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A collection of articles from Managed Care magazine
When capitation's hold weakens
Per capita claims costs may be rising more rapidly in western United States, according to Segal Co. [Chart]
[February 2003]
Providers turn to fee-for-service charges to make up revenue lost under capitation
Physician-group involvement in capitation is down by one fifth over a two-year period, while 2 of every 5 hospitals have moved away from it. [Chart]
[December 2002]
Has Capitation Weathered the Storm?
More difficult than ever to pull off, health care on a fixed, per-capita budget has gone out of style in a number of areas. But many things are cyclical - and this trend may be, too.
[July 2002]
The Effect of Practitioner Compensation on HMO Consumer Satisfaction
Consumer satisfaction with HMOs is negatively correlated with the percentage of practitioners who are compensated on a capitated-fee basis and positively correlated with the percentage of practitioners compensated with a fee-withholding incentive (e.g., a fraction of fees that are withheld until specific quality and cost-control goals are reached). Neither the percentage compensated under a bonus incentive system nor the percentage of general practitioners with board certification correlated with HMO consumer satisfaction.
[April 2002]
OUTLOOK: Interest in capitation backs off
More than half of provider organizations surveyed by Evergreen Re, a national reinsurance consultant and broker, had at least one capitation contract last year -- but use of capitation fell dramatically from 1999 to 2000. Perhaps not surprisingly, net profit, as a percentage of capitation revenue, for physician groups was down from 16 percent in 1999 to 8 percent in 2000. [August 2001]
COMPENSATION
MONITOR: Capitation rates see large boost
While many physicians argue that HMOs are stingy about passing
along revenue from premium increases, a new study suggests
otherwise. National Health Information, which surveyed 500 provider
groups and HMOs that subscribe to its newsletters, found that
global capitation rates are up an average of more than 7 percent
this year, and that payments for primary care services increased
almost 9 percent. [December 2000]
COMPENSATION
MONITOR: How you fare under capitation
Warren Surveys talked to about 50 HMOs and community based health
plans in 1999 to tally what they were paying physicians in
capitation and risk-arrangement contracts. [October
2000]
COMPENSATION
MONITOR: Capitation: How well is your back covered?
To succeed under capitation, physicians and other providers need a
strategy for protecting themselves in the face of catastrophic
loss. A new survey by Evergreen Re, a Florida-based health care
reinsurance broker, suggests that an understanding of this is
dangerously lacking among many providers.[September
2000]
Physician
Financial Incentives: Another UM Tool Bites the Dust
The managed care backlash has claimed another casualty: Financial
incentives in physician contracts as a means of controlling
utilization. Is capitation far behind? [June 2000]
COMPENSATION
MONITOR: Capitation: an update
Those not-so-long-ago predictions that global capitation would
come to define the financing of American medicine haven't come to
pass. In fact, the use of capitation has, more or less, hit a
plateau in the past couple of years. [May 2000]
Cigna Colorado
Ends Capitation For Most Primary Care Physicians
In a strategic move aimed at retaining and recruiting top
physicians, Cigna HealthCare of Colorado has dumped capitation.
[April 2000]
COMPENSATION
MONITOR: Providers gain capitation ground [charts]
National Health Information polled 466 provider groups; among the
questions was, "If you have renegotiated a contract in the last 12
months, has the capitation rate increased, decreased, or stayed the
same?" Answers given by providers contracting with HMOs seem to
indicate that those physicians are seeing better days, but you
shouldn't jump to conclusions. [March 2000]
COMPENSATION
MONITOR: Among Medicare HMOs, Capitation's the Way [charts]
Any way you cut the numbers, capitation is the most prevalent
form of payment by Medicare HMOs for both primary care physicians
and specialists. [February 2000]
COMPENSATION MONITOR:
Capitation payments shrinking[charts]
HMOs seem to be tightening capitation payments to physicians in an
effort to bolster sagging profits, according to a recent survey of
466 provider groups by National Health Information. [December
1999]
COMPENSATION
MONITOR: Meet capitation at least halfway [charts]
MGMA found that practices in 1998 that saw increases in capitation
revenue also rode "predictable" compensation-level curves. Family
practitioners who derived more than half their income from
capitation had higher revenues than those who depended less on this
form of payment, but for primary care in general, the differences
were small. [October 1999]
California
Physicians Struggling — Problems Ahead for Other States?
Primary-care practices are hurting, with bankruptcies by
the week, but California's problems today won't necessarily be
everyone else's tomorrow. [October 1999]
Don't Let a Fee-for-Service Mind Set Distort Your Approach to
Capitation
Both fee-for-service and capitation arrangements can bring
favorable compensation levels, but mixing the two poses problems.
