Physician refugees from managed care. The rise and fall of a practice management fiasco.
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Bankruptcy↗
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Cattle-rangeland management practices and perceptions of pastoralists towards rangeland degradation in the Borana zone of southern Ethiopia.
A survey was conducted in the Borana pastoral areas of southern Ethiopia to assess current livestock production systems, rangeland management practices and the perceptions of the pastoralists towards rangeland degradation. This information is considered vital to future pastoral development planning and interventions. Data were collected from a total of 20 villages that were identified from 5 peasant associations, namely Did Yabello, Moyatte, Did Harra, Dubuluk and Melbana. The average household size in the study area was 7.23. The majority of the pastoralists relied on both livestock and crop farming. The average livestock holding per household was 14 cattle, 10 goats, 6 sheep and 2 camels. Livestock holdings, with the exception of camels, has shown a declining trend over time. The two most important traditional rangeland management strategies adopted by the pastoralists included burning and mobility, but since 1974/75 burning has no longer been practised. With regard to mobility, the livestock herding falls in two categories, namely: home based and satellite herding. The former involves the herding of milking cows, calves and immature animals (<2 years) close to the encampments. The latter constitutes the herding of bulls and immatures (>2 years) further away from the encampments. Based on the pastoralists' perceptions, the major constraints on livestock production in descending order, were recurrent drought, feed and water scarcity, animal diseases, predators and communal land ownership. All the respondents considered the condition of the rangelands to have declined dramatically over time. In the past most development policies were based on equilibrium theories that opposed the communal use of the rangelands and traditional range management practices. The way in which the pastoral system affects the rangeland ecosystem functioning is contentious to this theory and the 'tragedy of the commons'. There was also a perceived problem of bush encroachment and the ban on traditional burning practices and recurrent droughts were seen as aggravating factors to this invasion process. The increasing practice of crop cultivation on the rangelands was identified as a serious threat to future livestock production and traditional resource management practices. Suggestions for possible interventions to improve the productivity and sustainable use of these rangelands are made.
Adult↗
The effects of continuing education in dental practice management.
A representative sample of 122 Washington State general dental practices received continuing education in the efficient utilization of auxiliaries. Dentist and staff attended a two-day workshop where goals for change in delegation to auxiliaries, scheduling, and communication were developed. The continuing dental education was individualized, required the practice to set explicit goals for change, involved both the dentist and staff in the decision-making process, and included in-office follow-up and consulting. Evaluation of the course's effects demonstrated that such a course in practice management can have a positive effect on delegation to auxiliaries, practice output, and dentist income. Degree of participation varied considerably across the 113 practices that completed the continuing education. The positive results of the training were dependent upon the practice implementing the goals for organizational change that it had set. The effects of the continuing education take time to become apparent and are sequential with changes in delegation to auxiliaries occurring first and increases in volume of services and income occurring later.
Consumer Behavior↗
Consolidation of medical groups into physician practice management organizations.
CONTEXT: Medical groups are growing and merging to improve efficiency and bargaining leverage in the competitive managed care environment. An increasing number are affiliating with physician practice management (PPM) firms that offer capital financing, expertise in utilization management, and global capitation contracts with health insurance entities. These physician organizations provide an alternative to affiliation with a hospital system and to individual physician contracting with health plans. OBJECTIVE: To describe the growth, structure, and strategy of PPM organizations that coordinate medical groups in multiple markets and contract with health maintenance organizations (HMOs). DESIGN: Case studies, including interviews with administrative and clinical leaders, review of company documents, and analysis of documents from investment bankers, the Securities and Exchange Commission, and industry observers. SETTING: Medical groups and independent practice associations (IPAs) in California and New Jersey affiliated with MedPartners, FPA Medical Management, and UniMed. OUTCOME MEASURES: Growth in number of primary care and specialty care physicians employed by and contracting with affiliated medical groups; growth in patient enrollment from commercial, Medicare, and Medicaid HMOs; growth in capitation and noncapitation revenues; structure and governance of affiliated management service organizations and professional corporations; and contracting strategies with HMOs. RESULTS: Between 1994 and 1996, medical groups and IPAs affiliated with 3 PPMs grew from 3787 to 25763 physicians; 65% of employed physicians provide primary care, while the majority of contracting physicians provide specialty care. Patient enrollment in HMOs grew from 285503 to 3028881. Annual capitation revenues grew from $190 million to $2.1 billion. Medical groups affiliated with PPMs are capitated for most professional, hospital, and ancillary clinical services and are increasingly delegated responsibility by HMOs for utilization management and quality assurance. COMMENT: Physician practice management organizations and their affiliated medical groups face the challenge of continuing rapid growth, sustaining stock values, and improving practice efficiencies while maintaining the loyalty of physicians and patients.
