Group practice plans in governmental medical care in programs. I. Group practice prepayment plans in the medicare program.
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An examination of the distribution of physician incomes between different types of practices could help policymakers and researchers alike to gain an understanding of the effects of different organizational characteristics of practices on the practice of medicine as a whole. This study uses a national database to explore the relationships that exist between practice incomes and practice types vis-à-vis the overall size of practices. The primary data source for this study, which includes 7757 office-based physicians, was provided by the Taiwan Department of Health (DOH), with the dependent variable of interest to this study being the annual gross income of physician practices, while the independent variables are physician practice types and the number of physicians within a clinic. Multiple regression analyses were used to model the logarithm of annual physician practice incomes as a linear function of a set of independent variables. Kruskal-Wallis test results revealed the existence of significant relationships between practice incomes and practice types (p<0.001) and the number of physicians within a clinic (p<0.001). Multiple regression analysis also showed that after adjusting for socio-demographic and professional characteristics, the annual incomes of physicians in both single-specialty or multi-specialty group practices (p<0.001) were higher than those of their solo practice counterparts. This study concludes that after adjusting for other factors, higher practice incomes are enjoyed by physicians in single-specialty or multi-specialty group practices as compared to their solo practice counterparts. The finding of higher incomes for those physicians organized into groups supports the policy call from the DOH in Taiwan for the widespread formation of group practices.
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CONTEXT: Although medical groups are adapting to changes in financing health care, little is known about individual physician incentives in this environment. OBJECTIVES: To describe methods group practices use to compensate primary care physicians in a managed care environment and to examine the association of revenue sources for the group practice from all patients and primary care physician incentives. DESIGN: We surveyed by mail group practice administrators for practices that had at least 200 members continuously enrolled in 1995. SETTING: Group practices that had contractual arrangements with Blue Cross/Blue Shield of Minnesota. PARTICIPANTS: One hundred of 129 group practices returned usable surveys. RESULTS: Most groups had some portion of primary care physicians' compensation at risk, although 17 groups compensated them through fully guaranteed annual salary. Seventy-one groups used productivity, 4 groups used quality of care, 1 group used utilization, and 30 used group financial performance. Factors reported to significantly influence primary care physician compensation included billings or charges, overall group practice performance, and net revenue or profit. Groups that had a higher proportion of income from various types of fee-for-service arrangements used lower proportions of base salary for primary care physician compensation and were more likely to relate physician income to measures of productivity. CONCLUSIONS: Substantial variation exists in the types of primary care physician incentives implemented by medical groups. Base salary, individual productivity, and group financial performance were most frequently used to determine compensation. Physician personal financial risk was higher overall in group practices that derived more revenue from fee-for-service contracts.
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The vast majority of physicians remain in small, inefficient practices. True group practice formation has been slow to develop, leaving physicians vulnerable to problems as the rest of the health care industry moves toward modernization and consolidation. The idea of integrated health care systems consisting of medical practices working with hospitals or hospital systems is an unattainable dream as long as the underlying medical practices themselves are years behind in evolution. The author describes the many aspects of group practice formation, and why physicians must move quickly toward their development.
Established group practices in Ontario were surveyed to determine their structure, characteristics and attitudes toward government assistance in the development of group practice. The degree of organization of the groups surveyed was related to size and less than that reported in surveys of United States group practices. Group size and years of operation were strongly associated. Night, weekend and vacation coverage, the use of a unit patient record and the employment of non-physician administrators were reported frequently, and were more common in older and larger groups. As well, fringe benefits, except for professional organization dues, were not commonly provided.
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