EhBeth & Misti-I had to switch my mom from a regular Medigap policy, to a Medicare HMO, because the cost of the Medigap was too high for her to handle. When I was doing my "homework" I asked for some info. that is contained in this letter. It is five years old, but nothing really has changed.
If you read it carefully, you will perceive some of the implications of this system, and believe me, it is horrendous!
Dear Medicare Complete Member:
Thank you for inquiring about our physician incentive -arrangements. We have several different types of contractual arrangements with our physicians, depending on the physician, physician group, or location within Florida. Your physician is paid according to one or more of the following types of arrangements: -
Arrangement A: We pay some physicians negotiated fee for service, which is a predetermined amount for each service they provide. This amount may be different than the amount the physician usually charges. Physicians under this arrangement do not receive any additional payments as part of an incentive plan. -
Arrangement B: We pay some physicians a salary - this applies only to the CAC Medical Center physicians. There are no additional incentive payments made to these physicians based on their referrals to other providers.
Arrangement C: We pay some physicians a capitation for primary care and/or specialty services. Capitation is a fixed amount of money each month to provide specific services to the members they see. This fixed amount is the maximum amount a provider would receive. No additional payments are made as part of an incentive arrangement.
Arrangement D: We pay some physicians a.capitation, and withhold a certain percentage of this fixed amount of money. If their expenses are less than budgeted, the health plan gives the withheld money back to the physicians. They may also be eligible for an extra amount of money (a ."bonus") if the costs of referral services are less than a budgeted amount.
Arrangement E: Some capitation arrangements provide the physician or physician group a global budget, with which the providers are responsible for providing or arranging for A types of care, including primary care and all referral services (both inpatient and outpatient). if the physicians' expenses are less than budgeted, the health plan rewards the physicians with an additional payment. The physicians assume substantial financial risk if costs-are greater than the' budgeted amount.
Note: In order to reduce the financial risk in arrangements such as D & E above, the Plan or the physicians purchase "stop-loss insurance," which is special insurance to protect the physician or
physician group ftom very large financial losses.
United HealthCare of Florida is required by the Health Care Financing Administration to survey .our current and previously enrolled members to ask if they believe they received the care they needed and if they were satisfied with the quality of care they received. The results of our survey W'@l be available after [email protected]
1, 1998, and can be obtained by contacting the health plan Member Services phone number on your ID :card or in your Member Handbook.
Thank you for your interest in United HealthCare of Florida.
HCFA T 4255 A 04/97