California↗
Practice management education--are residency programs properly preparing physicians for the 21st century?
Several surveys indicate that third-year physician residents and recent graduates felt that their training in practice management skills was inadequate and that they felt unprepared in this area. This professional paper will present a discussion of residency education and the current complex health care environment. It will also describe a three-year comprehensive curriculum in practice management which can be incorporated into the programs.
Curriculum↗
Innovation theory and its applicability to our understanding of the diffusion of new management practices in health care organizations.
There has been a longstanding interest in understanding how new management practices and organizational structures are diffused through the health care system. This article reviews current literature on innovation and diffusion to provide insight into how new management practices and organizational structures are introduced into the system. Understanding the process may help in accommodating new developments and provide managerial opportunities to take a more active role in encouraging or discouraging their further evolution.
Canada↗
Pain assessment and procedural pain management practices in neonatal units in Australia.
OBJECTIVE: To identify current pain assessment and procedural pain management practices in neonatal units in Australia. METHODS: Postal survey conducted during December 2003 and January 2004. The survey comprised questions relating to pain assessment scores, pain reduction strategies for minor painful procedures and the use of articulated policies relating to procedural pain management. Participants were the Nurse Unit Managers or their nominees of neonatal intensive care units, special care units and newborn emergency transport services in Australia. RESULTS: Surveys were sent to 181 eligible organizations, and 105 of these were returned (58%). Six units (6%) used pain assessment scores on a regular basis, and 16 units (15%) had an articulated policy directing pain management practices during painful procedures. Non-nutritive sucking and various nursing comfort measures were the pain reduction strategies most frequently used during minor painful procedures. Twenty-four units (23%) used sucrose or other sweet-tasting solutions during procedures; however, the reported frequency of their usage was low. Breast-feeding during venepuncture, heel lance and intramuscular or subcutaneous injection was infrequently practised and topical anaesthetic agents were rarely used. CONCLUSION: This survey demonstrates that the majority of Australian neonatal units have no articulated policy to guide pain management during painful procedures and do not regularly undertake pain assessments. Current evidence-based strategies to reduce procedural pain in hospitalized infants are used infrequently.
Australia↗
Variations in cholesterol management practices of U.S. physicians.
OBJECTIVES: This study sought to evaluate national cholesterol management practices of U.S. physicians. BACKGROUND: Past studies show that nonclinical factors affect physician practices. We tested the hypothesis that physician and patient characteristics influence cholesterol management. METHODS: We used a stratified, random sample of 2,332 office-based physicians providing 56,215 visits to adults in the 1991-1992 National Ambulatory Medical Care Surveys. We investigated physicians' reporting of cholesterol-related screening, counseling or medications during office visits and used multiple logistic regression to assess independent predictors. RESULTS: An estimated 1.12 billion adult office visits occurred in 1991 and 1992 (95% confidence interval 1.06 to 1.18 billion). For the 1.03 billion visits by patients without reported hyperlipidemia, cholesterol screening (2.8% of visits) and counseling (1.2%) were not frequent. The likelihood of screening increased with older age, cardiovascular disease risk factors, white race and private insurance. We estimate that only 1 in 12 adults received cholesterol screening annually. In the 85 million visits by patients with hyperlipidemia, cholesterol testing was reported in 22.9%, cholesterol counseling in 34.4% and lipid-lowering medications in 23.1%. Testing was more likely in diabetic and nonobese patients. Counseling was more likely with younger age, cardiovascular disease and private insurance. Medications use was associated with cardiovascular disease, Northeast region of the United States, nonobese patients and visits to internists. Physician practices did not differ by patient gender. CONCLUSIONS: Although clinical conditions strongly influence cholesterol management, the appropriateness of variations noted by payment source, geographic region and physician specialty deserve further evaluation. These variations and the low estimated volume of services suggest that physicians have not fully adopted recommended cholesterol management practices.
