High Levels Of Capitation Payments Needed To Shift Primary Care Toward Proactive Team And Nonvisit Care

Sanjay Basu; Russell S. Phillips; Zirui Song; Asaf Bitton; Bruce E. Landon

doi:10.1377/hlthaff.2017.0367

Prepayment with Office-Based Physicians in Publicly Funded Programs: Results from the Children's Medicaid Program

PEDIATRICS ◽

10.1542/peds.89.4.761 ◽

1992 ◽

Vol 89 (4) ◽

pp. 761-767

Author(s):

Stephen M. Davidson ◽

Larry M. Manheim ◽

Mina M. Hohlen ◽

Stephen M. Werner ◽

Beth K. Yudkowsky ◽

...

Keyword(s):

Primary Care ◽

Financial Incentives ◽

Primary Care Physicians ◽

Risk Sharing ◽

Financial Risk ◽

Fee For Service ◽

Publicly Funded ◽

Medicaid Program ◽

Alternative Approaches ◽

Capitation Payments

This paper is a report of the results of a demonstration designed to provide empirical evidence regarding the effects of alternative approaches to paying physicians for serving children in the Medicaid program: (1) visit fees set at twice regular Medicaid fees in return for physician agreement to manage utilization and (2) capitation and financial risk-sharing along with the same physician agreement to manage utilization. Participating physicians were assigned randomly to either of the two payment groups. Comparisons of utilization and expenditures were made between these two plans and the regular Medicaid program(fee-for-service, low fees). Results showed no adverse effect of capitation payments on primary care visits to office-based physicians. Capitation physician referrals to specialists decreased relative to all other groups studied, consistent with the theory that the financial incentives in capitation will lead primary care physicians to reduce referrals to specialists.

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Primary care capitation payments in the UK. An observational study

BMC Health Services Research ◽

10.1186/1472-6963-10-156 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 9

Author(s):

Gwion Rhys ◽

Hendrik J Beerstecher ◽

Claire L Morgan

Keyword(s):

Primary Care ◽

Observational Study ◽

Capitation Payments ◽

The Uk

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Measuring equity in per capita primary care investment in Ontario: Challenges for data linkage and analysis

International Journal for Population Data Science ◽

10.23889/ijpds.v3i4.952 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Sue Schultz ◽

Rick Glazier ◽

Michael Green ◽

Tara Kiran ◽

Imaan Bayoumi ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Interdisciplinary Teams ◽

Income Quintile ◽

Fee For Service ◽

Immigrant Status ◽

Per Capita ◽

The Government ◽

Capitation Payments ◽

Almost All

IntroductionFifteen years ago almost all primary care physicians (PCPs) were paid fee-for-service. Now, many physicians receive other payments as well, including capitation payments, incentives and bonuses and funding for other health professionals. It is challenging to track these changes in primary care payment and understand how they relate to individual patients. Objectives and ApproachThe objectives of this study were to assess changes in PCP payments from 2002/03 to 2011/12 and examine differences in per capita investment by urban-rural status, recent arrival (proxy for immigrant status) and income quintile. This required a three-step approach: assigning payments to physicians, assigning patients to physicians and then apportioning the payments by patient. Payments were apportioned based on the type of payment and how the data were captured. For example, capitation payments were paid monthly, but without any detail as to which patients they were for, so all capitation payments were summed and apportioned among all rostered patients. ResultsAll PCPs for whom we had payment data and to whom patients could be assigned were included. Three types of physician-patient 'relationships' were identified: the patient was on the physician's formal roster; the patient was 'virtually' rostered to the physician who provided the plurality of their care; or the patient was part of the physician's overall panel, which includes all patients seen during the year, rostered and not. The type of relationship determined which payment were allocated to each patient. When the $3.5B in payments were apportioned and different populations compared, we found inequities in new primary care investment by income, immigrant status and rurality. For example, we found a disproportionate investment in interdisciplinary teams for non-immigrant Ontarians living in more well-off suburban areas. Conclusion/ImplicationsEstimating per capita primary care investment is a challenging but worthwhile undertaking. The results of this study suggest that the Government of Ontario should facilitate increased participation in new primary care models by immigrants and people living in major urban centres.

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Evaluation of the equity of age–sex adjusted primary care capitation payments in Ontario, Canada

Health Policy ◽

10.1016/j.healthpol.2011.10.008 ◽

2012 ◽

Vol 104 (2) ◽

pp. 186-192 ◽

Cited By ~ 21

Author(s):

Lyn M. Sibley ◽

Richard H. Glazier

Keyword(s):

Primary Care ◽

Capitation Payments

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Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

American Journal of Law & Medicine ◽

10.1017/s0098858800002586 ◽

2003 ◽

Vol 29 (4) ◽

pp. 489-524

Author(s):

Brent Pollitt

Keyword(s):

Primary Care ◽

Mental Illness ◽

Nurse Practitioners ◽

Primary Care Physicians ◽

American Psychological Association ◽

The United States ◽

Psychotropic Medications ◽

American Psychological ◽

Training Requirements ◽

Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

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