PHP 0310 Lecture 7: 02-08 Managed Care
9 Feb 2017
School
Department
Course
Professor
Document Summary
Units of payment: continuum of aggregation (focus on archetypes of two extremes: fee for service: visit or procedure, per diem rates for hospitals, episode of illness. Bundling: capitation payment: a single payment per month/year for all care for a single person. Fee for service: historically physicians are paid usual, customary, and reasonable rate (ucr) Physicians set fees, patients and insurers paid them. Today in nyc, this is still the way it works: many private specialists won"t accept insurance, you have to pay cash. This approach has all but disappeared: gradually replaced by fee scheduled, determined by payers. Medicare uses resource based relative value scale (rbrvs) used for outpatient visits/procedures. Incentive is for volume, not quality of service. If you reduce per unit rates --> lost income is made up for in volume: culture in the us (both providers and patients) *all of these are untrue : carreyrou imrt wsj article. Imrt: intensity modulated radiation therapy for prostate cancer.
