Capitation continues to grow
Most group practices throughout the country now derive at least some of their revenue from capitation, according to the latest survey from the Medical Group Management Association.
The report, which is based on 1997 data, found that the percentage of physician groups accepting capitation varies depending on the size of the group. Nearly 55% of groups of 10 or fewer physicians accept capitation, while 92% of groups with more than 75 doctors accept risk. The survey also found that multispecialty groups of all sizes were more likely to accept capitated patients than single-specialty groups.
To order a free copy of the "Managed Care Digest Series, Medical Group Practice Digest 1999," call Hoechst Marion Roussel at 800-529-9615.
OIG: Fees for Medicare+Choice plans need to be readjusted
A new report from the HHS Office of Inspector General (OIG) says that Medicare might overpay health plans in the Medicare+Choice program more than $34 billion over the next decade unless HCFA adjusts its payments.
Under the Balanced Budget Act (BBA) of 1997, HCFA was directed to use standardized county rates as the basis for capitation payments to health plans. According to the OIG, however, these rates were based on actuarial estimates that will pay health plans 4.2% more than their actual costs.
During the next five years, the OIG warned, the numbers could cost Medicare more than $11 billion. The OIG has recommended that HCFA seek legislation to correct the problem.
In San Diego, a new source of help for the uninsured
The medical community in San Diego has decided to do something about the growing number of working- and middle-class people without health insurance.
Through a program called A2Z Consumer Choice, hundreds of physicians and other health care providers have agreed to substantially discount their fees for people with no health insurance. (A typical initial visit to a generalist costs between $25 and $36.) The program has also set up a guaranteed loan program for patients who can't afford even the discounted fees. It also helps patients locate low-cost health insurance.
Last year, A2Z served 15,000 people in San Diego. For more information, call 800-771-3325 or visit its Web site at www.a2zmedline.com.
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