Capitated contracting for emergency services.

Abstract

As a way of gaining further control over the cost of healthcare delivery, more managed care organizations are seeking to negotiate capitated contracts for emergency department services. In many instances, these contracts do not include disincentives that would discourage primary care physicians from sending patients who require nonurgent care to emergency departments for treatment. Without such disincentives, emergency departments may have to bear a considerable financial burden for providing additional services. Prior to negotiating the terms of capitated contracts for emergency services, managers should analyze carefully how patients use emergency department resources. By negotiating with managed care organizations to include volume stop-loss provisions and other financial disincentives to curb overutilization by physicians, financial managers can help protect their organizations from the costs of overutilization.