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Tax reform legislation and the formation of optometric group practices.

Tax reform legislation through 1987 was analyzed for its impact on whether a partnership form of group practice or a professional corporation form is more advantageous from a federal tax standpoint. The effect of new tax legislation on pension plan contributions and on the deductibility of fringe benefits is delineated and discussed. Several miscellaneous changes in the law affecting group practice modes are discussed. Even though the individual income tax rates are now slightly lower than the corporate income tax rates, there is still life left in the professional corporation form of group practice if the Subchapter S election is made.

Group Practice↗

Night calls in a group practice.

All the night calls attended in 1974 by seven doctors in a group practice were analysed. Each call was classified by the doctor attending, into categories of urgency.Half of all the night calls were found to be genuine emergencies, and only seven per cent were judged to be totally unnecessary.

Emergencies↗

The effects of the ADA on group practice.

In this article, James Frierson, J.D., outlines the requirements for group practices under the Americans with Disabilities Act (ADA). Rules concerning required changes take effect in January of 1993 (and sooner for some groups), making it imperative that group practices be aware of the new law.

Architectural Accessibility↗

Academic group practice. The patient's perspective.

The effect upon patient satisfaction of a reorganization of a traditional medical clinic into a group practice model was examined in a controlled trial in which both patients and physicians were randomized. The group practice model, unlike the traditional clinic, provided decentralized registration, 5 days/week clinic coverage, and night/weekend phone coverage. Residents worked in small groups with an attending physician, a nurse practitioner, and a receptionist. This reorganization resulted in a substantial decrease in charges and utilization for patients in the experimental group. A panel of 302 patients was interviewed prior to the reorganization and 1 year later. Patients in the experimental groups perceived improvements in access to their physicians as well as decreases in clinic waiting time and decreases in the lag time between requesting and obtaining an appointment. General health perceptions and other satisfaction measures were unchanged. The authors conclude that a group practice organization can result in decreased patient charges without substantially altering patient satisfaction.

Academic Medical Centers↗

Bacteriuria diagnosis and antibiotic susceptibility testing in a group practice by dipslide techniques.

In group practice, screening for bacteriuria and antibacterial susceptibility testing of bacteria in urine specimens were performed by dipslide methods (Uricult and Sensicult, Orion Diagnostica) and the results were evaluated with respect to conventional cultivation of urine specimens and standardized susceptibility testing by the disc diffusion method at a bacteriological laboratory. Bacteriuria diagnosis by screening by the Uricult method seemed to be satisfactorily performed except for some streptococcal strains. In the case of direct susceptibility testing by the Sensicult dipslide method, however, the results obtained by personnel at the surgeries and by trained bacteriologists displayed unacceptable disparities, despite the fact that a continuously running training programme was established.

Anti-Bacterial Agents↗

Americans with Disabilities Act: physician-shareholder practice groups and ADA compliance.

This article examines the application of Americans with Disabilities Act requirements to professional associations like physician practice groups. In general, employers with 15 or more full-time employees must comply with the Act. However, the definition of an employee is sometimes unclear, especially as applied to business entities commonly used by physician practice groups. A recent case decided by the United States Court of Appeals for the Ninth Circuit held that physician-shareholders of a professional corporation are employees for Americans with Disabilities Act coverage purposes. Analogous cases in other federal circuits have held differently, likening the "owners" of professional corporations to partners in a partnership, who are not considered employees. Similar questions arise for popular business entities, such as Limited Liability Companies and Limited Liability Partnerships. This article discusses the nature of the business forms commonly used by physician practice groups and how their characteristics impact employee status for Americans with Disabilities Act coverage. It then suggests that examination is useful beyond business formation characteristics to the purpose of the Americans with Disabilities Act and other employment antidiscrimination statutes.

Persons with Disabilities↗

Group practice innovations and the cost of quality in behavioral health services.

Group practices have enhanced the accessibility and quality of care through continuous innovation and performance improvement initiatives. However, sustaining a quality infrastructure can be costly. Will purchasers and consumers demand a group-model delivery system that provides accessible, effective, accountable, efficient, and coordinated care when network-models with little overhead can provide basic services for less? Here's how groups in the Institute for Behavioral Healthcare's (IBH) Council of Behavioral Group Practices are innovating to sustain excellence and superior performance.

Community Networks↗

Office visit patterns in physician group practices.

In summary, this study provides evidence that with as few as five diagnosis it is possible to identify some physician group practices that consistently treat patients with more or fewer visits, on average. However, even among group practices that vary considerably in size, location, and organizational structure, there is little deviation from the norm in terms of office visits. A study of more than 30 patients per site using data from both office records and insurance claims is needed, however, to examine the entire spectrum of treatment, including lab tests, special procedures, medications, and hospitalization. Such future studies may exploit the possibilities and avoid the pitfalls describes here to better characterize physicians' practice patterns.

Asthma↗

Evaluation of sexually transmitted disease control practices for male patients with urethritis at a large group practice affiliated with a managed care organization--Massachusetts, 1995-1997.

