Reference no: EM132469377

Risk-Based Reimbursement

A primary care physician is often reimbursed by Health Maintenance Organizations (HMOs) via capitation, fee-for-service, relative value scale, or salary. Capitation is considered as a risk based compensation.

In an effort to understand the intricacies involved with physician reimbursement, particularly in an era of health care reform, identify an expert in the field, such as:

• Hospital Administrator
• Managed Care Organization (MCO) executive
• Health care Consultant
• Legal Professional

Assumption: MCOs use risk-based reimbursement for primary care physicians.

Asking the following questions in the interview:

• What kind of risk do the MCOs assess?
• Does risk-based compensation limit the freedom of primary care physicians in any way in terms of patient care? Why or why not?
• How does the capitation model of reimbursement work? Do physicians generally prefer one model over the other? Why or why not?
• Why do HMOs prefer the prepaid, monthly premium?
• Is pay-for-performance a better model than existing models of compensation? Are there limitations to it as well?