As a manager in a medical setting, it is an expectation to continuously seek out

Question

As a manager in a medical setting, it is an expectation to continuously seek out new opportunities to save money and manage patients more efficiently.  In this scenario, assume the role of a manager in a medical clinic.  A new opportunity to work with an MCO has been made available to the clinic and needs to be brought to the senior management team.

Instructions:

Write a memo to the senior management staff explaining the new MCO opportunity.

In the memo, include the following:

Summarize the three reimbursement methodologies (capitation, discounted fees, and salaries) in 250 words or less.

Choose one of the three reimbursement methodologies to recommend to the senior staff.

Provide a rationale for the selection.

Discuss the pros and cons of the methodology.

Explanation / Answer

MEMORANDUM

TO: CHIEF MEDICAL OFFICER (CMO)

FROM: CLINIC MANAGER

DATE:- 14 SEPTEMBER,2018

SUBJECT:- OPPURTUNITY FROM MCO

A LEADING MCO HAS APPROACHED OUR CLINIC TO HELP US TO IMPROVE OUR MEDICAL FACILITIES AND THEY HAVE SUGGESTED US TO IMPROVE OUR REIMBURSEMENT METHODS SO THAT UNNECESSARY HEATH CARE COST COULD BE REDUCED AND PATIENTS WILL GET BETTER HEALTH CARE FACILITIES.

For this they have suggested 3 methodologies for further concern and finalise the one we found best they are:-

1. Capitation:- In this type of reimbursement method physicians are paid a fixed amount per enrollee, not per service, on a monthly basis.

2.Discounted fees for service : in this method -physicians are paid for every service and test they provide based on a fee schedule or pre-determined discount rates that are charged from other physicians in the market.

3.salaries:- In this method  physicians are paid a fixed weekly or monthly amount, and pay is not tied to enrollees or services rendered.

According to me the best option will be of theDISCOUNTED FEES FOR SERVICE.

As it is the type of reimbursement method in which physicians are paid on the basis of the services provided by them also at discounted rates as compared to other physicians in the market.

Adavntages:-

Disadvantages:-

To balance it out we can provide Bonuses to the physicians at the end of the year,for keeping the health plan's payments, particularly to specialists below a pre-determined budget .Bonuses may also be determined from measures of patient satisfaction, access and outcomes of care.

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