patients
- variable cost per patient
- under-capacity medical group office utilization rates, and
- fixed overhead office-cost coverage [+/-].
Assessment
Visit: www.CertifiedMedicalPlanner.com
More case models: https://medicalexecutivepost.com/2010/03/12/healthcare-case-models-cd-rom/
Conclusion
And so, your thoughts and comments on this ME-P are appreciated. What is your solution; accept or reject the contract proposal? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.
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Filed under: "Advisors Only", "Ask-an-Advisor", Managed Care, Practice Management | Tagged: capitation, fixed rate medical reimbursement, HMO, Managed Care, MCO, medical contracting | 2 Comments »
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