Physician's Capitation Trends

News Briefs

Cap rates rising, study finds

Nearly 70% of providers and HMOs report their capitation rates have increased this year, and 78% say they are either seeking more capitation or maintaining their current level of risk agreements for global coverage, primary care, hospital services, and ancillary services, finds a National Health Information survey.

The study also found:

• an average 2000 global per member per month rates increased 7.4% compared with the 1999 average, rising from $107.88 pmpm to $115.95 pmpm.

• average commercial primary care rates increased 8.8% compared with last year, rising from $11.07 pmpm to $12.05 pmpm.

• twenty-six of 35 specialties saw their commercial cap rates rise this year. Specialties with healthy hikes in the double digits included endocrinology, laboratory, neurology, psychiatry, and radiology.

• 69% of providers said their capitation-related business is more profitable than their discounted fee-for-service business.

Discrepancies found in pay times

The Office of Inspector General has found what it calls a series of serious discrepancies in records tracking how fast the Health Care Financing Administration pays physician claims.

HCFA’s National Claims History File, for instance, shows the agency paid more than 80% of its Part B claims before expiration of the mandatory 14-day waiting period. But the OIG researchers also found HCFA’s Contractor Reporting of Operational and Workload Data (CROWD) system reported that less than 1% of Part B claims were paid before the waiting period closed.

The OIG’s report, Inconsistent Medicare Data Concerning Carrier Payment Dates (OEI-03-00-00350), is available on the web at www.dhhs.gov/progorg/oei.