Medical supplies abstract
Methods for capitation of medical supplies including determining
a fixed price for medical supplies to be used in a medical procedure,
and billing a buyer based on the number of medical procedures performed
times the fixed price are provided.
Medical supplies claims
1. A method for capitation of medical supplies, comprising: determining
a fixed price for medical supplies to be used in a medical procedure;
consigning the medical supplies for at least one of said medical
procedures to a buyer; recording the number of said medical procedures
performed during a predetermined period of time; and billing the
buyer based on the number of said medical procedures performed times
the fixed price.
2. The method of claim 1, wherein the fixed price is determined
by a negotiation between a supplier of the medical supplies and
the buyer.
3. The method of claim 2, wherein an insurance company approves
the fixed price.
4. The method of claim 1, wherein the fixed price is determined
by a negotiation between a supplier of the medical supplies and
an insurance company.
5. The method of claim 1, wherein the fixed price is determined
based on an estimated amount of medical supplies to be used in said
medical procedure.
6. The method of claim 5, wherein the fixed price is periodically
adjusted to reflect the average amount of medical supplies used
in said medial procedure.
7. The method of claim 1, wherein the fixed price is reduced based
on the number of said medical procedures performed during the predetermined
period of time.
8. The method of claim 1, wherein the fixed price is adjusted based
on the cost of maintaining the medical supplies before or during
said medical procedures.
9. The method of claim 8, wherein maintaining the medical supplies
comprises maintaining the medical supplies within a predetermined
temperature range.
10. The method of claim 8, wherein maintaining the medical supplies
comprises maintaining the sterility of the medical supplies.
11. The method of claim 1, wherein an amount of medical supplies
consigned to the buyer is an estimated amount of medical supplies
required for an average number of said medical procedures performed
during the predetermined period of time plus an additional estimated
amount of medical supplies required for an average number of said
medical procedures performed during a portion of the predetermined
period of time.
12. The method of claim 11, wherein the supplier further consigns
an amount of medical supplies to replace an amount of medical supplies
used by the buyer during the predetermined period of time.
13. The method of claim 1, wherein the buyer is billed in a subsequent
predetermined period of time.
14. The method of claim 1, wherein the buyer is a medical facility.
15. A method for capitation of medical supplies, comprising: negotiating
a fixed price for medical supplies to be used in a medical procedure
by negotiations between a supplier of the medical supplies and an
insurance company; consigning the medical supplies for multiple
said medical procedures to a medical facility; reporting a number
of said medical procedures performed during a predetermined period
of time by the medical facility to the supplier and the insurance
company; and sending an invoice based on the number of said medical
procedures performed times the fixed price to the medical facility
from the supplier.
Medical supplies description
[0001] This application claims the benefit of U.S. Provisional
Application Ser. No. 60/705,496, filed Aug. 5, 2005 which is incorporated
herein in its entirety.
BACKGROUND OF THE INVENTION
[0002] The term "capitation" refers to, for example,
a predetermined per-person or per-procedure payment to provide specified
services. The predetermined payment can be fixed or adjusted based
on actuarial projections of the requirements for the medical services.
Capitation provides buyers with predictable costs associated with
a given level of service. However, in certain circumstances where
third-party reimbursement is required, capitation may introduce
uncertainty regarding whether buyers will be fully reimbursement
for expenses associated with medical services.
[0003] The transaction costs resulting from negotiating reimbursement
schedules for the equipment and supplies necessary for various medical
procedures impose a serious burden on medical facilities. Medical
facilities may be unable to obtain the necessary equipment and supplies
to provide medical services. Alternatively, the costs may be passed
on to patients resulting in increased unreimbursed health care costs.
Patients may be forced to delay medical procedures, forgo them altogether,
or use another medical facility. Insurance companies also bear additional
transaction costs resulting from increased staff time devoted to
negotiating reimbursement schedules for various procedures. Increased
costs to insurance companies are likely to be passed on to policy
holders in the form of increased premiums. Finally, the manufacturers
and suppliers of medical and surgical equipment and supplies have
increased costs resulting from delayed payments and the costs of
carrying excess inventory or, alternatively, the delays associated
with not maintaining sufficient inventory to meet a sudden increase
in demand.
[0004] Medical equipment and supplies may enter into requirements
contracts with their customers. However, there is no assurance that
the terms negotiated by the suppliers and customers are on terms
acceptable to insurance companies. What is needed is a simplified
method and system for capitation of medical supplies.
SUMMARY OF THE INVENTION
[0005] To address the disadvantages encountered in the prior art,
one object of the present invention to streamline capitation transactions
for supplies between medical facilities, insurance companies, and
suppliers.
