[Balint-inspired general practice groups].
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Family Practice↗
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The impact of health care reform on group practice.
Just two years ago, it would have been very difficult to imagine that reform of the health care system would today be a national domestic priority and that Congress would be considering one of the most significant and far-reaching pieces of legislation in the past 50 years. The issue is still in doubt, but it seems clear that, in this session of Congress or the next, legislation of far-reaching consequences will likely be passed. In fact, change on a widespread scale has already begun. During 1993, every state legislature except those of Nevada and Wyoming considered measures that would alter the way medical care is financed and delivered. Of the states that acted, both last year and in recent legislative sessions, eight have passed laws with the ultimate objective of ensuring access to medical care for all citizens. Government, at both the state and federal level, is clearly taking on the health care issue. The impact of reform on physicians, and thus on group practices, will be substantial. This article outlines the current course of health care reform and addresses its specific implications for the management of group practices.
Cost-Benefit Analysis↗
Comparative costs to the Medicare program of seven prepaid group practices and controls.
This research was conducted in order to compare costs to the Medicare program for providing health care service to old people enrolled in two forms of health delivery organization: open market and prepaid group practice (pgp). Two data sources were employed: cost data provided by the Social Security Administration for seven prepaid group practices in five SMSAs and northern California and interviews conducted with administrators of the prepaid groups to determine: organizational sponsorship, incentive structure, pattern of selectivity of patients, and resource availability. Major findings are: (1) Enrollees in prepaid groups incur higher physician costs. This includes services provided by practitioners in and outside the plans. (2) Overall, prepaid groups demonstrate savings to the Medicare program in provider-initiated services- in hospital care and extended care facility services, but not in home health care. (3) Reduced spending in the hospital component does not imply reduction in the extended care facility or home service. (4) Outpatient costs in the hospital are generally higher in the open market modes, probably because this mode of care is viewed as an alternative to physician visits. (5) The greatest cost savings to the Medicare program are demonstrated by groups which are relatively small, yet hospital-based.
Aged↗
Functions performed by level of practice of registered dietitian members of the diabetes care and education dietetic practice group.
The purpose of this study was to examine current professional practices of registered dietitians (RDs) in the Diabetes Care and Education dietetic practice group (DPG), analyzed by levels of practice: entry-level, specialty-practice, or advanced-level. The results of the Diabetes Care and Education DPG 2002-2003 membership survey were used for this study. The study was limited to RD members of the Diabetes Care and Education DPG who completed the membership survey in its entirety. Frequency distributions, chi2, Fisher exact test, and cluster analysis were performed with a prior alpha set at .10. Sixty-one (5.0%) RDs were functioning as an entry-level practitioner, 851 (69.1%) were functioning as a specialty-practice practitioner, and 320 (25.1%) as an advanced-level practitioner. Significantly more advanced-level practitioners were performing more tasks compared with entry-level practitioners. Entry-level RDs performed a mean of 2.4 functions, specialty-practice practitioners performed 7.7, and advanced-level practitioners performed 11.6 functions. The results of this survey further delineated that RDs function at various levels of practice and that credentials for RDs increased as level of practice advanced.
Chi-Square Distribution↗
Managing the complexities of group practice. An interview with ACMPE president Robert Nelson.
Robert A. Nelson, FACMPE, the new president of the American College of Medical Practice Executives (ACMPE) and a principal with the Canon Group, Santa Barbara, Calif., took time to share his vision of the ACMPE and the state of group practice with the MGM Journal. A past president of MGMA. Nelson was honored in 1999 with the ACMPE's Harry J. Harwick Award--the College's highest recognition for health care executives.
Attitude of Health Personnel↗
Deterrents to family enrollment in a prepaid group practice.
Research suggests that there are three prime deterrents to enrollment for persons who are attracted to prepaid group practice (PGP): 1) reluctance to change imbedded habits; 2) low expected utilization (low risk); and 3) payment for health insurance through employment. This study tests the influence of these enrollment barriers by examining families of new PGP members who are grouped according to whether their family members joined (FP) or remained outside (IP) the PGP under examination. The two groups of families do not differ in health status or past utilization as proxies of expected use of medical services. They do, however, differ according to the presence of a regular source of care. Although more IP than FP families report prior physician ties, the influence of this factor is diminished when other family characteristics are accounted for in a multivariate analysis. The variables explaining the most variance in enrollment type are family size, employment status and income. IP families are typically small (often without children), have two employees and a low adjusted family income. Although many PGPs have attempted to attract this family type through multitiered rate systems, it is doubtful that this approach can be effective in the long run. The broad practice of job-centered health insurance provides these families no systematic mechanism for combining their employee benefits to purchase a family plan and therefore little incentive to join a PGP family plan. Changes in the way health insurance is obtained are encouraged.
Adult↗
The family doctor in group practice.
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Group Practice↗
Establishment of two group practice centres by conversion of existing houses.
A practice of five (later six) doctors established their own group practice centre by purchase and conversion of an existing house. Later a second, smaller centre was established in the same way to replace an existing branch surgery.The planning, financing, and execution of these projects is described.
England↗
Implementation of COSTAR in an academic group practice of general pediatrics.
High-quality medical care requires a medical record that is complete, legible, and readily available. Information storage and retrieval are often more difficult in academic group practices than in private offices because of the complexity of the delivery system. We implemented a computerized medical record (COSTAR) in our academic group practice in pediatrics, and recorded data on 14,486 visits for preventive health care or illness over an 18-month period. Except when follow-up visits were made within 48 hours of an encounter, a complete medical record was available at all times. The attending staff physicians were enthusiastic about the computer-based record, and after a period of adaptation, the residents were as well. The nurses and clerical staff agreed that it improved office efficiency and thus patient care. Yet the system was abandoned in the face of medical college politics and problems in other practices at our institution.
