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PubMed1979

Rates of surgical care in prepaid group practices and the independent setting: what are the reasons for the differences?

The Seattle Prepaid Health Care Evaluation Project is a comparative study designed to assess the care received by persons enrolled in either a large prepaid group practice (PGP) or in a prepaid, independent practice setting in which physicians are reimbursed on a fee-for-service basis (IPP). As part of the study we assessed the patterns of surgical care for hysterectomy, cholecystectomy, appendectomy, and tonsillectomy/adenoidectomy. Overall, there were 215 such procedures with an exposure adjusted rate being five times higher in the IPP than in the PGP. After eliminating 43 per cent of procedures in the IPP and 22 per cent in the PGP which did not meet specified criteria for either necessary, appropriate or justifiable surgery, the exposure-adjusted rate differential was 3.9 times higher in the IPP with the difference in the rates being mainly attributable to hysterectomy and tonsillectomy/adenoidectomy. We conclude there were more unnecessary procedures in the IPP, but the fact that a significant difference in the incidence of surgery persisted even after elimination of such cases suggests that the differences in rates of surgery between the IPP and PGP cannot be solely attributed to a higher rate of inappropriate surgery in the IPP.

Adenoidectomy↗
PubMed1984

Consumer-sponsored prepaid group practice: restructuring the health care system.

The traditional separation of health care delivery and financing systems is breaking down as various new types of health care facilities are established and as payment continues to be a major concern. Group Health Cooperative of Puget Sound (GHC) was organized as a prepaid group practice system responsive to consumers. Costs, methods of payment and delivery of care are interrelated and are all influenced by consumer ownership. GHC has been refining its benefit programs since 1945. Strategies for controlling use and costs focus on improved provider management and on flexibility. This article explains how the structure of GHC benefits the consumer.

Community Participation↗
PubMed2004

General practitioners' perceptions of sharing workload in group practices: qualitative study.

OBJECTIVE: To explore general practitioners' beliefs and experiences of distribution of workload and teamwork between doctors in general practice. DESIGN: Qualitative semistructured interview study. SETTING: South London. PARTICIPANTS: 18 general practitioners from 11 practices. MAIN OUTCOME MEASURES: Perceptions and experiences of distribution of workload and teamwork between doctors. RESULTS: Equitable distribution of workload was a common concern among general practitioners in group practices. Several ways of addressing the problem were identified, including relying on trust, creating systems of working based on explicit rules such as points' systems, and improving communication. Improvement of communication was hampered by the taboo nature of the problem. CONCLUSION: Resentment about perceived inequalities in workload places a further burden on general practices. The issue of working together warrants further support.

Attitude of Health Personnel↗
PubMed1993

Is bigger really better? An analysis of economies and diseconomies of scale in orthopaedic group practice.

As administrators, we continually strive to compare our group's performance to accepted standards of cost and production. In making comparisons to national norms, it is important to understand the statistical sample of groups from which these norms are drawn. Therefore, differentiations in the size of a group alone may have predisposed a group to either favorable or unfavorable comparisons to national standards. This professional paper was written in order to investigate the relationship between group size and measures of performance.

Cost-Benefit Analysis↗
PubMed1987

Single-dose cephalosporin prophylaxis of 929 surgical procedures in a prepaid group practice: a prospective, randomized comparison of cefoperazone and cefotaxime.

In this report, we summarize 929 surgical cases (812 evaluable) receiving preoperatively prophylaxis with either cefoperazone (1 g), or cefotaxime (1 g). The patients were randomized to one of the two single-dose cephalosporin regimens and by operative procedure groups that included hysterectomies, genitourinary procedures, gastrointestinal operations, and the "other procedures" category that was dominated by orthopedic cases, such as total joint replacements and open fracture reductions. The postoperative wound infectious morbidity rates were: cefoperazone 2.2% and cefotaxime 3.0% (overall rate, 2.6%). Most wound infections were superficial, with more than half discovered after patient discharge and unrelated to the surgical prophylaxis. The wound infections associated with colorectal surgery cases given a single-dose of cefoperazone were twofold higher than the control regimen. Non-wound infectious morbidity was 5.8% (p greater than 0.05) for cefoperazone, mostly urinary tract infections causes by Escherichia coli, Streptococcus faecalis, and Staphylococcus spp. Side effects were not considered severe and occurred at a very low rate. Abnormally elevated prothrombin times of patients receiving cefoperazone were not any more frequent than the control regimens. The two prophylaxis regimens were not different statistically (p greater than 0.05) as to the infectious morbidity or adverse reactions. By using either studied single-dose schedule in our prepaid group practice setting, compared with the previously used multi-dose schedules, we could predict an annualized cost savings of $50,000 (cefazolin) and greater than $200,000 (cefoxitin). We propose a single 1-g dose of cefoperazone or cefotaxime (FDA approved) as a cost-effective prophylaxis alternative.

Adolescent↗
PubMed1984

Evaluating health planning: empirical evidence on HSA regulation of prepaid group practices.

The regulation of HMOs by health planning agencies serves as a "tracer" to aid in evaluating HSAs, and as a source of empirical evidence for the heretofore largely theoretical health policy debate between market reformers and regulators. Two complementary studies (the authors' 1979 survey investigating the hospitalization policies of prepaid group practices, and AMPI 's study of all HMO applications submitted to HSAs from 1975 through mid-1978) provide information about the extent of HMO applications to planning agencies, the rate of rejections, the burden of the planning process of HMOs, and the possibility that negative perceptions of regulation may have led HMOs to refrain from activities requiring planning approval. Both studies reveal that health planning review was detrimental to 20 to 30 percent of HMOs. Thus data collected during the period of extensive HSA regulation of HMOs seem to justify the current policy that gives HSAs only very limited authority over HMOs.

Economic Competition↗
PubMed2006

Assessment of female participation in an employee 20-week walking incentive program at Marshfield Clinic: a large multispecialty group practice.

OBJECTIVE: We evaluated the short-term effect of a worksite-based walking incentive program to promote physical activity and well-being in employees of a private healthcare clinic. DESIGN: A prospective, observational follow-up study. SETTING: The study was conducted at Marshfield Clinic, a large private multispecialty group practice healthcare institution in Marshfield,Wisconsin, USA. PATIENTS: Subjects for this study were Marshfield Clinic physicians and staff. METHODS: From March 31, 2005 to August 20, 2005, physical activity level, body mass index (BMI) and other well-being characteristics were observed pre- and post-program among 191 female participants from the Marshfield Clinic. A brief Web site-accessible, self-reported survey assessed the effectiveness of the exercise program. RESULTS: Our data show a statistically significant (p <0.0001) increase in participants' physical activity level, while a significant (p = 0.021) decrease in mean BMI was observed. However, there was no evidence of our incentive program reducing participants' blood pressure. CONCLUSION: Preliminary findings of our study suggest that the goal of worksite programs designed to support employees in their efforts to improve or maintain their level of wellness is potentially achievable. Continuing research is needed to further assess whether persistent health benefits can be induced by worksite wellness programs.

Exercise↗
PubMed2000

Physician responses to the marketplace: group practices and hospital alliances.

Congress is now debating legislation that would give independent physicians the right to bargain collectively with managed care organizations. Proponents argue that this legislation is needed to counterbalance the market power of managed care organizations; opponents argue that physicians can already gain leverage and negotiating strength by forming group practices or through joint ventures with hospitals. This debate has brought attention to the competitive nature of the health care marketplace, and physician responses to managed care. This Issue Brief examines how physicians are reorganizing their practices to meet the demands of the competitive marketplace.

Delivery of Health Care, Integrated↗