Cost Control and Capitation Flashcards
The potential to lose money, earn less, or spend more time without additional payment on a reimbursement transaction is known as…
Risk
This reimbursement type is characterized by the party paying the bill (e.g., insurance company, government agency, or patient) being the one who absorbs all the risk.
Fee for service (FFS)
Which unit of payment for services is characterized by “payment per visit or procedure” and has the incentive to provide more services to bring greater revenue?
A. Fee for service
B. Per episode of illness
C. Per diem payments to hospitals
D. Capitation
E. Payment per time period
A. Fee for service
Which unit of payment for services is characterized by “one payment made for each patient per month (or year)”?
A. Fee for service
B. Per episode of illness
C. Per diem payments to hospitals
D. Capitation
E. Payment per time period
D. Capitation
Which unit of payment for services is characterized by “physician is paid one lump sum for all services delivered during an episode of illness” and has the incentive to limit the number of visits?
A. Fee for service
B. Per episode of illness
C. Per diem payments to hospitals
D. Capitation
E. Payment per time period
B. Per episode of illness
Controlling price inflation, eliminating ineffective care, prevention, and innovation are examples of what strategy?
Cost containment
What are the two mechanisms for controlling costs?
Financing and Reimbursement
What is financing?
controlling the flow of dollars (premium and taxes) from purchasers to insurers
What is reimbursement?
controlling the flow of dollars from insurance plans to providers
How may adding OTs into the intensive care unit help with cost containment?
Less hospital readmission
What is the major difference between the British healthcare system and the US healthcare system?
UK- everything covered except some prescription costs which sometimes need to be paid out of pocket.
US- you must pay attention to and understand very clearly the health plan you select.
What are the 3 managed care plans and give a brief description?
- Fee-for-service with utilization review: coverage can be authorized or denied; payment per service rendered
- Preferred Provider Organizations (PPO): insurers contract with specific hospitals/providers on a discounted FFS/UR
- Health Maintenance Organizations (HMO): Patients must see providers in HMO network only
How is OT impacted by cost containment strategies?
Could be good — increase in jobs, salary, more complex patients
Or bad — if 20-year cap of Medicare B not repealed
