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Group practice recommendations of the Committee on the Costs of Medical Care: a new look at an old issue.
The model of comprehensive group practice advanced by the CCMC in 1932 has been an elusive reformist vision. Changes in the techniques and techology of medical practive will require new professional agendas as well a new political constituencies. Analysis of the process of these changes must balance avocacy of any uptopian forms of practice.
Prepaid group practice staffing and U.S. physician supply: lessons for workforce policy.
This paper describes staffing at eight large prepaid group practices (PGPs) serving more than eight million enrollees at Kaiser Permanente and two other health maintenance organizations (HMOs). Even after characteristics of the patient populations and outside referrals are accounted for, these PGPs have a physician-to-population ratio that is 22-37 percent below the national rate. Two decades of historical data at Kaiser Permanente indicate that its rate of specialist growth was far higher than that of primary care. The study suggests that efficient systems of care can readily meet the demands of patient populations with workforce staffing ratios below current U.S. levels.
Software for the group practice: finding the needle in the haystack.
With the variety of systems currently offered, physicians need help in building a group practice software specification and in culling programs. Listed herein are pitfalls to avoid.
Description of a faculty-student group practice.
Dental schools are facing budgetary constraints, decreasing clinic patient populations, and increasing competition. At the same time, there is a need to provide students a realistic educational environment. The Dental Practice Systems (DPS) Program is a partially self-supported student-faculty group practice designed to address these issues. All individuals appearing for care are accepted into the program. Services are delivered by vertical teams of faculty preceptors, in-house specialty consultants, dental and dental hygiene students, and appropriate auxiliaries. All third- and fourth-year students rotate through the program providing clinical services. In addition, fourth-year students are assigned specific managerial responsibilities. The DPS Program maximizes the use of auxiliaries and students, allowing each to function as autonomously as is consistent with good patient care.
Hospital-based group practice and HMOs: a case study.
In its seven years of operation, Family Health Associates (FHA), established in 1977 by St. Mary's Hospital, Rochester, NY, has grown steadily, proving that hospital-based group practices can provide a solution to the need for reasonably priced high-quality care. An extension of the hospital's outpatient department, FHA combines features of the private-practice and hospital settings. Its physicians, who are hospital employees, may join HMOs and contract with third parties. All revenue, however, accrues to the hospital. The practice incorporates a complex sharing of decision-making authority to allow physicians to feel involved as well as to support the hospital administration's authority. Physicians may structure their schedules within the required total office time and refer patients to any hospital or specialist in the area. They are encouraged to participate in the hiring of nurses and secretaries and as a group may approve or disapprove facility schedules, plans for expansion and physician recruitment, revision of charges, and budget requests. They do not have final authority over budgets or staff terminations. Because of a shortage of physicians and diminishing referrals to the hospital's consultant staff, no appreciable opposition to FHA resulted in the beginning. Midway through the program's history, however, a conflict arose over FHA physicians referrals to the hospital's surgical specialists. Although surgeons believed that referrals should be shared equally, the medical staff's governing body supported FHA's objective of freedom of referral. Patient volume would increase more quickly, the medical staff believed, if FHA physicians were perceived as competitive in the public's eyes. Relationships with the medical staff gradually have improved as FHA physicians involve themselves in hospital committees and admit an increasing share of inpatients.
Social work in a pediatric primary health care team in a group practice program.
The inclusion of a psychiatric social worker as a member of a pediatric team in a prepaid group practice extends the range of pediatric mental health services to children. This paper discusses the collaboration of the social worker with the pediatricians and allied health personnel on the team in dealing with the emotional problems of referred children and their parents. Case examples are included. All cases seen by the social worker during a 6-month period are reviewed. With available psychiatric backup a wide range of emotional problems are identified, and effective mental health care is provided.
Expanding to cyberspace. What one practice learned in developing a web site for a large multispecialty group practice.
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Developing a group practice comprehensive care education curriculum.
