SAN DIEGO-Many oncologists attending a session on capitation at the Association of Community Cancer Centers’ 14th National Oncology Economics Conference may have hoped the speaker would reveal the “ideal rate” to charge for capitated oncology care, but, unfortunately, “there is no such thing,” Philip L. Beard told the gathering.
SAN DIEGOMany oncologists attending a session on capitation at the Association of Community Cancer Centers 14th National Oncology Economics Conference may have hoped the speaker would reveal the ideal rate to charge for capitated oncology care, but, unfortunately, there is no such thing, Philip L. Beard told the gathering.
What really matters is not just the money promised but all the variables and the level of risk the physician is asked to assume. Even if a payer wont budge on the rate, there are ways to make the contract workableby negotiating exclusions, said Mr. Beard, president of ProSTAT Resource Group, a Kansas City consulting firm. Mr. Beard has represented more than 2,000 physicians in negotiations with managed care providers.
The path that could ultimately lead to a signed contract is littered with land mines, Mr. Beard warned as he outlined some contract hot spots physicians need to watch out for:
Watch out for language that says the plan in its sole discretion will decide whether physicians have met the bonus incentive. The requirements are often so vague, he said, that its like trying to nail Jello to a tree.
In one contract, the payer stated that the providers and the corporation would have to meet or exceed targets on mutually agreed upon quality indicators, but the payer did not provide the indicators.
Physicians need to push for a contract that provides different rates for commercial, Medicaid, and Medicare patients. The contract should also include a statement that rates will be renegotiated if the demographics of the patient pool change.
Physicians should push for protection in case the payers enrollment figures fall below a specified level, such as requiring that payment then revert to fee-for-service. Doctors should also try to exclude unpredictable services, such as emergency and out-of-town services or drugs.
Questions to Ask
When negotiating a contract, physicians must be prepared to ask specific questions on specific issues. Mr. Beard recommends the following: