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Old 08-27-2015, 02:53 PM
Examtaker999 Examtaker999 is offline
 
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Default Risk Pool vs. Withhold

I'm trying to better understand the similarities and differences between the two of these risk-based physician payment mechanisms: A PCP Withhold and an Individual Risk Pool set up for Referrals. The question at hand is regarding the capitation arrangement for a single physician.

I understand how they are initially established: PCP Withhold as a % of the PCP capitation payment and that the risk pool is set up separately as a fixed $$ amount. However, from there how are they handled differently? Is there ever a situation where it's advantageous to have both a withhold and a risk pool for referrals established with a capitated physician?
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Old 08-27-2015, 03:20 PM
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DefTones DefTones is offline
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I had this same question when reading through the first time. I speculate that a withhold is done at the physician-level and can be set up in a FFS or a capitated environment. A withhold is a type of risk pool, but a risk pool is more comprehensive and can include other services (referral, hospital, ancillary services, etc) and multiple physicians.

In your example, I don't think you would have both a withhold and a risk pool for referrals. If the physician had a withhold for referrals, there could be a risk pool for ancillary services pooled with other physicians in the capitated arrangement.

This is all speculation, however, I found this helpful:
http://www.ama-assn.org/ama/pub/advo...withholds.page
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