Capitation Payment Plans and Financial Incentives Place the Patient at Risk of Injury or Death

Purpose:

The purpose of this website is to Save Lives by stimulating discussion on the use of capitation payment systems and financial incentives to the medical insurance companies, medical providers, and medical professionals in the New World of medical care for our nation's population.

This website presents a case study of an actual case which took place in January 2016. It demonstrates what happens, and the medical risks that it poses to the patient when the medical industry is offered the opportunity to utilize capitation payments and financial incentives when making decisions on their patient's health.

Capitation has the effect of flowing the risk down from the insurance company to the patient. Capitation payment systems put medical providers and medical professionals at financial risk in the care of the patients that they serve. The capitation system moves the financial risk from the insurance company and places it in the hands of the medical providers and doctors, making them a quasi-insurance company. Unfortunately for my wife of 52 years, the healthcare providers pushed that risk down on her causing damage to her health and her death. This process puts the patient at risk of harm to their health or death, because medical professionals are now considering their wallet when making decisions on the patient?s health.

The question is; Should capitation and financial incentives to medical providers and professionals be used in our new world of health care which is expected to be a big topic of discussion in the next few years.

Whether or not we have Medicare for all or some other payment method, we need to discuss the use of capitation and other financial incentives as part of our plans,

Capitation and incentive advocates say that it is a cost-saving method that makes healthcare more affordable. Those opposed say that it puts the medical profession and providers in the position of making medical decisions while considering their wallets. Capitation creates a dilemma that a medical provider will consider when making decisions on the patient?s future healthcare.

Capitation is not a new story. This method of payment started in the 1980s and has gone through periods of acceptance and rejection for the last 30 years. The PBS program Frontline produced a program on this subject in the late 1990s. The TV program was called Dr. Solomon?s Dilemma. That program spawned a website that can be viewed today at website address which explains the pros and cons of capitation from the medical provider?s perspective.

We have placed a reading list on this website that considers many of the points of view both pro and con to help the reader understand the question and educate the reader to make their own decision on the use of capitation.

This site contains a case study involving my wife Susan Black who?s life was full of beauty. Unfortunately, her life was shortened due to the actions and in-actions of the insurance company and those in the medical profession that had a duty to operate and make decisions in her best interest consistent with the rules of Medicare Advantage Plans.

A search of the Internet using search words like capitation, and Risk, will result in many different articles regarding the topic that discuss the financial risks to providers and doctors through the use of capitation. What you probably will not find our discussions on the health risk to the patient through the use of capitation and financial incentives. This site is designed to shed light on the chances that the patient takes on as soon as he/she signs on to a policy that contains capitation and incentives. Very few people understand capitation and how it works with your insurance policy. This case study, hopefully, will shed light on the subject so the beneficiaries of insurance policies will be able to make an informed decision should they decide to sign on with capitation.

We believe the insurance company, the medical group, the hospital, the doctors, and the Quality improvement organization (QIO), all breached their duty, through a coordinated effort, to discharge her from the hospital before she was fit to be released. Each of them breached their duties in their way. Each of them benefited in their way by operating to discharge her before she was fit to be discharged.

After a 22 month study by the Medical License Board, the Attorney General has filed an accusation against the attending physician, for Gross Negligence, Repeated Negligent Acts, and Failure to Maintain Adequate and Accurate Records.

This site is just getting started. 4/15/19. It will soon contain all of the medical records, legal arguments, story of my wife's stay in the hospital, laws that were violated, experience with the doctors.
It is not built for revenge or money. Revenge has no place in this discussion.

The focus on the healthcare industries wallet instead of the health of the patient is why we are here having this discussion. We believe that, but for Capitation, the outcome would have been different.

The site is being built to save lives and give information to patients that have had similar experiences to report their story, lawyers to get insight into the lessons learned to use with other capitation cases.
It is designed to shed light on the Motivation, means, and methods, tools, and techniques Used to buy each organization and doctors to discharge her as soon as possible for their financial gain.
Please Email me with your comments. We may or may not use your comments on our website. Under no circumstances will your comments be posted to our website without your written permission.