[0006] It is also an objective of the present invention to provide
a method to reduce the transaction costs resulting from negotiating
reimbursement schedules between a medical facility and an insurance
company.
[0007] It is a further objective of the present invention to provide
a method to reduce the transaction costs resulting from re-negotiating
contracts between a medical facility and a supplier with an insurance
company.
[0008] The present invention provides exemplary methods for capitation
of medical supplies by determining a fixed price for supplies needed
for a medical procedure, and billing a buyer a price calculated
by multiplying the number of medical procedures performed by the
fixed price. In a preferred embodiment of the invention, the method
and system relates to establishing a fixed price for providing a
predetermined amount of medical supplies to a medical facility.
[0009] Other features and advantages of the present invention will
become apparent from the following description of the invention
which refers to the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWING
[0010] FIG. 1 is a flowchart illustrating the method in accordance
with an embodiment of the present invention.
DETAILED DESCRIPTION OF EMBODIMENTS OF THE INVENTION
[0011] The present invention provides methods for capitation of
medical supplies. One embodiment of the invention is the method
100 illustrated in the flow chart shown in FIG. 1. Referring to
FIG. 1, a manufacturer or supplier of medical equipment and/or supplies
("Supplier") negotiates a fixed fee for providing the
equipment and/or supplies needed for a medical procedure with an
insurance company (step 110). Alternatively, the fixed fee may be
negotiated between the Supplier and an insurance company. Next,
in step 120, the Supplier consigns the equipment and/or supplies
necessary for a given medical procedure to a medical facility ("Buyer"),
such as a surgical center, facility, or hospital. The Buyer reports
the number of procedures conducted in a given period of time (e.g.,
daily, weekly, monthly, annually) to the Supplier and the insurance
company in step 130. In step 140, the Supplier sends an invoice
to the Buyer based on the total number of procedures multiplied
by the fixed price per procedure.
[0012] In another embodiment of the invention, the fixed price
is determined according to the estimated amount of equipment and/or
supplies for a given medical procedure. Depending on the volume
of equipment and/or supplies needed, a partially discounted, or
fully discounted price per procedure can be negotiated. Certain
procedures may require a larger volume of equipment and/or supplies
or the equipment and/or supplies may need to be maintained in a
certain condition before or during the procedure (e.g., sterility,
temperature). The requirements of a given procedure can be taken
into account when negotiating the amount of the fixed price per
procedure. In addition, the parties may agree to adjust the fixed
price periodically to reflect the actual requirements for the procedures
as measured during a given time period.
[0013] In yet another embodiment of the invention, the amount of
medical supplies consigned to the Buyer is an estimated amount of
medical supplies required for an average number of medical procedures
performed during the predetermined period of time and further includes
an additional estimated amount of medical supplies required for
an average number of said medical procedures performed during a
portion of the predetermined period of time. For example, if the
Buyer performs an average of 20 procedures per week and the predetermined
period is two weeks long, the Supplier could cosign enough supplies
for 40 procedures to cover the two week period plus supplies for
an additional 20 procedures to cover an extra week.
[0014] In a further embodiment, the Supplier further consigns an
amount of medical supplies to replace the amount of medical supplies
used by the Buyer during the predetermined period of time and bills
the Buyer during a subsequent predetermined period of time.
EXAMPLE
[0015] An arthroscopic surgical center (ASC) desires to obtain
a sufficient quantity of suture anchors and associated disposables
to perform various arthroscopic surgical shoulder procedures, such
as rotator cuff repair. On average, the ASC performs 20 rotator
cuff procedures each week. According to the ASC's internal procedures,
a two week supply of anchors and disposables necessary to perform
a shoulder repair procedure is required to be available on site
at any given time. The Supplier negotiates a price for providing
the anchors and disposables to the ASC on a price per procedure
basis. The Supplier submits the negotiated price to the ASC's insurance
company for approval. The insurance company approves the negotiated
price. The Supplier enters into a contract with the ASC to provide
the suture anchors and disposables in sufficient quantities to meet
the expected need to perform 20 procedures per week and maintain
a two week supply of anchors and disposables (i.e., 40 procedures).
Every two weeks, the ASC reports the actual number of procedures
performed to the Supplier and the insurance company. The Supplier
replenishes the anchors and disposables and sends the ASC an invoice
reflecting the actual number of procedures performed in the previous
two weeks. The ASC remits payment of the invoice and requests reimbursement
from the insurance company. The Supplier and ASC agree to review
the fixed price once a year to determine if the price should be
adjusted.
[0016] Although the present invention has been described in relation
to particular embodiments thereof, many other variations and modifications
and other uses will become apparent to those skilled in the art.
It is preferred, therefore, that the present invention be limited
not by the specific disclosure herein, but only by the appended
claims. |