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PubMedDate not supplied

Physician executives in the '90s: report of a national survey.

In fall 1990, Witt Associates again catalogued the progress of physicians as they obtain management positions of increasing importance. The firm has conducted a continuing study of the position since 1979. The current survey of vice presidents of medical affairs/medical directors renders a candid portrait of the physician manager. The profile that emerges is a 53-year-old white male, working almost 50 hours a week in a full-time position, appointed by the hospital and reporting to the Chief Executive Officer. This individual is board certified and has major responsibilities for quality assurance, credentialing, risk management, and utilization review. His or her salary is into six figures.

Employment↗
PubMedDate not supplied

What do you have to do to become a medical director?

Medical management is a large and growing profession. The need for physicians in management roles grows unabated in hospitals, managed care organizations, group practices, and myriad other environments. But entry is not merely a matter of wishful thinking. Painstakingly assembled credentials and skills are the order of the day. The advice in this column is distilled from Medical Directors: What, Why, How, a new College monograph.

Career Mobility↗
PubMed1995

Wanted--seasoned veterans. Diamonds in the rough need not apply.

Health care organizations looking for physician executives prefer seasoned veterans--doctors who have already done the job. They want job-specific experience. Most organizations do not provide training grounds and orderly career ladders for aspiring physician executives. The Permanente Medical Groups, Family Health Plans, and some very large group practices are exceptions, but, for the most part, rising medical directors in these organizations stay with them. Most hospitals are not large enough to have associate or assistant medical directors or an environment that could provide a training ground for rising physician executives. On the other hand, hospitals, larger group practices, health insurance companies, and managed care organizations provide ample opportunities for nonphysician managers to train, gain experience, and climb the ladders. How can the novice physician executive break into the world of management and begin establishing management credentials? The author provides some key steps that can lead to success.

Certification↗
PubMed1996

Designing drug-usage evaluation to meet Joint Commission requirements.

Strategies for influencing prescribing practices utilizing the drug-usage evaluation (DUE) process are described. Our DUE program has evolved into a collaborative program that provides significant pharmacy involvement while maintaining medical staff responsibility, as outlined by the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission). A multidisciplinary approach is utilized to identify prescribing problems, develop prescribing criteria, and provide educational initiatives. Pharmacists provide drug therapy monitoring, engage in clinical interventions, and document the outcomes of these interventions. DUE pharmacists report results of these initiatives to the medical staff and quality assessment program. Physician performance compliance is incorporated into the credentialing process. Corrective measures are determined by the Pharmacy and Therapeutics Subcommittee, with subsequent actions carried out by peer physicians. The net result is a positive influence on prescribing practices that improves the appropriate and effective use of drugs, while meeting Joint Commission standards.

Cost-Benefit Analysis↗
PubMed1996

The MBA mystique.

Is an MBA the solution for you? Do physician executives need to have a business degree to compete in today's competitive marketplace? What are clients looking for when they make hiring decisions? The answers may surprise you. This column is an attempt to dispel myths about physician executives and the MBA degree. Clients want to attract and hire physician executives who possess sometimes intangible skills--with or without the MBA credential. These intangible skills include the ability to educate other physicians to the new health care realities, a sales orientation emphasizing effective communication that focuses on patients and payers as customers, comfort with ambiguity, flexibility, and tact and sensitivity in negotiations.

Commerce↗
PubMedDate not supplied

Developing physician leaders in academic medical centers. Part 1: Their changing role.

While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management, intramurally conducted courses in leadership skill development; management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. This article article was prepared by the author from research into and presentation of a thesis entitled. "The Importance of Leadership Training And Development For Physicians In Academic Medical Centers In An Increasingly Complex Healthcare Environment, " prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in the College (ACHE). Part 2 will appear in the next issue of the Journal.

Academic Medical Centers↗
PubMed1996

Telemedicine and the law.

Telemedicine is a compelling healthcare delivery option that allows physicians in isolated and rural areas to access a full range of specialists and cutting-edge technologies usually available only at large, urban medical centers. However, there is uncertainty in the healthcare community about the impact this new technology will have on professional liability. A lack of legal precedents makes it difficult to determine how the courts would respond to malpractice claims related to the practice of telemedicine. Providers of telemedicine can limit the potential for liability exposure by clarifying physician licensure issues, revising physician credentialing procedures, establishing practice standards, videotaping telemedical procedures, safeguarding computerized medical records, and learning more about the impact of telemedicine on malpractice insurance rates.