Effective management for sexually transmitted diseases (STDs) depends on appropriate testing, treatment, partner management, and complete and timely reporting of positive STD tests (1). Testing can ensure appropriate treatment of initial or recurrent infections and identification of drug-resistant pathogens, appropriate treatment can reduce risk for complications and development of drug resistance, and complete and timely reporting of positive test results by laboratories and STD cases by health-care providers to health departments can facilitate rapid sex partner notification and outbreak detection. By 1998, private providers, including those affiliated with commercial or Medicaid managed care organizations (MCOs) (2,3) were caring for approximately 70% of persons with chlamydia and 55% of persons with gonorrhea. To assess the quality of STD care at a MCO-affiliated multisite facility, the testing, treatment, and reporting practices of gonorrhea- and chlamydia-associated urethritis in male patients were evaluated. This report summarizes the evaluation, which indicated that the providers tested most men with urethritis symptoms, prescribed CDC-recommended therapy to all patients, and reported most laboratory-confirmed chlamydia and gonorrhea cases of urethritis to the state health department. Several interventions introduced at this large group practice may have encouraged these favorable STD practices.

Adult↗

Using activity-based costing to track resource use in group practices.

Research shows that understanding how resources are consumed can help group practices control costs. An American Academy of Orthopaedic Surgeons study used an activity-based costing (ABC) system to measure how resources are consumed in providing medical services. Teams of accounting professors observed 18 diverse orthopedic surgery practices. The researchers identified 17 resource-consuming business processes performed by nonphysician office staff. They measured resource consumption by assigning costs to each process according to how much time is spent on related work activities. When group practices understand how their resources are being consumed, they can reduce costs and optimize revenues by making adjustments in how administrative and clinical staff work.

Accounting↗

Enhanced managed care opportunities of group practices. Attention to four key factors can improve a practice's contracting position.

As managed care penetration increases throughout the nation, group practices should evaluate their business composition and practices to make the most of the managed care arrangements into which they enter. By evaluating their practice in terms of its structure, organizational maturity, information collection capabilities, and financial position, a group practice will be able to make changes that will enhance its market position and improve its negotiating leverage.

Data Collection↗

Health outcomes for a chronic disease in prepaid group practice and fee for service settings. The case of rheumatoid arthritis.

The authors compare health care use and outcomes of a panel of persons with rheumatoid arthritis receiving health care in prepaid group practice and fee-for-service settings. In 1982, they randomly sampled one half of all 114 board-certified or eligible rheumatologists in Northern California. Those who participated provided the names of all patients with rheumatoid arthritis presenting during a 1-month period; 812 of these patients (97% of those listed) were interviewed. In 1984, 745 of them (92% of the baseline cohort) were interviewed; 569 receive care in fee-for-service settings and 176 in prepaid group practice. As in the baseline survey year, the prepaid patients received similar amounts and kinds of health care as their fee-for-service counterparts. The prepaid and fee-for-service patients achieved similar outcomes, as measured by symptoms of illness, functional status, and work disability. The fee-for-service patients reported poorer overall health status. The authors conclude, after 2 years of follow-up study, that patients in prepaid group practice receive similar medical care inputs and achieve outcomes at least as good as those in fee-for-service.

Analysis of Variance↗

A comparison of surgical assisting in a prepaid group practice and a community hospital.

Previous studies of the work loads and time utilization of general surgeons in two different practice settings suggested that paraprofessional surgical assistants (SAs) could reduce surgeon assisting time and perhaps increase productivity. In order to further assess the potential advantage of using SAs as surgical assistants, the present study examines assisting patterns in a prepaid group practice where SAs are used and in a community hospital where only physicians are available to assist. In the prepaid group practice, 87 per cent of general surgical procedures were performed with an assistant; in the c ommunity hospital, 67 per cent of general surgical procedures were performed with an assistant. General practitioners also were found to assist in the community hospital; family practice residents, medical students and "others" also assisted in prepaid group. In both settings, the propensity to use an assistant was positively correlated with operative complexity. On operations of greatest complexity, surgeons were most likely to act as first assistants. The use of SAs was not usually associated with operative sessions longer than when surgeons assisted, except on operations of high complexity. In the prepaid group, SAs also frequently assisted on orthopedic surgery, neurosurgery and obstetrics-gynecology, only occasionally on otolaryngology and plastic surgery, and never on ophthalmology. It appears that in organizations such as a prepaid group practice, where mechanisms for sharing resources exist and incentives are provided to minimize the total cost of surgery, the utilization of SAs might be associated with cost savings. At present, organizational and financial barriers exist to the introduction of paraprofessionals as surgical assistants. It is difficult to advocate the modification of these barriers to facilitate the training and large-scale introduction of this new group of paraprofessionals in the current surgical market where there may already be an excess supply of surgeons.

General Surgery↗

A comparison of quality and utilization problems in large and small group practices.

Physicians practicing in large, multispecialty medical groups share an organizational culture that differs from that of physicians in small or independent practices. Since 1980, there has been a sharp increase in the size of multispecialty group practice organizations, in part because of increased efficiencies of large group practices. The greater number of physicians and support personnel in a large group practice also requires a relatively more sophisticated management structure. The efficiencies, conveniences, and management structure of a large group practice provide an optimal environment to practice medicine. However, a search of the literature found no data linking a large group practice environment to practice outcomes. The purpose of the study reported in this article was to determine if physicians in large practices have fewer quality and utilization problems than physicians in small or independent practices.

Centers for Medicare and Medicaid Services, U.S.↗

Value marketing in your group practice.

The negative association with marketing in group practice is generally unavoidable writes Eileen Chiama, M.S., and dates back to the turn of the century. Medical groups are now, however, starting to effectively use marketing, especially as a means of adding value to their product.

Consumer Behavior↗

Notes on the history of group practice: the tradition of the dispensary.

According to author Donald Madison, M.D., medical group practice is, "an original American phenomenon...its appearance coincided with specialization in medicine and much of the early growth was fed by the experiences of American physicians who served...during World War I." Madison answers the questions of how, where, when and why group practice developed as it did.

Group Practice↗