Mountain HMO pays its primary care physicians (PCPs) by capitation, but a percentage of the totalcapitated amount

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Question:

Mountain HMO pays its primary care physicians (PCPs) by capitation, but a percentage of the total capitated amount is withheld and distributed to individual PCPs based on aggregate PCP performance. The financial goal of importance to Mountain is to achieve total actual specialty care and hospital costs less than budgeted. To this end, Mountain provides a financial incentive to its PCPs to encourage careful referral of patients to these services. The financial incentive is based on the referral gain or loss, defined as the difference between the actual and budgeted specialty care and hospital cost. More specifically, Mountain uses the following risk-sharing rules:

If a total referral gain, then all of the total withhold is returned to the PCPs
If a total referral loss < total withhold, then the difference (withhold - referral loss) is returned to the PCPs based on the number of patients per PCP
If a total referral loss > total withhold, then none of the withhold is returned to the PCPs

Last year, Mountain's capitation payment to the PCPs was $20 PMPM, but 10 percent of this amount was placed into the PCP risk pool. The budgeted amount for specialty and hospital costs was $50 PMPM. At the end of the year, the following data were recorded for the four Mountain PCPs:

Dr FargoDr BarneyDr WellsDr Smith

Number of patients 600 800 1,000 1,600

Actual referral costs $346,000 $610,000 $590,000 $880,000

a) Calculate the total compensation of each PCP at the end of the year.

b) Were each of the PCPs fairly compensated? What incentives does this single risk pool based on aggregate PCP performance present to the individual PCPs? What should be investigated to assess the fairness of the PCP compensation?

Use Excel in presenting the answers for your work. Be sure to show calculations (using cell formulas is suggested).