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Class Description:

SPECIALISTS  

The last class explained how Primary Care Physicians acting as “Gatekeeper” are in control of the patient’s continuum of care. Taking that logic one step further, means Primary Care Physicians can decide whether or not to use Specialists.

This class will examine how systems-based practice, and specifically gatekeepers, effects specialists and reasons why some specialists were seeking retraining into primary care, especially during the late 1990s. This class will examine point-of-service plans and uniform billing system. Also, this class will go into more detail about risk sharing pools, a potential source of funds to pay specialists for their services rendered to managed care patients. This class will look at how variable incentive compensation methods are increasingly being used by various entities.

Topics:   

SPECIALISTS

Key Objectives:

  1. Analyze how systems-based practice effects Specialists.
  2. Summarize how gatekeeper effects Specialists.
  3. Describe variable compensation programs in sharing both the risks and rewards of health care delivery.

Review:

  1. Synthesize how systems-based practice effects Specialists, include analyzing carve-outs.
  2. Describe in detail how healthcare moving in the direction of outpatient, group practice, capitated settings would effect Specialists. Also, analyze in detail how healthcare moving in the direction of centers of excellence and pay for performance would effect Specialists.
  3. Describe two reasons incentive pay would be used as part of the Specialist’s compensation.