[April 1999]
COMPENSATION MONITOR: All health care is local, but its financing
is universal [charts]
An analysis of HMO payment systems reveals remarkable uniformity,
regardless of market size. Capitation is HMOs' favored method of
reimbursement for primary care physicians, while discounted fee for
service is the primary order of business for HMOs when contracting
with specialists. [October 1998]
NEWS: Managing capitation risk
[chart]
How physician groups with capitated contracts determine capitation
rate adequacy / How physician groups protect themselves from
outliers [April 1998]
LEGAL FORUM: Determine a Comfortable Capitation To
Effectively Negotiate Contracts
The ability of a physician or medical group to determine an
affordable fee payment level is a cornerstone of effective managed
care contract negotiation. [March 1998]
COVER STORY PACKAGE, NOVEMBER 1997
The March of Capitation: Reversed or Just Delayed?
Contrary to many experts' predictions, per-member, per-month prepayment of managed care physicians isn't sweeping the nation. But it can't be counted out, either.'Contact Capitation' and its Cousins
Between fee-for-service payment and pure capitation, health plans are developing several alternative means of paying specialists. So-called "contact capitation" is one of them.The Future of Capitation In a World of Shared Risk
Will global capitation be the means of reducing HMOs to the status of third-party administrators? Experts differ on that one. But they agree that capitation, in its various forms, is here to stay.
COMPENSATION MONITOR: Most physicians flourish under
capitation, despite declining commercial payments
[charts]
Capitation rates are falling, but physicians are nonetheless
profiting under capitation. Data released by newsletter publisher
National Health Information indicate that despite an overall
decline in average per-member, per-month payments in the last year,
most physicians report higher profits from commercial capitation
contracts. [November 1997]
How Capitation Turned Red Ink to Black At Harris Methodist Health Systems
When Harris Health System began posting losses, it became apparent that a new compensation system, with incentives to providers to control costs, was in order. Risk sharing was the answer.Capitation Is for Specialists, Not for Primary Care Physicians
On the theory that capitating primary care can lead to unnecessary referrals, a group of California physicians has decided to pay fees to primary care and to capitate specialists. It seems to work.Making the Transition From Productivity Compensation to Capitation
How do you devise a capitation plan that works? With understanding, hard work and gumption, says the chief financial officer of Sharp Rees-Stealy Medical Group in San Diego.
COMPENSATION MONITOR: How capitation's prevalence varies with
practice size [charts]
More than one-third of all physicians now have capitation
contracts that account for at least some of their practice
revenues, according to recent survey data from the American Medical
Association. That proportion rises to one-half when only members of
the two main primary care specialties are considered. [June
1997]
Capitation Contracts: Time for a New
Attitude
As the health care market evolves, physicians will be wise to
adopt new ways of dealing with managed care organizations, says
this consultant, especially when it comes time to ink capitation
contracts. [April 1997]
COMPENSATION MONITOR: The growth of capitation continues
[charts]
Capitated payment for physician groups has had its critics lately,
but a recent survey by a stop-loss insurance brokerage firm shows
that its prevalence is still on the rise. [January 1997]
Has Productivity Become a Bad Thing?
Under capitation, a medical practice's earnings don't rise
directly with its production. That doesn't mean, says Jeffrey J.
Denning, that productivity payment systems for individual
physicians should be junked. [December 1996]
Will States Ban Capitation?
Salem, Ore., ophthalmologist Gordon Miller wants to ban capitated
payments to physicians. His ballot measure apparently didn't light
up the skies, but some wonder if a brushfire could yet spread.
[November 1996]
Is Paying Physicians By Capitation Wrong?
The concerns of Oregon anti-capitation crusader Gordon Miller draw
a surprising degree of sympathy from managed care experts. But they
say he's tarring good and bad health plans with the same brush.
[November 1996]
The Smart Way To Take 'The Capitation
Plunge'
Think you know everything physicians should consider when they
take on a capitated contract? You may be surprised by what you
learn from this practice-management consultant's succinct advice.
[July 1996]
COMPENSATION MONITOR: Payment by capitation comes on
strong–but so far, mostly in primary care
[charts]
Widely heralded as tomorrow's nearly universal method of paying
doctors because of its potential for limiting costs, capitation now
accounts for some reimbursement of nearly half of all primary care
physicians, according to a recent report. But it lags behind with
specialty physicians, with whom fee-for-service payment remains
predominant. [June 1996]
ETHICS: Should Capitation's Financial Incentives Be Part of
Informed Consent to Treatment?
Capitation asks doctors to shoulder financial risk for their
patients' care. Capitation is defined as a flat "fee per head per
time": usually dollars per member per month. Capitation dollars are
revenue, which is different from income. Income is what the doctor
keeps after health care services are paid for. [April
1996]