In fall 2002 the University of Illinois at Chicago College of Dentistry implemented a Group Practice Comprehensive Care Clinical Education Curriculum. The primary responsibility for patient care has shifted in this comprehensive care curriculum from the students to the faculty and staff. Students have a primary responsibility for learning. This competency-based education curriculum utilizes a variety of student evaluation methods including self-evaluation, OSCE, and portfolio to verify competence. Formative evaluation methods are utilized in daily assessment of student performance. On-time graduation rates have increased from 60-70 percent to 96 percent, and regional board first-time pass rates have been maintained at 90+ percent. Overall predoctoral clinical productivity in the first full year of the program has increased by over 300,000 dollars.
Commentary on "Membership Duration and Utilization Rates in a Prepaid Group Practice," be Mary Jane Griffith and Nicholas Baloff.
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The relation of membership duration to prepaid group practice utilization rates: a reexamination.
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New entity for conducting group practice offers new potential.
A new form of entity, the limited liability company (LLC), may be used by physicians to conduct group practices with the tax advantages of a partnership and insulation from liability for copractitioner's acts. The author reviews the New Jersey Limited Liability Company Act.
Group practice owned by a partnership using some salaried dentists and contracting directly with purchasers of group dental care.
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[Group practice, an American attempt at finding a new form for practice].
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[Clinical pathology in practice: 6-year experience with a laboratory in a veterinary group practice].
From January 1st 1979, the Veterinary Association of South-East Drenthe made use of the services of a self-operated clinical-pathological laboratory. In the present paper, the reasons for choosing this form of service and the possibilities of research available to the laboratory are stated. In addition, the extent of activities over the last six years is reviewed. Experience so far is favourably assessed, both by veterinary practitioners and by clients.
Attitudes of patients toward family care in a family practice group.
There is little information documenting the extent to which the ideal of whole family care is represented in the real world of family practice. A previous study of a suburban family practice group revealed that only 28 percent of families obtained whole family care from a single physician. Interviews were conducted on a sample of 97 of these patients in an effort to gain insights into the factors influencing the choice of a single physician or more than one physician providing their health care. There were no significant differences between same-physician and different-physician families with respect to demographic factors or attitudes toward physician characteristics and family care. Most families had no insights into the potential value of having a single physician for the whole family; indeed, only one family specifically selected a single physician with the belief that it would thereby gain better care. If the observations reported here are representative of the situation at large in the country, family physicians have an important task ahead in patient education.
Comparison of obstetric outcome of a primary-care access clinic staffed by certified nurse-midwives and a private practice group of obstetricians in the same community.
OBJECTIVE: The purpose of this study was to compare the obstetric outcome of a primary-care access clinic staffed by certified nurse-midwives, supervised by a private practice group of four obstetricians, with the obstetric outcome of that group's private practice patients. STUDY DESIGN: A retrospective cohort study was performed. Obstetric outcome of 496 clinic patients was compared with that of 611 private patients in the same community from Aug. 1, 1991, to March 31, 1994. RESULTS: Obstetric outcomes as measured by (1) perinatal morbidity and mortality, (2) Apgar score, (3) birth weights, and (4) prematurity rates were comparable between the two groups. Significant was the cesarean section rate of 13.1% (10.5% primary) for the clinic patients and 26.4% (18.5% primary) for the private patients and the high percentage (81.8%) of private patients who elected to have repeat cesarean sections. CONCLUSIONS: (1) Low-income, uninsured, and underinsured women who have access to excellent prenatal care with supervised certified nurse-midwives can have obstetric outcomes similar to women having prenatal care with private obstetricians. (2) Prenatal care with supervised certified nurse-midwives can reduce the cesarean section rate without compromising infant outcome. (3) Utilization of certified nurse-midwives supervised by obstetricians may provide the optimum model for perinatal care, particularly for those women who are at high risk because of social and economic factors and who are currently underserved.
Prepaid group practice in Sault Ste. Marie, Ontario. I. Analysis of utilization records.
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