Evaluating and negotiating payment options
Do you know whether you can afford the bundled payment you are being offered by a payer that has traditionally paid you fee-for-service? Would you actually get a bonus if you participated in another payer’s shared savings program?
As complex as it is to manage fee-for-service payments, payments based on a "budget"—that is, a prediction of how much it will cost to treat a particular patient population or a particular condition—raise a host of issues that physicians must understand to successfully negotiate the evolving payment environment.
For an overview of the manual and how it can help you evaluate, negotiate, and manage budget-based payment systems, including payment bundling, pay-for-performance, withholds and risk pools, capitation and shared savings, please view this 12-minute introductory webinar. You can also view the in-depth version of this webinar, which goes into more detail on each of the manual's chapters, in addition to providing an overview of the manual and its concepts.
Developed by the AMA and experts in physician payment issues, this series of resources discusses each of the various payment options physicians are now being offered and sets forth the key issues physicians must consider when determining whether to agree to a particular payment system, how to determine a fair price and how to reconcile any payments received to ensure that they are accurate. Topics addressed include:
- Introduction: Evaluating & negotiating emerging payment options
- How to establish your baseline costs
- Fee-for-service issues, including issues raised by fee schedules based on the Medicare fee schedule or the Medicare RBRVS
- Pay-for-performance programs
- Shared savings proposals
- Bundled payments
- Withholds and risk pools
- Risk adjustment
- Stop-loss insurance
- Working with actuaries
- Negotiating the deal
- Joint contracting/Collective bargaining
- Ethical implications of financial incentives in Managed Care Contracts
- Evolving compensation methodologies for employed physicians in an era of changing clinical practice, reimbursement and health reform