SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Disruptions in the governance of a group practice can throw the organization into turmoil or paralyze its direction. Three case studies demonstrate how dysfunctional medical groups got back on track.
Night calls attended in 1977 by four doctors in a group practice were analysed and divided into categories of urgency.Slightly over half the night calls were genuine emergencies, and only four per cent were totally unnecessary.
From a marketing perspective, there are many differences between private and academic medical center (AMC) group practices. Given the growing competition between the two, write John Eudes and Kathy Divis, it is important for the AMC group practice to understand and use these differences to develop a competitive market advantage.
This study compares the financial and productivity performance of hospital- versus physician-owned medical group practices. Nineteen hospital-owned and twenty-three physician-owned family practices were matched by location (state) and size (full-time equivalent providers). The data were obtained from the 1998 Medical Group Management Association (MGMA) Cost Survey database. The focus of this study is on the "bottom-line" performance of the organizations as well as the production costs of the different type of practices. Analyses of these data consider staffing differences, charge and revenue differentials, productivity factors, and differences in patient volume and procedure volume. When comparing the hospital-owned and physician-owned family practice groups, the statistical analysis of these data suggest that the underlying distinctions are driven by differences in the volume of patients and volume of procedures.
BACKGROUND: For decades, reformers argued that medical groups can efficiently provide high-quality care and a collegial professional environment. The growth of managed care and the movement to improve quality provide additional reasons for physicians to practice in groups, especially large groups. However, information is lacking on recent trends in group size and the benefits of and barriers to group practice. OBJECTIVES: To identify benefits of and barriers to large medical group practice, and to describe recent trends in group size. DESIGN, SETTING, AND PARTICIPANTS: Information on benefits and barriers was obtained from 195 interviews conducted during round 3 (2000-2001) of the Community Tracking Study with leaders of the largest groups, hospitals, and health insurance plans in 12 randomly selected metropolitan areas. Information on recent trends in group size was obtained from more than 6000 physicians in private practice in 48 randomly selected metropolitan areas via Community Tracking Study telephone surveys in 1997-1998, 1998-1999, and 2000-2001. MAIN OUTCOME MEASURES: Benefits of and barriers to large group practice, as perceived by interviewees, and changes in percentages of physicians in groups of varying sizes. RESULTS: Gaining negotiating leverage with health insurance plans was the most frequently cited benefit; it was cited 8 times more often than improving quality. Lack of physician cooperation, investment, and leadership were the most frequently cited barriers. Survey data indicate that 47% of private physicians work in practices of 1 or 2 physicians and 82% in practices of 9 or fewer, and that the percentage of physicians in groups of 20 or more did not increase between 1996 and 2001. CONCLUSIONS: Current payment methods reward gaining size to obtain negotiating leverage more than they reward quality. However, barriers to creating large medical groups are substantial, and most private physicians continue to practice in small groups, although the size of these groups is slowly increasing.
This paper examines the basis for the selection of prepaid group practice in a dual-choice situation, and the social, attitudinal, and health characteristics of populations choosing prepaid programs in contrast to other plans. When asked in an open-ended way why they made the decisions they did, those selecting prepaid group practice most frequently referred to the more comprehensive coverage provided and to the fact that at the time of choice they lacked a continuing or adequate relationship with a physician. Enrollees in the prepaid program were better educated and, contrary to previous research, more likely to be unmarried. There was little evidence that enrollees in the prepaid plan brought with them distinctive kinds of attitudes and orientations toward illness and medical care. Enrollees in the prepaid program were also comparable to those retaining an alternative health insurance option on a number of indicators of health status. However, prepaid practice enrollees tended to report more chronic conditions than persons who declined to enroll in the prepaid program. Although the overrepresentation of persons with chronic illnesses is not large, data drawn from a related study suggests that persons with several chronic conditions tend to be heavy users of medical services.
This study was designed to identify the relevant components of the organizational culture of medical group practices and to develop an instrument to measure those cultures. Building on the work of industrial psychologists and organizational sociologists, a 35-item instrument was developed through an iterative process with more than 100 medical groups. The final instrument was tested using responses from physicians practicing in two very different medical groups: one a prepaid group practice with salaried physicians and the other, until recently, a fee-for-service practice. Using stepwise discriminant analysis of the responses to this instrument, more than 90% of the physicians were able to be placed in the appropriate practice setting.
Records of prescriptions that originated from one group practice and were dispensed at one pharmacy were maintained for one year. The information recorded included the age and sex of the patients, the name of the prescribing doctor, and the drug(s) prescribed and their cost. Analysis of the records showed considerable differences in average prescription costs among doctors. For all the major therapeutic groups, repeat prescriptions were more expensive than new prescriptions, children had cheaper prescription costs than adults, and prescriptions for women were cheaper than those for men. Within an age-sex group or a therapeutic group, however, prescription costs were similar for each doctor. These results indicate that the differences in overall prescribing costs among doctors were not due to different management of the same disorders, but were due to different types of patients being seen.
