Capitation Is for Specialists, Not for Primary Care Physicians Essays

Capitation Is for Specialists, Not for Primary Care Physicians Essays Capitation Is for Specialists, Not for Primary Care Physicians Paper Capitation Is for Specialists, Not for Primary Care Physicians Paper Capitation is the changing of risk and the medical management responsibility to physicians in exchange for a flat, per-member payment, usually in monthly allotments. It means the cutting of physicians compensation and using it as a medium for providing reimbursement incentives to decrease the number of inpatient bed days and unnecessary specialist procedures. Problem of the Article The problem is on what model or practice of capitation must be used and applied in order to resolve the proper allocation of budget among health authorities. This article is written to help develop an understanding by presenting the viable ideas on choosing the right model. It presents the advantages and the disadvantages of the models of capitation. The specialist at the Unified Physicians is capitated while specialists from other Independent Practice Association are not. United Physicians gets $36 per member per month to give a full range of professional and diagnostic services to commercial patients while the IPA funds are retained in risk pools or reinsurance, which serves as their only source of income. The risk pool funds are excess amounts that remain in the hospital pool, which is shared with the HMO or the hospital. Techniques Used to Address the Problem: Pro’s and Con’s There are two models for capitation. The first model is shared capitation, which is about setting a limited budget for the amount allocated for specialty care. Specialists bill into this pool, and is being paid back for adjustments based on the utilization trend. There continues to be the same number of physicians and everybody is participating thus it is easy. It projects a moderate climate of competition among the specialists over the fairness of the distribution of the funds. However, the disadvantage is on the utilization and budgeting part. In this model, everybody bills into this fund and an uncontrolled utilization results. It is not unusual for the fund to fall short at the end of the first or second quarter because shared capitation does not help the risk pools and0 it neither controls inpatient nor outpatient utilization. In addition, it does not solve the clinical variation across the broad range of physicians in the medical group or IPA. Group capitation as chosen by the Unified Physicians has the greatest political risk because there is a selection of physicians to participate and a disenfranchisement of some physician. In other words, if the physicians have been participating in the IPA for a number of years, they may be paralyzed and loses out of patients that they have previously seen for some time. In addition, some shareholders may be offended, and it is the most politically risky undertaking. Nevertheless, group capitation was chosen mainly because it puts utilization back in the hands of the providers. In this model, there is a rejection of prior authorization as physicians join to develop guidelines and best practices. They can create guidelines in each specialty and across specialties. Assessment The trends of medical care have changed a lot since 1997 to the present day. It has become very flexible and assures competency among practitioners. It is created to meet the demand of the health care services regardless of the model whether it is a capitation or a fee-for-service. References Kullman, Shelley. (1997). Capitation Is for Specialists, Not for Primary Care Physician. Pacific Communities Management Services Organization Harbor City, Calif.

