You are a new physician setting up your own practice in a new town. You are...

You are a new physician setting up your own practice in a new town. You are researching the different MCOs offered in your area and are considering becoming a physician for one of these networks. You have also invited the sales representatives of several health plans to speak with you about the benefits of choosing their plans. Based on the above scenario, answer the following questions: What effects would joining a MCO have on your clinic regarding staffing, patient volume, and financial stability? What policies and procedures should be used by the MCOs to reduce costs for their clientele? Discuss the ethical issues or concerns about MCOs providing a lower quality of care compared to traditional fee-for-service (FFS) organizations? What are some of the questions you would ask each representative about his or her company's specific plan that will help you make a decision? Do you believe that the evolution of MCOs and consumer driven health plans (CDHPs) has affected the healthcare environment today by integrating the financing and delivery of healthcare services? If yes, how? How have the roles and relationships between physicians and patients changed by each of these types of plans?

Expert Solution

Answer:-

The staff has to be decreased, the patient volumes will increase and will cause difficulty for hospital financially.

MCO's sometimes may ask doctor to minimize certain surgical procedures, This will help them minimize costs, MCO's further pay lower than traditional plans which also helps them reduce costs

MCO's are consumer driven plans, you get what you pay for. But, MCO's are not bad after all they are governed by policies. It is far better to have MCO than not having insurance at all

Please clearly mention who will take decision about procedures to be performed on patients is it me or the MCO company

If patient needs certain procedure immediately what will MCO do, Do they automatically authorize us with faith in us or we have to call their helpline

Yes, MCO's to a large degree helped customers to get health insurance which otherwise is out of reach of most self-employed or low wage earners

Physician has become point of contact not decision maker. This is one troublesome feature of MCO.

Rahul Sunny answered 2 years ago

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