Adult↗
Practice management skills for the nurse practitioner.
The faculties of three schools of nursing involved in a collaborative family nurse practitioner (FNP) program designed a study to address issues involved in preparing the nurse practitioner for the challenges of practice management in the clinical environment. The purposes of the study were to (1) identify business concepts necessary to successfully manage a primary care practice; (2) determine which of these concepts should be incorporated into an FNP curriculum; and (3) clarify information to be taught regarding each identified concept. Fifty-four business concepts related to primary care were identified from a literature review. A survey was then developed to assess the extent to which the identified concepts were necessary for an FNP to effectively manage a practice. Seven experts and five FNP faculty responded to the survey. The Content Validity Index (CVI) defined by Lynn (1986) was applied and 20 concepts necessary for an FNP to effectively manage a practice were identified. A focus group that included nurse practitioners (both faculty and nonfaculty) from the three collaborative sites connected by interactive telecommunications determined that all 20 of the identified concepts should be included in an FNP curriculum. Additionally, the focus group clarified relevant information to be taught regarding each identified concept.
Curriculum↗
The role of best management practices in alleviating water quality problems associated with diffuse pollution.
This paper introduces the concept of best management practices for the control of diffuse pollution. It considers where they are appropriate, and how the concept of a best management practice approach differs from the conventional means of controlling pollution by regulating each point source, in relation to established environmental quality standards and available dilution.
Agriculture↗
College health providers' knowledge, attitudes, and management practices of genital HPV infection.
This comparative survey of college health providers explored nurse practitioners' (N = 73) and physicians' (N = 70) knowledge, attitudes, and management practices related to genital human papillomavirus (HPV) infection in females. Both groups had adequate knowledge of basic issues of HPV epidemiology, diagnosis, and treatment. Divergent attitudes and management practices were reported among the providers, with generally low agreement with national STD treatment guidelines published by the Centers for Disease Control and Prevention (CDC). Generally, providers tended to practice a more aggressive management approach on several aspects of HPV infection than recommended by the CDC guidelines. The one major exception reported by the majority of providers was the conservative use of colposcopy for identifying subclinical HPV infection in patients with external genital warts, a finding consistent with CDC guidelines. The availability of colposcopy within a provider's health center was found to be associated with the reported use of colposcopy. Recommendation for future research and implications for college health and advanced nursing practice are addressed.
Adult↗
Where does the failure of physician practice managers leave physicians?
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Bankruptcy↗
The influence of an organizational pain management policy on nurses' pain management practices.
PURPOSE/OBJECTIVES: To examine the influence of a formal organizational pain management policy on nurses' pain management practices. DESIGN: Descriptive correlational. SETTING: Tertiary-care medical center. SAMPLE: 91 nurses providing direct patient care on five study units during a 72-hour study period. METHODS: Off-going nurses completed three self-administered questionnaires one-half hour before the end of each eight-hour work shift. Opioid administration data also were collected. Data were analyzed using correlational, t test, chi-square, and analysis of variance analyses and descriptive statistics. MAIN RESEARCH VARIABLES: Nurses' knowledge of the healthcare organization's chronic pain management policy; nurses' knowledge of pain and pain management; nurses' perceived accountability for pain management activities; the ratio of actual amounts of opioid analgesics administered compared with maximum amounts ordered. FINDINGS: Nurses' knowledge of pain management and their perceived accountability for pain management were significantly related to knowledge of the organization's chronic pain management policy. Correlations were lower than expected, based on theoretical relationships proposed in the open system study framework. CONCLUSIONS: Further research is needed to explore the influence of a high-quality pain management policy on nursing practice and clinical pain management. IMPLICATIONS FOR NURSING PRACTICE: Better understanding of the influence of organizational policy could lead to much needed improvements in pain management.
