tag:blogger.com,1999:blog-32053362.post1353389732134955606..comments2024-03-18T06:27:51.599-04:00Comments on Not Running a Hospital: Something we could learn from changes in referral ratesPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-32053362.post-34923862607017272302012-01-30T17:24:27.550-05:002012-01-30T17:24:27.550-05:00This from HSR's special payment reform issue l...This from HSR's special payment reform issue last month http://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2011.01294.x/abstract<br />might be relevant: "[Primary care][P]hysicians in highly capitated practices had the lowest total costs and intensity of care, suggesting that these physicians develop an overall approach to care that also applies to their FFS patients."Marco Hueschnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-52968000333393146342012-01-30T14:00:31.939-05:002012-01-30T14:00:31.939-05:00If you look at this strictly from a viewpoint of w...If you look at this strictly from a viewpoint of what generates the most revenue for a health care system, then it makes sense to structure things so that your primary care docs do not have the time to perform an adequate job, and are encouraged to refer up the food chain. The specialist canthen garner a larger profit margin.<br /> <br />PCPs that are self employed may also be under less constraints as to the number of patients they need to see as well as the time frames of appointments. Also, as systems become larger with staff and PCPs that are not as familiar with the patient, you may also encounter more situations where there is not appropriate time booked for the patient. My staff knows of those patients that are more complicated and likely to take more time and books extra time accordingly.<br /><br />It all depends on whether your trying to build a cost efficient health care system or one that churns out income. Unfortunatly, most seem more interested in the income stream which is why our health care system has tilted so heavily toward high tech specialty care as opposed to most other world wide health care systems with a single payer interested in constraining cost; or at least getting quality for its money.Keithnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-79315631115072119282012-01-29T19:35:42.235-05:002012-01-29T19:35:42.235-05:00Even in areas with greater ratios of primary care ...Even in areas with greater ratios of primary care to specialists (and presumably less referrals due to the math and panel size), mitigating cost is complex and hard to untangle. If I had to bet, if you looked more deeply, the association between referrals and utilization would be highly variable, and not one that would repair with a top down fix.<br /><br />http://content.healthaffairs.org/content/28/5/1327.abstract<br /><br />BradBrad Fhttp://blogs.hospitalmedicine.org/SHMPracticeManagementBlog/?author=14noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-37560660688733108632012-01-29T18:49:42.892-05:002012-01-29T18:49:42.892-05:00I'm going to put my money on this being predom...I'm going to put my money on this being predominantly a PPO phenomena and not seen as much with managed care contracts, and further wager that it is higher outside of small practices.<br /><br />Here's the reasoning: out here in CA large companies like Sutter are gobbling up smaller practices and clinics. If a patient has a PPO then turning one visit into multiple visits (via referral) all the money stays in-house since the referral will be to another doctor under the corporate umbrella. Since doctors get paid a share of the profits...Anonymousnoreply@blogger.com