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1) Dr. Maguire, a local pediatrician, accepts Red Square Insurance, a commercial insurance company, for payment. Since Dr. Maguire has agreed to accept a 20%
1) Dr. Maguire, a local pediatrician, accepts Red Square Insurance, a commercial insurance company, for payment. Since Dr. Maguire has agreed to accept a 20% discount off of their normal charges, Red Square has made Dr. Maguire a member of their 'preferred provider' list. If Dr. Maguire normally charges $100 per routine office visit (a pretty standard amount in the region). A) Is this a Fee for Service, Capitated, or Bundled Payment kind of reimbursement (payment) model? Why do you think that? B) If Dr. Maguire's business goes from treating 5 patients with Red Square per week to 8 patients with Red Square insurance per week, would their revenue from Red Square increase, decrease, or stay the same? Why? 2) Give 3 examples of how (i.e. tools, operating policies, restrictions) managed care "manages" health services usage and controls expenditures
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