Bass, Berry & Sims attorney Nesrin Tift provided comments for an article in Modern Healthcare detailing the hidden risks of capitated payment models for physicians. Under this type of payment model, a healthcare provider is reimbursed at a set rate related to patient care, regardless of cost to the provider. While this model can provide more flexibility for physicians, there also can be more red tape to consider before adopting it in full.
“It can be trickier in states where insurance law is grayer on what constitutes risk, and there is an element of having to sort of carve the path themselves and then potentially be subject to regulation at the state insurance level,” Nesrin said.
In addition, Nesrin warns that providers will still be liable under state and federal fraud and abuse laws to determine relationships between physicians and referral sources.
The full article, “Capitated Payment Models Come with Lots of Hidden and Not-So-Hidden Hurdles,” was published by Modern Healthcare on September 19 and is available online (subscription required).