Kennedy K M
ECG Management Consultants, Seattle, WA, USA.
Healthc Financ Manage. 1997 Feb;51(2):44-9.
Evaluating the financial terms of capitation contracts and negotiating their nonfinancial provisions are becoming increasingly important responsibilities for healthcare financial managers. To evaluate the financial terms of a contract, financial managers must understand both incremental and replacement pricing strategies. They also must understand when strategic positioning objectives make a capitated plan attractive despite limited financial rewards. Before a contract is accepted, financial managers can take steps to increase its potential profitability by negotiating the nonfinancial provisions that can help control contract expenses. These provisions are related to services to be provided, payment terms, withholds and risk pools, access to data, provision of eligibility data, utilization review and quality assurance procedures, filing of grievances, contract renewal terms, and contract termination.
评估按人头付费合同的财务条款并就其非财务条款进行谈判，正日益成为医疗保健财务经理的重要职责。为了评估合同的财务条款，财务经理必须理解增量定价策略和替代定价策略。他们还必须明白，尽管财务回报有限，但在何时战略定位目标会使按人头付费计划具有吸引力。在接受合同之前，财务经理可以通过就有助于控制合同费用的非财务条款进行谈判，采取措施提高合同的潜在盈利能力。这些条款涉及提供的服务、付款条件、预扣款项和风险池、数据访问、资格数据提供、利用审查和质量保证程序、申诉提交、合同续签条款以及合同终止。
