Reference no: EM133130389

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Risk-Based Reimbursement

For your assignment, a primary care physician is often reimbursed by Health Maintenance Organizations (HMOs) via capitation, fee-for-service, relative value scale, or salary. Capitation is considered as a risk-based compensation.

To understand the intricacies involved with physician reimbursement, particularly in an era of health care reform, identify and interview an expert in the field, such as:

• Hospital Administrator

• Managed Care Organization (MCO) executive

• Health care Consultant

• Legal Professional

Assumption: MCOs use risk-based reimbursement for primary care physicians.

Ask the following questions in the interview:

• What kind of risk do the MCOs assess?

• Does risk-based compensation limit the freedom of primary care physicians in any way in terms of patient care? Why or why not?

• How does the capitation model of reimbursement work? Do physicians generally prefer one model over the other? Why or why not?

• Why do HMOs prefer the prepaid, monthly premium?

• Is pay-for-performance a better model than existing models of compensation? Are there limitations to it as well?