Levin D C, McArdle G H, Lockard C D
Department of Radiology, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
Radiology. 1996 Mar;198(3):651-6. doi: 10.1148/radiology.198.3.8628849.
The authors describe how to develop and manage a capitated outpatient radiology contract. Aspects of a capitated fee structure and the need to apportion fees between a hospital and its radiology group are discussed. During negotiations with a managed care organization (MCO), certain information and commitments should be obtained. Utilization data should also be obtained from the MCO, but if they are not available (or are thought to be unreliable), certain norms can be used. Once a utilization projection is arrived at, reimbursement calculations can be made and compared with assumed reimbursements under a known fee schedule, such as that of Medicare. This procedure allows one to estimate whether a capitated proposal is financially feasible. Once a contractual agreement is instituted, the radiology group must then track and manage utilization. An understanding of these principles should enable radiologists to deal effectively with both practice and fiscal concerns presented by managed care.
作者介绍了如何制定和管理按人头付费的门诊放射科合同。讨论了按人头付费结构的各个方面以及在医院及其放射科之间分配费用的必要性。在与管理式医疗组织（MCO）谈判期间，应获取某些信息并做出承诺。还应从MCO获取使用数据，但如果数据不可用（或被认为不可靠），则可以使用某些标准。一旦得出使用量预测，就可以进行报销计算，并与已知收费表（如医疗保险收费表）下的假定报销进行比较。此程序可以估算按人头付费提案在财务上是否可行。一旦签订合同协议，放射科就必须跟踪和管理使用情况。理解这些原则应能使放射科医生有效应对管理式医疗带来的业务和财务问题。
