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All America HMO pays its primary care physicians (PCPs) by capitation, but a percentage of the total capitated amount is withheld and distributed to individual
All America HMO pays its primary care physicians (PCPs) by capitation, but a percentage of the total | ||||||||
capitated amount is withheld and distributed to individual PCPs based on aggregate PCP performance. The | ||||||||
financial goal of importance to All America is to achieve total actual specialty care and hospital costs less | ||||||||
than budgeted. To this end, All America provides a financial incentive to its PCPs to encourage careful | ||||||||
referral of patients to these services. The financial incentive is based on the referral gain or loss, defined | ||||||||
as the difference between the actual and budgeted specialty care and hospital cost. More specifically, All | ||||||||
America uses the following risk sharing rules: | ||||||||
If a total referral gain, then all of the total withhold is returned to the PCPs | ||||||||
If a total referral loss < total withhold, then the difference (withhold - referral loss) is returned to the PCPs based on the number of patients per PCP | ||||||||
If a total referral loss > total withhold, then none of the withhold is returned to the PCPs | ||||||||
Last year, All America's capitation payment to the PCPs was $20 PMPM, but 15 percent of this amount was | ||||||||
placed into the PCP risk pool. The budgeted amount for specialty and hospital costs was $50 PMPM. At | ||||||||
the end of the year, the following data were recorded for the four All America PCPs: | ||||||||
Dr Smith | Dr Barney | Dr Wells | Dr Fargo | |||||
Number of patients | 600 | 800 | 1,000 | 1,600 | ||||
Actual referral costs | $504,000 | $470,000 | $590,000 | $880,000 | ||||
Calculate the total compensation of each PCP at the end of the year. Dr. Smith: Dr. Barney: Dr. Wells: Dr. Fargo: |
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