Adult↗
A successful PPMC (physician practice management company) acquisition strategy: vision, focus and discipline.
Acquisitions have become increasingly necessary for managed care organizations to create product value and operating synergies. Physician practice management companies (PPMCs) that have successfully acquired and consolidated group practices and IPAs have a clear vision of their mission, focus on their target markets, and adhere to a disciplined methodology of financial evaluation, negotiation, and transition. Growing a PPMC entails risks, but expectations are for continued expansion of these organizations. The vision-focus-discipline method can help buyers adhere to a successful strategy during the acquisition process.
Economics, Medical↗
The case management practices of community mental health nurses: 'Doing the best we can'.
This paper reports findings from an investigation into the case management practices of a group of community mental health nurses in metropolitan South Australia. Such practices have received little attention in the Australian literature to date. These nurses collectively organized their clients into four informal groups in order to manage the demands of heavy workloads. The implications of these findings and recommendations for further evaluative investigations into the nature of case management practices are discussed.
Case Management↗
Computerization: the future of dental practice management.
Although computers are currently used in many dental offices, they are often simply PCs used for word processing or billing. There are some clinical dental computer systems in use, but, in the past, software limitations kept these systems from being integrated into practice management solutions. Dental computer systems in the future will combine clinical and practice management information, as well as marketing information, for optimal patient care with practice growth as a benefit.
Humans↗
Performance appraisal: helpful hints for the busy medical practice manager.
This article describes the performance appraisal process in terms of its three fundamental steps. defining job performance, measuring actual job performance, and providing job performance feedback. Given that most practice managers wear many hats and do not have extensive experience or staff support in human resources, the purpose of this article is to provide these busy individuals with useful, practical suggestions that should enhance the effectiveness of the performance appraisal process for nonphysician employees within the medical practice setting. Performance appraisal should be a priority for all practice managers, as the performance of individual employees represents the key to long-term success for any medical practice.
Employee Performance Appraisal↗
Farm characteristics and management practices associated with development of Rhodococcus equi pneumonia in foals.
OBJECTIVE: To identify farm characteristics and management practices associated with development of Rhodococcus equi pneumonia in foals. DESIGN: Prospective case-control study. ANIMALS: 5230 foals on 138 breeding farms with 9136 horses. PROCEDURE: During 2003, participating veterinarians provided data from 1 or 2 farms with > or =1 foal with R equi pneumonia and unaffected farms. Data from affected and unaffected farms were compared by use of logistic regression analysis. RESULTS: A number of variables relating to farm size and desirable management practices were significantly associated with increased odds of farms being affected with R equi pneumonia. By use of multivariate logistic regression, affected farms were determined significantly more likely to have raised Thoroughbreds, housed > or =15 foals, used concrete floors in foaling stalls, and tested foals for passive transfer of immunity than unaffected farms. These results remained significant even after accounting for exposure of foals to other breeding farms during the first month of life. Conclusions and Clinical Relevance-Breeding farms with large acreage and a large number of mares and foals have greater odds of being affected by R equi pneumonia. Clinical relevance of associations with Thoroughbred breed and concrete flooring in foaling stalls remains uncertain. Desirable management factors commonly used on farms were not effective for controlling or preventing development of R equi pneumonia. This finding indicates a need to focus on host factors that influence disease development.
Actinomycetales Infections↗