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How can vascular surgery survive capitated care?
1University of Colorado School of Medicine 80498, USA.
Insights
Vascular surgeons must adapt to capitated care by controlling costs and optimizing resource use. Success requires efficient practices, conservative interventions, and understanding per capita costs for contract negotiation.
Area of Science:
- Health Economics
- Vascular Surgery
- Managed Care
Background:
- Fee-for-service and capitated care models present distinct challenges for vascular surgeons.
- Managed care, despite flaws, is likely to persist for cost containment.
Purpose of the Study:
- To explore the impact of capitated care on vascular surgical practice.
- To identify strategies for vascular surgeons to succeed in managed care environments.
Main Methods:
- Characterization of fee-for-service vs. capitated care differences.
- Exploration of practice scenarios and potential solutions (gatekeepers, carve-outs).
- Analysis of key success factors in managed care.
Main Results:
- Capitated care necessitates efficient use of diagnostics, conservative interventions, and hospital resources.
- Vascular surgeons must develop efficient practice environments and understand their costs.
- Effective contract negotiation requires per capita cost analysis.
Conclusions:
- Vascular surgeons need to prepare for and adapt to managed care systems.
- Efficiency in resource utilization and cost management are crucial for success.
- Understanding practice costs and patient populations is vital for contract negotiation.
Abstract:
The basic differences between fee-for-service and capitated care are characterized and how they are likely to impact the practicing vascular surgeon are explored. Likely practice scenarios under capitated care are given. If the potential problems associated with using primary care "gate keeper" physicians materialize, secondary "carveouts" by vascular specialists may prove feasible. The alternative, particularly in large patient care consortiums, is to educate gatekeepers with efficient management algorythms in exchange for appropriate referrals. In spite of demonstrable flaws and abuses, capitated, managed care is likely to persist in some form, as an effective way to control spiraling health care costs. Therefore, vascular surgeons need to be prepared to compete under such systems. The major keys to success are efficient use of diagnostic tests, applying conservative, cost conscious indications for intervention, and efficient use of hospital resources (judged by lengths of stay in the intensive care unit and hospital and readmissions under the same diagnosis). In addition to developing better practice profiles, in these and standard mortality and morbity parameters, vascular surgeons need to create or join an efficient practice environment, with a minimum number of efficient personnel and teaching and research costs tightly controlled. To negotiate contracts effectively, vascular surgeons must know their costs, of delivering care on a per capita basis in their environment, adjusted for specific (eg, working or retired) patient populations. Outcomes and cost comparisons and other management research must vie for attention with new technology and basic research.