HMO Doctors... How do they get Paid ?

[Mike Siegal]

Hey Buds,

(I think i know the answer, but i need confirmation)

QUESTION: DO 'Primary Care HMO under 65 doctors' get paid on 'the number of patients whom selected them as their Primary' (even though they may never see them)?

• DR SMITH: Has 400 HMO Patients (choose him as primary)
• DR WEBB: Has 1000 HMO Patients (choose him as primary)

Theoretically, Dr Webb should be making more $....Correct ?

NOTE: In MA, the above ex. Webb makes more $ than Smith (generally speaking). Medicare pays both Dr a fee every month for doctors on the books (whether they see them or not).

Is it THE SAME with HMO under 65 ?

 

[LeeV]

Depends on the HMO model, and there is no set method, each can be tailored. Staff Model will pay a salary, and have bonuses. Group Models, think of Kaiser, have salary and bonuses. Bonus can be based on quality outcomes, profitability, etc. An IPA doctors earn a fee based on services rendered or a monthly fee per HMO patient, regardless of whether the patient is seen. Open Ended HMO's tend to mimic IPA.

 

[Carmelo Belardo]

When a patient has an HMO rather than a PPO or EPO, the doctor isn't compensated at all for an office visit. Instead, each HMO patient who picks that doctor receives a monthly compensation known as a capitation. To learn more: USHEALTH Group | Family and Individual Health Coverage

 

[LeeV]

When a patient has an HMO rather than a PPO or EPO, the doctor isn't compensated at all for an office visit. Instead, each HMO patient who picks that doctor receives a monthly compensation known as a capitation. To learn more: USHEALTH Group | Family and Individual Health Coverage

Carmelo, thanks for the reply, but it is not true. Some HMO providers may be paid on a capitation, some may not.

 

[goillini52]

in my province there is a public website link that provides a breakdown of the annual billings to the govt. of each physician in the province. I would imagine the same type of info. is probably available in most provinces. If so, can anyone provide the link for that info. for Ontario?

We don't have provinces here.

 

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[rmhaire]

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