CONSIDERATIONS – Class 4

1. In your opinion, should HMO’s be required by law to allow specialists to use third party mediators to settle disputes with HMO’s on patient care. If yes, why and who would be the third party mediators. If no, why not.

2. Under managed care, list the concerns of being a specialist.

3. If your practice as a specialist does not keep you as busy as you would like, list alternatives of what would you do.

4. List factors you would look at to determine whether you should be a PCP or a Specialist.

5. Under managed care, some specialists may find they have increased volume of patients and financial opportunities. Other specialists might find they have decreased volume of patients and financial opportunities over time. List reasons why some specialists would be winners under managed care and others might be losers.

6. List three reasons some Specialists seek retraining.

7. Describe two reasons incentive pay would be used as part of the Specialist’s compensation.

8. You are a specialist and you are referred a patient by this patient’s PCP. The PCP authorizes three visits and then tells the patient that your services are no longer needed and that the PCP can provide continuing care. You think the patient needs more care by a specialist with your type of training and that the PCP is wrong. What do you do?

Scenario: You are a cardiovascular specialist. A PCP referred a patient to you for specific needs. You met with the patient and provided those specific services as requested by the PCP and in so doing discovered other complications in which you recommend certain services that you believe only a cardiovascular specialist is qualified to perform. You inform the PCP of this situation and recommend you continue seeing the patient for about five more visits. The PCP says thank you for the information but that he/she will take over at this point. What do you do?

9. You are a specialist and your managed care contract requires you to use a certain laboratory for all testing if you want to be compensated for those lab teats. You believe the laboratory is incompetent, what should you do?

10. You are an angioplast cardiologist for a hospital and have a research grant. Your research funding is getting significantly reduced and you are considering going into private practice as a specialist. List the factors you would look at to make your decision.

11. An endocrinologist with continuous treatment of diabetic patients over an extended period of years can possibly reduce potential costly bad outcome in the future for those patients. How do you determine when it is cost effective to treat all patients the same and use the savings (from not continually treating potential bad outcome) for actually incurred bad outcome.

12. At what point do you as a PCP accept uncertainty and quit ordering tests and referring patients to a specialist?

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