Humans↗
PubMedDate not supplied

Developing physician leaders in academic medical centers.

While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management; intramurally conducted courses in leadership skill development, management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. While part one of this series, which appeared in Volume 43, No. 6 of Medical Group Management Journal addressed, "The changing role of physician leaders at academic medical centers," part 2 will examine as a case study the faculty leadership development program at the University of Texas M.D. Anderson Cancer Center. These two articles were prepared by the author from his research into, and the presentation of a thesis entitled. "The importance of leadership training and development for physicians in academic medical centers in an increasingly complex health care environment," prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in this College.*

Academic Medical Centers↗
PubMed1997

Physicians as executives: boon or boondoggle?

It should come as no surprise to any observer of trends in the U.S. healthcare delivery system that physicians are taking a keener interest in the organization and management of that system. The practice of medicine has become, to a large degree, overtaken by events. Managed care and system integration have tended to place decision making at points further and further removed from patient care, the natural purview of the physician. It is to regain the initiative on how patient care is provided that physicians are moving in greater numbers into management. It is our contention that this move portends well for the future of the system. The unique advantage of the physician executive is the ability to bring to bear on healthcare management an understanding of the clinical processes that are its essential content. With strong clinical credentials and excellent management training, the physician is poised to make significant contributions to a healthcare organization's success.

Career Mobility↗
PubMed1997

How HMOs assess medical groups and IPAs.

California health maintenance organizations (HMOs) frequently capitate physician organizations--independent practice associations (IPAs) and multispecialty medical groups--to export their risk for professional and outpatient ancillary services. Physician organizations benefit when successful in managing the risk, and from having greater control over medical management decisions. HMOs carefully assess the physician organization's ability to manage capitated risk and provide high-quality care. HMOs gather information on the physician organization's finances, business relationships, physician compensation arrangements, credentialing, hospital relationships, ancillary contracts, procedures for 24-hour care, claims administration, member services, information systems for reporting and tracking utilization, and procedures for utilization/quality management. These data are analyzed to determine whether capitation contract negotiation should proceed.

California↗
PubMed1997

Use of National Practitioner Data Bank disclosure information for decision making.

Hospital, state licensing boards, and managed care organizations query the National Practitioner Data Bank to receive malpractice payment and adverse licensure or clinical privileges reports concerning licensed health care practitioners. The results of a national survey of queriers strongly suggest that Data Bank reports impart valuable information that affects licensing and credentialing decisions. Thus, the Data Bank is fulfilling the role lawmakers intended in improving the quality of health care.

Data Collection↗
PubMedDate not supplied

Using patient outcomes to screen for clinical laboratory errors.

How to measure the quality of laboratory testing has long been a challenging problem for laboratory managers and accrediting agencies. Traditionally, laboratory quality has been assessed by direct inspection, proficiency testing, and the credentials of staff. None of these methods is entirely satisfactory at answering a fundamental question: does the laboratory give technically accurate and clinically meaningful information for each patient that it tests? This paper discusses how information on patient outcomes can be used to screen for laboratories that may be making frequent random or systematic errors. This approach is called downstream event monitoring (DEM). The basic idea is to look at what happens to a laboratory's patients in a critical window of time after they have been tested. The approach carries out a basic adage of quality management: follow up with your customers to see if your product has met their needs. The main idea of DEM is that if a laboratory has not conveyed accurate information, the clinician may take actions that fail to help, or maybe even harm, the patient. If a laboratory's patients have an unusually high rate of adverse events that happen within a window of time when the laboratory test would have played a critical role, the laboratory should be further examined to see if it is the cause of the problem. Right now, DEM is a technique under development. It needs a clinical logic to relate a patient's outcomes back to a laboratory test, and it needs good data to compare laboratories. This paper discusses how the prothrombin time test and the serum digoxin test have been examined for Medicare patients to see if certain laboratory characteristics are associated with unusually high occurrences of adverse events after testing. The need for future validation studies is also discussed.