Academic Medical Centers↗
Converting a teaching hospital medical clinic to a group practice: patients vote with their feet.
Traditional general medical clinics (GMCs) have been criticized as providing less than optimal primary care while losing money for the sponsoring teaching hospital. In addition, the GMC has become less attractive as a site for training house staff. In response, a number of teaching hospitals have sponsored the development of a primary care group practice as a more efficient alternative to the GMC. Under the new model, certain measures of patient care frequently improve, house staff receive better training, and the hospital may be able to trim financial losses. While the literature contains numerous descriptions of such conversions, very little information is available about the compliance of patients who are transferred to the new model with relatively little preparation or choice. Institutions that convert their GMCs may do so to attract new clientele. But they have a responsibility to their long-time patients and certainly should address the question of whom they expect to transfer successfully and what the dropout rate will be. New York City's Mount Sinai Hospital completed conversion of its GMC to a primary care group practice in 1983. A sampling of patients taken before the conversion, then followed up 6 months latter, revealed that 82 percent of the former GMC patients were successfully referred to the new model. Patients given specific appointments rather than instructions to call for their own appointment had a better "show" rate. Noncompliers were more likely to be female, Medicaid-covered, 46-65 years old, and living outside the hospital's immediate service area. Our data suggest that when hospitals close a GMC and transfer patients to a hospital sponsored alternative, they can expect to refer most patients successfully.
Adult↗
Estimation of unreimbursed patient education costs at a large group practice.
INTRODUCTION: A search of the literature on the cost of patient education found that provider education time per patient per day was rarely reported and usually not derivable from published reports. Costs of continuing education needed by health professionals to support patient education also were not given. Without this information, it is difficult to appraise the costs of existing or newly proposed patient education activities and technologies. METHODS: An extensive literature search was conducted. Clinic and hospital personnel at a large group practice were surveyed to obtain per patient per day estimates for comparison with the literature. RESULTS: Although the literature now spans several disciplines, few useful empiric studies exist. In the group practice, 18.6 minutes per patient per day were spent on patient education. Unreimbursed cost of patient education by nurses alone was $28,258,478 to $48,710,368 annually. These costs do not include costs of continuing education to maintain and upgrade patient education. DISCUSSION: The cost figures reported above are consistent with the limited information in the literature. The present study suggests that patient education costs are substantial, and more attention needs to be given to the costs of continuing education intended to improve patient education.
Costs and Cost Analysis↗
Factors affecting pediatric preventive care utilization in a prepaid group practice.
Previous research on the utilization of pediatric preventive care has shown that certain sociodemographic factors, such as age, birth order, family size and race, as well as health attitudes and beliefs are related to the use of well-child services. To examine the simultaneous effects of sociodemographic, psychosocial and behavioral factors, we conducted a 16-month prospective investigation of 532 children belonging to a university-affiliated prepaired group practice. The children were under 5 years of age upon enrollment and came predominantly from white, middle-class families with well-educated parents. Our bivariable results showed that 13 factors were related to preventive care utilization (p less than 0.05) and, in effect, confirmed findings from previous investigations. However, using model-fitting procedures, we found that only two variables, child's age and birth order, significantly predicted the rate of preventive care visits; a high utilization rate was observed for younger children and for first-born children. Since the observed age-specific rates of preventive care utilization were nearly identical to the schedule recommended by the pediatricians in this practice, we believe that most of the variability in well-child care in our population was due to provider-induced demand. Furthermore, none of the other demographic or psychosocial factors that significantly predicted acute care utilization in this population had any effect on preventive care once age and birth order were accounted for.
Birth Order↗
The impact of RBRVS on this group practice.
Given the importance of the resource-based relative value scale (RBRVS) on group practice, it is important to analyze the emerging data from Medicare. In this article, authors Troy Pickens, CPA, and Walter Jones, Ph.D., look at the current and anticipated payment patterns for their practice as well as trying to determine the actual impact of RBRVS on reimbursement levels.
Costs and Cost Analysis↗
Marriage guidance counselling in a group practice.
This paper describes the work of a marriage guidance cousellor in a group-practice centre. The considerable advantages to patient, doctor, and counsellor of her close association with the primary medical care team are discussed.
Counseling↗
Physician group practice turnaround. Focus on physician behavior.
Physician behavior is an important driver in a group practice turnaround. A strong leadership team, giving physicians ownership, governance and proper incentives, creates the necessary behavior changes. It's also critical to have budget discipline, identify and make the hard decisions, provide effective care management, employ a sound business infrastructure and good contracting, and attend to physician morale.
Budgets↗
Clinical and health service research needs in the group practice organization.
Clinical and health services research will play a more important role in group practice organizations because it provides a vehicle to identify and answer critical questions. Study initiatives can identify, describe, quantify, and help predict trends in clinical practice. Systematic investigation is a means to link structure and processes of care to clinical parameters, patient outcomes, and cost variables. Findings can be used to support sound clinical, quality of care, and educational decision making. The ultimate goal of research is to promote the appropriate access and delivery of quality care in a cost-effective manner.
Costs and Cost Analysis↗
HIV-antibody testing in a multispecialty group practice.
The authors reviewed the trends in HIV-antibody testing at a multispecialty group practice with more than 280 physicians. Based on a chart review of 243 randomly selected patient records, they judged 38% of the tests ordered to be for low-risk individuals. Forty-five percent of the records documented the patient's informed consent before testing, and only 15% noted that patient education or counseling had been given.
AIDS Serodiagnosis↗