Computer software may be most useful in helping physicians analyze reimbursement under capitated contracts. Some programs allow users to import data from their practice management systems, making it even easier to run these comparisons. Ms. Stelzer also uses computer technology to make sure the group's practitioners are getting paid fairly. Seven physicians and a nurse practitioner receive capitated payments for assigned groups of patients, and when colleagues cover for another the software helps ensure no one gets stuck caring for too many of the other's patients. But if one physician sees 50 and the other physician sees none of anybody else's patients because he's too busy, we need to look at that from an income standpoint.
Software can help physicians forecast the financial effects of signing a capitated contract.
Many reimbursement programs contain detailed utilization estimates that help predict how many office visits and procedures the average patient will need in a year. Internists, for example, do not want utilization data that lump all patients over age 65 into one group. Specific utilization data can be invaluable in disputing fees. A growing number of computer programs can help physicians deal with reimbursement issues in managed care. Products range from overall practice management systems that handle all the needs of large groups to smaller, niche systems that carry out more limited functions such as creating fee schedules.