EFFECT OF CONVERSION FROM A FEE-FOR-SERVICE PLAN TO A CAPITATION REIMBURSEMENT SYSTEM ON A CIRCUMSCRIBED OUTPATIENT RADIOLOGY PRACTICE OF 20,000 PERSONS

PURPOSE: To assess the effect of a capitation reimbursement plan with attendant changes in service arrangements on the utilization of radiol ogic services, financially on the payer, and on the satisfaction of pa tients and referring physicians. MATERIALS AND METHODS: Outpatient rad iologic services for a defined population of 20,000 company employees and their dependents were converted from a point-of-service managed ca re plan to a capitation payment plan. Under the capitation plan, nonem ergent outpatient diagnostic imaging was performed at a newly construc ted imaging center staffed by general radiologists. All cross-sectiona l images and certain projectional studies were also over-read (read ag ain after the initial reading by local radiologists) by subspecialists . Utilization data obtained before and after the conversion were analy zed. The financial effect on the employer and the satisfaction of pati ents and physicians were also assessed. RESULTS: Quality imaging servi ces were provided under the capitation plan with financial savings by the employer. Use was higher for crosssectional imaging, especially ma gnetic resonance imaging studies, and was lower for nonmammographic pl ain radiography. Consumer satisfaction was high. CONCLUSION Under cert ain conditions, conversion to a capitation system for imaging can lead to improved quality of care and decreased overall health-care costs.