Impact of the Limited Generalist (No Hospital, No Procedures) Model on the Viability of Family Practice Training. The Journal of the American Board of Family Practice, 2002. 15(3): p. 191-200. Compared payment systems and their influence on physician prac

Background: Some doubt the desirability and cost-effectiveness of continuing to provide an expanded scope of primary care practice. Additionally, there has been concern about declining reimbursement from Medicaid and Medicare. Although an expanded scope of patient care services are required for training, we wanted to determine whether these services drain resources and time from other primary care activities. Methods: To determine the financial impact of deleting services other than office visits from an urban primary care practice, we tabulated charges, economic case mix, and actual collections during 12 con-secutive months. Using regional and national norms, the practice set charges for hospital services, office visits, and procedures at approximately 50th percentile as a maximum. Common diagnostic and thera-peutic procedures were tabulated, and gross charges per item per year were tabulated. To validate net collection predictions for a predominately TennCare (Medicaid) practice and compare these with pro-jected net collections from private practice, charges were compared with projected collections using two expectations (40 % net and 80 % net). Overall collections were projected and then compared with actual collection. For hospital services and office procedures, costs were attributed to equipment, training, liability insurance, and lost opportunity for office visits. The setting was an urban family practice teaching program providing hospital services, hospital de