A new method of specialist reimbursement called contact capitation can put power back in physicians' hands and help physician groups stay within budget.
Geoffrey Baker, managing director of Physician Management Alliance, a San Francisco-based managed-care consulting and software company, will discuss contact capitation in the Medical Group Management Association presentation "Can Contact Capitation Replace Specialty Capitation?" Tuesday, Oct. 6, at 10: 45 a.m.
Contact capitation is a way of distributing funds from a specialist capitation pool to more than one provider in a specialty group. Each physician is paid monthly in proportion to the number of patient referrals, or contacts, made. A contact starts at the initial referral, and the specialist is responsible for that patient over a period of time.
Contact capitation makes physicians more accountable, Baker says.
Because the specialty group begins with a fixed reimbursement pool, payments cannot exceed the established budget. Each doctor in a specialty group gets less reimbursement per contact as the number of contacts increases; each gets more reimbursement per contact as the number of contacts decreases.
Accountability brings more control and allows patients more choices.
"A specialist does not have to go back to an HMO to get additional authorization for treatment," Baker said.
Other reimbursement models that base physician payment on the number of services may not be as efficient, says Julie Jacobs, PMA's director of decision support.
"When you compensate somebody on how much they do, they naturally do more," she says.
But not all specialty groups should jump into contact capitation, especially without a lot of preparation, Baker says.
"Contact capitation is very difficult to administer," he says. "The implementation of contact capitation has had mixed results across the country. People have not put a lot of thought into implementation, which normally takes six to nine months. They jump in. That doesn't work."
Group managers must also make sure that physicians understand contact capitation and accept its pluses and minuses.
"Anyone who attempts to skirt or skimp on the physician buy-in process will fail," Baker says.