View Full Version : 8M quickie

08-21-2002, 12:08 PM
Hi. In FFS/PPD chapter 1, the flowchart example of the Asbury Medical group capitation on the last page or so of the chapter, Asbury Medical Group gets paid a $48.89 PMPM capitation rate. No problem.

There's also risk-sharing; the book says that "if the HMO's shared risk pool has a surplus/deficit at the end of the year, Asbury Medical Group earns/loses 15% of the profit loss". This is completely independent of the $48.89 capitation, right? The Asbury Group always gets its $48.89 capitation, no matter what, right? Just making sure.

Thank you,

08-23-2002, 09:36 AM
I am not 100% certain, but I think the physician group gets the $48.89 capitation initially. At the end of year, if there is a surplus in the shared risk pool, then the physician gets 15% of the surplus. If there is a deficit, then the physician needs to pay to the HMO 15% of that deficit. So technically, the $48.89 is at risk, since they may have to give some of it back.

08-23-2002, 11:06 AM
Josie - thank you very much!

I have another related qwestion. In SN 8GM-305, they give a bunch of examples where there are two "risk funds" -- a Professional Fund and an Institutional Fund -- and at the end of the year, there is a surplus/deficit in those Funds, the physicians earn extra money / don't get back their withhold.

Are these Risk Funds the same thing as "Capitated Pools" in Kongstvedt Ch. 8? Thanks!