Calculate the amounts paid to the primary care physicians (PCPs) and specialty care physicians (SCPs) if the following withhold system is in place.
PCP SCP
Payment $38 PMPM $70 per visit
Annual Budget (10,000 lives) $4,560,000 $1,050,000
Withhold 10% 20%
Risk Pool $456,000 $210,000
Split 68.5% 31.5%
A. Assume that actual billings correspond exactly to the budget, i.e. total SCP billings equal $1,050,000 (15,000 visits).
B. Assume that the use of specialist services is less than planned, i.e. total SCP billings equal $980,000 (14,000 visits).
C. Assume that the use of specialist services is greater than planned, i.e. total SCP billings equal $1,260,000 (18,000 visits). What is the marginal revenue per specialist visit in excess of the planned 18,000 visits?