Definition and Discussion of Renaissance Rhetoric

Definition and Discussion of Renaissance Rhetoric Definition The expression Renaissance rhetoric refers to the  study and practice of rhetoric from approximately 1400 to 1650. Scholars generally agree that the rediscovery of numerous important manuscripts of classical rhetoric (including Ciceros De Oratore) marked the beginnings of Renaissance rhetoric in Europe. James Murphy notes that by the year 1500, only four decades after the advent of printing, the entire Ciceronian corpus was already available in print all over Europe (Peter Ramuss Attack on Cicero, 1992). During the  Renaissance, says Heinrich F. Plett, rhetoric was  not confined to a single human occupation but in fact comprised a broad range of theoretical and practical activities. . . .  The fields in which rhetoric played  a major part included scholarship, politics, education, philosophy, history, science, ideology, and literature (Rhetoric and Renaissance Culture, 2004). See the observations below. Also see: Copia What Is Rhetoric? Periods of Western Rhetoric Classical RhetoricMedieval RhetoricRenaissance RhetoricEnlightenment RhetoricNineteenth-Century Rhetoric New Rhetoric(s) Observations [D]uring the European Renaissancea period which, for convenience, I take as stretching from 1400 to 1700rhetoric attained its greatest preeminence, both in terms of range of influence and in value.(Brian Vickers, On the Practicalities of Renaissance Rhetoric. Rhetoric Revalued, ed. by Brian Vickers. Center for Medieval and Renaissance Studies, 1982)Rhetoric and the renaissance are inextricably linked. The origins of the Italian revival of classical Latin are to be found among the teachers of rhetoric and letter-writing in northern Italian universities around 1300. In Paul Kristellers influential definition [in Renaissance Thoughts and Its Sources, 1979], rhetoric is one of the characteristics of renaissance humanism. Rhetoric appealed to the humanists because it trained pupils to use the full resources of the ancient languages, and because it offered a genuinely classical view of the nature of language and its effective use in the world. Between 1460 and 1620 more than 800 editions o f classical rhetoric texts were printed all over Europe. Thousands of new rhetoric books were written, from Scotland and Spain to Sweden and Poland, mostly in Latin, but also in Dutch, English, French, German, Hebrew, Italian, Spanish, and Welsh. . . .The classical texts studied and the writing exercises undertaken at the Elizabethan grammar school show considerable continuity with their medieval forbears, and some differences in approach and in the writing textbooks employed. The most important changes brought about during the renaissance were the result of two centuries of development rather than of a sudden break with the past.(Peter Mack, A History of Renaissance Rhetoric 1380-1620. Oxford University Press, 2011) The Range of Renaissance Rhetoric[R]hetoric regained an importance in the time span from about the middle of the fourteenth to about the middle of the seventeenth century, which it did not possess before or after. . . . In the eyes of the humanists, rhetoric is equivalent to culture as such, the perennial and substantial essence of man, his greatest ontological privilege. Renaissance rhetoric was, however, not confined to the cultural elite of the humanists but became a substantial factor of a broad cultural movement which had great impact on the educational system of the humanities and encompassed increasingly more social groups and strata. It was not limited to Italy, from whence it took its origin, but spread to northern, western and eastern Europe and from there to the overseas colonies in North and Latin America, Asia, Africa, and Oceania.(Heinrich F. Plett, Rhetoric and Renaissance Culture. Walter de Gruyter, 2004) Women and Renaissance RhetoricWomen were more likely to have a ccess to education during the Renaissance than at earlier periods in Western history, and one of the subjects they would have studied was rhetoric. However, womens access to education, and especially the social mobility such education afforded women, should not be overstated. . . .For women to have been excluded from the domain of rhetorical theory . . . constituted a serious limitation on their participation in shaping the art. Nevertheless, women were instrumental in moving rhetorical practice in a more conversational and dialogic direction.(James A. Herrick, The History and Theory of Rhetoric, 3rd ed. Pearson, 2005) English Rhetorics of the Sixteenth CenturyBy the mid-sixteenth century, practical handbooks of rhetoric began to appear in English. That such works were written is an indication that some English schoolmasters for the first time recognized a need to train students in the composition and appreciation of English. . . . The new English rhetorics were derivative, based on continental sources, and their main interest today is that collectively they show how rhetoric was taught when the great writers of the Elizabethan Age, including Shakespeare, were young students. . . .The first full-scale English rhetoric book was Thomas Wilsons Arte of Rhetorique, eight editions of which were published between 1553 and 1585. . . .Wilsons Arte of Rhetorique is not a textbook for use in school. He wrote for people like himself: young adults entering public life or the law or the church, for whom he sought to provide a better understanding of rhetoric than they were likely to get from their grammar scho ol studies and at the same time to impart some of the ethical values of classical literature and the moral values of the Christian faith.(George Kennedy, Classical Rhetoric and Its Christian and Secular Tradition, 2nd ed. University of North Carolina Press, 1999) Peter Ramus and the Decline of Renaissance RhetoricThe decline of rhetoric as an academic discipline was due at least in part to [the] emasculation of the ancient art [by French logician Peter Ramus, 1515-1572]. . . .Rhetoric was henceforth to be a handmaiden of logic, which would be the source of discovery and arrangement. The art of rhetoric would simply dress that material in ornate language and teach orators when to raise their voices and extend their arms to the audience. To add insult to injury, rhetoric also lost control of the art of memory. . . .Ramist method worked to abbreviate the study of logic as well as that of rhetoric. The law of justice allowed Ramus to remove the subject of sophistry from the study of logic, since the arts of deception had no place in the art of truth. It allowed him to eliminate the Topics as well, which Aristotle had intended to teach the source of arguments on matters of opinion.(James Veazie Skalnik, Ramus and Reform: University and Church at the End of the Renaissance. Truman State University Press, 2002)