An innovative model is being tried:
Rather, Qliance’s target demographic is the working poor and uninsured. It does not accept insurance, instead charging between $39 and $74 a month for an individual, depending on age. (The older you are, the more you pay.) That fee covers most of what encompasses primary care, including office visits, phone consultations, common X-rays, and some procedures and lab tests. Other tests, including those for cholesterol, diabetes, and blood count, will be offered at close to cost, for $7 to $17.50 each.
(via The Medical Quack)
Similar Posts:
- Patient costs when making medical decisions
- Should specialists be re-trained as primary care physicians?
- Health reform ignores primary care doctors at its own peril
KevinMD.com on Facebook
{ 5 comments }
Kevin.
If a privare individual pays out of his own pocket, a monthly fee to be on the panel of a certain physician or medical group, it’s called “boutique” care.
If an insurance company paid the same doctor a monthly fee for one of their insured to be on the panel of a certain physician or medical group, it’s called “capitation”.
Why is that?
Why is that? Because they are completely different, that’s why.
The boutique care patient pays both for the “membership,” the privilege of being empaneled and then pays again for care. Whether an outside insurer covers any specific services will depend on the insurance policy and the provisions for out-of-network care. The relationship between the patient and his insurer is just that and nothing more. The insurer does not pay the doctor for anything. The membership fee may include a number of services, annual physicals, immunizations and travel medical consultation, and may leave others to a cash paid as-required basis. That will depend on the particular practice. With the boutique, there is usually a limited number of enrolled patients, which is meant to guarantee a level of service otherwise not available.
In capitation, the practice receives a fixed fee per patient enrolled per period of time which does not vary with the number of services performed, only the time period enrolled. The insurance company pays on behalf of the patient at a rate nominally negotiated between the doctor and the insurer, but usually not. The patient often pays nothing or perhaps a fixed per-visit co-payment. There is no limit on panel size or expectation of a higher level of service by exclusivity.
There are insurances I’ve accepted, where I get a monthly payment from insurance, for that person to be on my panel. If that person actually needed care, the patient’s insurance paid for the service according to the fee schedule, and the patient had certain copays.
I forget the name now, it was some sort of managed care, where the monthly payment was called “capitation”. Though strictly speaking, it was partial capitation.
I had three of them at one time.
Actually, I never participated in any fully capitated plans.
Not much difference between your descriptions of boutique and capitation, except one has an insurance company as an intermediary.
>>There is no limit on panel size
Of course there is. Every contract I’ve had allows me to close to new patients, or I would not sign it. At the worst, you limit your panel size when you close your entire practice to new patients.
>>or expectation of a higher level of service by exclusivity.
Whatever level of service they offer is the same to all their patients. They do all their practice on the same basis. They may have a different level of service compared to other practices, but that’s another story.
Its a great development that providers are starting to experiment with delivering better service. The combination of retail clinics and low-cost boutique care are the start of a system meant to deliver high quality care that serves patient needs…and will grow into better chronic care and specialty care platforms. Join my discussion of this trend at http://consumerfocusedcare.blogspot.com/2007/07/service-moves-downstream-consumers.html
Comments on this entry are closed.