· Half the primary care doctors in the US are at some financial risk for the care
· The top five states for doctors involved in risk-based contracts are:
California, Arizona, Minnesota, Florida and Massachusetts.
· Though most medium-to large-size metropolitan area in the U.S. will have
doctors who are capitated in risk-based contracts, rural areas, where there are
fewer patients to form risk pools, often have doctors still being paid on a
per-procedure basis (known as fee-for-service).
· In California, the state where risk-based, capitated contracts have the longest
history, doctors receive monthly fees ranging between $35-$50 for each patient
they see who is covered by a commercial plan. They must manage the total care
of that patient for that amount. If a patient needs extensive care, that
patient becomes a money-loser for the physician's practice.
· According to PriceWaterhouseCoopers, 10 percent of the medical groups in
California are operating under Chapter 11 protection, while one-third of the
medical groups are at or near bankruptcy. The cause: Doctors are not able to
cover the operating costs of their practices based on the reimbursement rates
of these risk arrangements.
· The number of patients doctors have in capitated, risk-bearing contracts varies
from practice to practice. However, when as little as 25 percent of a doctor's
patient pool is capitated, that provider will generally treat all patients as
capitated, meaning he or she will become cost-conscious indiscriminate of the
fact that many are covered by traditional indemnity health plans.