RESEARCH IN PREPAID GROUP PRACTICE PROGRAMS.
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Group Practice↗
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The effects of capitation payment on the organizational structure of medical group practices.
This study explores the effects of capitation payment on the structural elements used by medical group practices to control physician-directed use of resources and the quality of patient care. Forty-five medical groups located in the highly competitive Minneapolis/St. Paul metropolitan area were studied. The range of capitation payment in these medical group practices is from 2% to 87%. Although the practices vary considerably in the extent to which they have developed these control mechanisms, it does not appear that capitation payment is a major factor influencing that pattern. It appears that many of these medical group practices either use less formal mechanisms than those included in this study to control resource use and the quality of care or use none at all. In either event, the data suggest that the effects of capitation payment on the structure of medical practices may be overestimated.
Capitation Fee↗
Group practices explore EDI options.
Although physician groups have been relatively slow to take advantage of electronic commerce, more are discovering the benefits. Once group practice administrators get beyond their initial trepidation and realize that EDI is efficient, many are pleased with the results. And some are automating other transactions, including verifying patient eligibility for insurance coverage, gaining insurance authorization for referrals to specialists and checking the status of claims.
Centers for Medicare and Medicaid Services, U.S.↗
IS/IT the prescription to enable medical group practices attain their goals.
The US spends significantly more money as a percentage of GDP on health care than any other OECD country and more importantly, this amount is anticipated to increase exponentially. In this high cost environment, two important trends have occurred: (1) the movement to managed care, and (2) large investments in Information Systems/Information Technology (IS/IT). Managed care has emerged as an attempt to provide good quality yet cost effective health care treatment. Its implications are not well discussed in the literature while, its impact on different types of medical group practices is even less well understood. The repercussions of the large investments in IS/IT on the health care sector in general and on the medical group practice in particular, although clearly of importance, are also largely ignored by the literature. This study attempts to address this significant void in the literature. By analyzing three different types of group practices; an Independent Practice Association (IPA), a Faculty Practice and a Multi Specialty Group Practice in a managed care environment during their implementation of practice management/billing systems, we are able to draw some conclusions regarding the impacts of these two central trends on health care in general as well as on the medical group practice in particular.
Contract Services↗
Medical group practice applications for HEDIS: reality or myth?
Through administrative review or random sample, health plan statisticians have ventured into group practice to collect indices that attempt to assess and measure quality. Yet group practice, as a means for assisting in the data collection processes of HEDIS, has had little participation in its development. This professional paper seeks to explore ways in which a group practice can play an important part in some area of HEDIS measurement and data collection.
Data Collection↗
Organizational technologies of chronic disease management programs in large rural multispecialty group practice systems.
Four large rural multispecialty group practice systems employ a mix of organizational technologies to provide chronic disease management with measurable impacts on their patient populations and costs. Four technologies-administrative, clinical, information, and social-are proposed as key dimensions for examining disease management programs. The benefits of disease management are recognized by these systems despite marked variability in the organization of the programs. Committees spanning health plans and clinics in the 4 systems and electronic medical records and/or other disease management information systems are important coordinating mechanisms. Increased reliance on nurses for patient education and care coordination in all 4 systems reflects significant extension of clinical and social technologies in the management of patient care. The promise of disease management as offered by these systems and other auspices are considered.
Chronic Disease↗
The effects of medical group practice and physician payment methods on costs of care.
OBJECTIVE: To assess the effects of payment methods on the costs of care in medical group practices. DATA SOURCES: Eighty-six clinics providing services for a Blue Cross managed care program during 1995. The clinics were analyzed to determine the relationship between payment methods and cost of care. Cost and patient data were obtained from Blue Cross records, and medical group practice clinic data were obtained by a survey of those organizations. STUDY DESIGN: The effects of clinic and physician payment methods on per member per year (PMPY) adjusted patient costs are evaluated using a two-stage regression model. Patient costs are adjusted for differences in payment schedules; patient age, gender, and ACG; clinic organizational variables are included as explanatory variables. DATA COLLECTION: Patient cost data were extracted from Blue Cross claims files, and patient and physician data from their enrollee and provider data banks. Medical group practice data were obtained by a mailed survey with telephone follow-up. PRINCIPAL FINDINGS: Capitation payment is correlated with lower patient care costs. When combined with fee-for-service with withhold provisions, this effect is smaller indicating that these two clinic payment methods are not interchangeable. Clinics with more physician compensation based on measures of resource use or based on some share of the net revenue of the clinic have lower patient care costs than those with more compensation related to productivity or based on salary. Salary compensation is strongly associated with higher costs. The use of physician profiles and clinical guidelines is associated with lower costs, but referral management systems have no such effect. The lower cost clinics are the smaller, multispecialty clinics. CONCLUSIONS: This study indicates that payment methods at both the medical group practice and physician levels influence the cost of care. However, the methods by which that influence is manifest is not clear. Although the organizational structure of clinics and their use of managed care programs appear to play a role, this influence is less than expected.