If competition proposals are to reduce the cost of medical care, they must put forth a key role for physicians. Inasmuch as most proposals focus on the market for health insurance, the means by which policies that affect insurers are transmitted to influence the behavior of physicians are largely unknown. A larger role for competing groups of physicians is hypothesized, but the effect of competition is likely to be uneven, because group practice physicians are already in the most competitive areas of the country in terms of the density of physicians, and very few are in rural areas or in other particular regions of the country. Little evidence can be found in productivity or fee level differences between solo and group practice physicians. Thus the value of promoting group medical practices rests on their ability to reduce the use of expensive medical care. It is possible that competition proposals may not hold much promise for reducing costs. Nevertheless, they may still be worthwhile if they are better able than the present system to translate the wishes of consumers into the services of providers.
Medical groups are challenged to develop a satisfying context for physicians to deliver patient care. This article reports on the efforts of the Lovelace Medical Center and the Lovelace Clinic, P.C. (professional corporation), in Albuquerque, New Mexico, to create a distinctive environment for its medical staff members. A job-design model is examined wherein core job characteristics and physician growth-need strength influence critical psychological states and satisfaction. The results of this longitudinal study suggest that from the perspective of primary care physicians, the practice setting at Lovelace has improved markedly between 1984 and 1990. In addition, fewer changes were observed for specialists, ostensibly due to extremely favorable perceptions of the practice setting at Lovelace during this time period. The implications of these results point primarily to the value of consciously designing and periodically monitoring the practice environment within medical groups.
The US Congress has approved a prospective payment plan for Medicare using DRGs, which becomes effective October 1, 1983. This article explains DRGs, demonstrates the specific ways DRGs may affect group practice physicians, and discusses how group practices can avoid being adversely affected. A brief history of the DRG concept is presented along with a discussion of the evolution of DRGs and case-mix reimbursement. Actions hospital administrators are taking relative to the new reimbursement plan and the impact these actions will have on medical groups are examined.
The dominant managed care model in the USA is the individual practice association (IPA), in which physicians in separate practices contract with a health plan. One alternative model, the capitated multispecialty group practice (CMGP), has some distinct advantages: (i) the best randomized trial comparing a health management organization (HMO) with indemnity insurance showed equivalent health outcomes for a prepaid group-practice model HMO, with about a 40% saving in cost, mostly from lower hospital utilization. There is no comparable evidence for IPA-style HMO's; (ii) most managed care plans control costs through 'gatekeeper' primary care physicians or capitated payment. Strong financial disincentives to care, applied to small practices, lead to a significant risk of withholding needed care. Large capitated groups diffuse the risk among hundreds or thousands of physicians; (iii) small practices also lack the financial resources and expertise to develop information systems, continuous quality improvement programs, and other means of improving efficiency. Larger groups can integrate specialty and primary care, laboratory, pharmacy, information technology and other services, to improve quality and cost-effectiveness, while maintaining physician control of the process; (iv) in urban California, HMO enrollment in six large capitated groups increased by 91% from 1990 to 1994. Hospital utilization for these groups was less than half the USA average; (v) because it is self-insured, the CMGP could contract directly with purchasers, eliminating the need for the insurance intermediary. The CGMP offers an ethical, effective alternative that maintains the primacy of the physician in health care: physician-managed care.
Profiling is a technique that large, multispecialty group practices, like many insurers, can use to monitor and improve quality and efficiency. Groups can examine physician performance by calculating ratios of medical inputs to patient or population outputs. Physician control can help to achieve balance between clinical benefits and economic considerations. Profiles need to reflect a group's multiple missions, such as clinical care, research, and education; philosophy of care; and organizational ethos regarding physician compensation systems. Groups may need to customize standard approaches because of their emphasis on early utilization of specialists and the atypical case mixes often found in referral practices.
This paper describes the experience of the two prepaid group practice plans in Ontario before and after universal health insurance. Both plans were capitalized, before national health insurance, by member contributions and both have had persistent problems with enrollment constraints and professional opposition. The Sault Ste. Marie Plan began in 1963, six years before Canadian medicare. The plan was paid a capitation fee for medical services but did not share in savings from its reduced hospital use. After universal insurance sharing in decreased hospital use was offset by regulations which allowed plan members to use non-plan physicians at Plan expense. Payments to non-plan physicians now take up 20 per cent of Plan income. Active enrollment of members has been replaced by a Ministry of Health registration system which is based on overall utilization. The St. Catharine's Plan began at the same time as universal insurance in 1969. Its out-of-plan use averaged about 40 per cent of total income. Most recently this program has shifted from capitation to cost-reimbursement payment. In Canada present trends include cost containment, financing by general tax revenues rather than premiums and increased categorical benefits. Under Canadian universal health insurance prepaid group practice has an uncertain future.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.