Clinical Laboratory Techniques↗
PubMed1998

Approval of courses in new skills.

The Committee on Emerging Surgical Technologies has previously published "Guidelines for Evaluation of Credentials of Individuals for the Purpose of Awarding Surgical Privileges in New Technologies." In that statement, which was approved by the American College of Surgeons' Board of Regents and published in 1994, the completion of a defined educational program in the technology, including didactic and practical elements, was recommended. The following statement, which was approved by the Board of Regents in October 1997, defines standards for courses in new technology that are designed to prepare the practicing surgeon to apply the technology to the care of patients.

Curriculum↗
PubMedDate not supplied

Boldly going where no one has gone before.

With all the changes occurring in the U.S. health care system come new opportunities for physician executives willing to boldly go where no one has gone before. These positions are being newly created and thus are somewhat undefined and uncharted. Health care organizations want individuals for high-risk positions with unique skill sets and bright, new ideas. Organizations want to find people who can do what has never been done before-for them, at least, if not anywhere in the universe. How does that translate into experiences that you might want to acquire? Most organizations today are looking for individuals with some networking experience, but analogous experience (such as in a multi-site medical group or active involvement in formation of IPAs) is often a good alternative. In addition, true line experience in one or more organizations is a solid credential. Knowledge of where managed health care dollars begin and end is a necessity. As always, executive style and presence are expected.

Personnel Selection↗
PubMedDate not supplied

Why become a certified physician executive?

What is the CPE Tutorial and how can it help advance the careers of physician executives? This five-day program teaches executive skills that make physician executives more valued in the marketplace. When candidates successfully pass an evaluation judged by a panel of health care CEOs, recruiters, and Fellows of the College, they become Certified Physician Executives (CPEs). This certification provides recognition to potential employers that CPEs have: stature as a physician; been successfully tested in all disciplines of medical management; demonstrated management experience; and successfully completed the Tutorial with a five minute presentation describing skills and competencies on the last day. As CPEs become widely known in the marketplace, the designation will be a valued credential that helps physician executives get and keep desirable positions, as well as advance to the next level in their careers.

Certification↗
PubMed1998

Patient-centered philosophy at core of successful pain management program.

In 1996, the American Nurses Credentialing Center in Washington, DC, recognized the UC Davis Medical Center in Sacramento as a magnet nursing center of excellence. The pain management program was cited as one of the distinguishing activities that promotes quality of patient care services and development of successful nursing strategies.

Aged↗
PubMed1998

Clerical, clinical changes increase nursing efficiency.

Only six health care systems in the nation have received the Magnet Nursing Services Recognition Award from the American Nurses Credentialing Center in Washington, DC. This prestigious designation acknowledges quality of patient care services and the development of successful, professional nursing practices and strategies. Here is how one hospital used clerical staff to help it win this award.

Benchmarking↗
PubMed1994

Quality versus variance: a plea for a different focus and terminology.

Much has been written about quality assurance in medical practice over the past 15 years. Medicine suddenly found itself trying to design systems that ensured that medicine was being practiced according to standards of quality when it had neither a definition of its product nor defined standards of practice. Consequently, early quality assurance programs focused primarily on documentation of patient care. As the process matured, it evolved to generic screens, with tolerances and outliers. The theory was that the quality of medical care was enhanced by physicians who practiced within often artificially established norms and was diminished by physicians who practiced outside those same norms. It was much like saying that the quality of manufacturing a new car could be improved by reducing all systems down to one of closely standardizing, observing, and documenting how each individual assembly worker put on a lock nut and then holding each worker independently accountable for the final quality of the care. Physicians felt they were being held responsible for conforming to a rigid set of poorly designed and retrospectively applied standards. Moreover, they were held accountable for applying those standards to all practice situations. Understandably, physicians felt at the mercy of nonphysician quality assurance "detectives" in hospitals and became increasingly suspicious of nurses and administrators, who were perceived as abusing the system at the expense of the physicians. Because of these inadequacies of the earlier quality assurance programs, paranoia among physicians about the quality assurance process remains rampant today. The use of blind outcome scores and practice patterns in credentialing and the reporting of these data to databanks have reinforced the paranoia.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

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