Adolescent↗
Medical audit of the care of patients with epilepsy in one group practice.
The care given in a group practice to 47 patients with epilepsy was reviewed.Since 1960 all newly diagnosed patients had been referred for a specialist opinion and EEG before the diagnosis of epilepsy was confirmed.Patients were not being counselled sufficiently on the problems of epilepsy, and over half the patients considered themselves to be unacceptable to the rest of society.Less than half the patients were treated with a single drug; more could probably have achieved control with one drug and run fewer risks of drug interaction. Although consideration of the clinical condition and haematological results showed problems in only 38 per cent of the patients, the use of serum drug level estimation affected decisions on management in 70 per cent. I suggest that the more widespread use of serum drug levels would be of great value to general practitioners interested in the care of epileptics.In half the cases it was the patient and not the doctor who decided the frequency of consultations. Of 17 patients with problems, nine were not having regular follow-ups. Since patients with epilepsy maintain regular contact with their family practitioner by requests for repeat prescriptions, it should not be difficult for the doctor to exercise appropriate control of the care of his patients.
Epilepsy↗
Who took the group out of group practice?
Thirty-five years ago bonding between physicians in a group practice was strong. Spouses played an important role. New members were enthusiastically welcomed. But group practice medicine is no longer one-for-all and all-for-one.
Group Practice↗
Precision maneuvers. A recent survey finds group practices are gearing up for reform and systems integration.
Physician group practices, like other providers, are experiencing the rapid transition to a new health care environment dominated by managed care penetration, at-risk capitation, and reform-related changes. Just how quickly things are changing is revealed by a new nationwide survey, which was conducted by Hospitals & Health Networks, the American Group Practice Association, Alexandria, VA, and Hamilton/KSA, Atlanta.
Attitude of Health Personnel↗
The role of group practice in the distribution of physicians in nonmetropolitan areas.
The geographic maldistribution of physicians persists as a major obstacle to improving the availability of health services in rural areas. This study looks at group practice as a potential factor in the location of physicians in nonmetropolitan areas. The basic assumptions are 1) the expected conditions of practice are critical to a physician's decision about where to locate, and 2) a group practice form of organization alleviates many of the deterrents to rural practice. The sample for the study is 287 nonmetropolitan trade areas in eight geographic regions of the U.S. Stepwise multiple regression is used to evaluate the relationship of demographic and health system variables, including group practice, to the physician/population ratio. Analyses are done for 1960 and 1970 and then for the change over the ten-year time period. The regression outcomes show that income, population over age 64, and urbanization are most helpful in explaining physician distribution in 1960. In 1970, hospital facilities also contribute. However, the percentage change in the physician/population ratio between 1960 and 1970 is explained by the 1960 physician/population ratio and the per cent of physicians in group practice in 1960. The findings suggest that attractive practice arrangements may be one way to alter the geographic maldistribution of physicians.
Aged↗
Partners: group practices and hospitals.
Many hospital executives see the emergence of medical group practices as a threat to their autonomy. However, the degree of future success of hospitals and group practices may depend on their willingness and ability to develop common goals and strategies.
Cardiology↗
Landmark survey looks at group practice.
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Efficiency↗
Management consultants and the group practice.
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Consultants↗
Average incomes of private practitioners in solo and group practices, 1977.
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Group Practice↗
New prepaid, group practice system.
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Group Practice↗
A business plan for starting a behavioral group practice.
The era of the solo behavioral healthcare practitioner is ending, as market forces spur the formation and the merging of group practices. But what are the financial realities of forming a behavioral group practice? In this article the author reviews the likely market entry strategy, organizational structure, expense line items and cash flow projections involved in the formation of a hypothetical, four-member behavioral group practice corporation.
Capitation Fee↗