1987 practice survey--part 4. Group practices show big gains.
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Adult↗
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Improving group practice performance with benchmarking.
Group practices can use benchmarking to improve physician productivity to best-practice levels. The benchmarking process can be broken down into two phases. In the first phase, the problem is identified. This phase involves identifying critical drivers, choosing an external benchmark, gathering internal data, identifying variances, and establishing targets. In the second phase, action is taken. This phase involves identifying actions to take, defining responsibilities, implementing the changes, and monitoring performance. Group practices that use benchmarking need to understand the tool's limitations. Benchmarks serve as roadmaps, but any action plan should be tailored to the practice and take a variety of factors into consideration.
Benchmarking↗
The future of group practice and MGMA (Medical Group Management Association). Interview by Dennis Barnhardt.
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Forecasting↗
Getting started: quality improvement in an academic group practice. A university physicians' group measures results.
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Academic Medical Centers↗
Group practice in Singapore.
For a group practice to be successful compatibility of the members of the group is of paramount importance; other important considerations must include mutual respect and common objectives. Despite any high ideals, adequate reward for productivity is always expected by members of the group and any agreement must include an equitable financial distribution. In Singapore with a dentist population of 588, only 97 are involved in group practices. The assistantship type of practice is popular among new graduates who do not have the finance to invest in single-handed practices. Associateships do exist but in view of the increasing over supply of dentists it is envisaged that this type of grouping may not be too common in the future. There are 19 partnership practices in Singapore; a personal example is described to illustrate a successful group practice.
Group Practice, Dental↗
A fourth-year orthodontic elective in an educational group practice.
An educational group practice is described in which a fourth-year dental student actively observes and participates in orthodontic decision making and treatment delivery. The student takes part in patient treatment under the direct supervision of a second-year orthodontic resident. The residents reinforce the skills which the students learn in class and laboratory. In this way an effective learning experience results for both the resident and the fourth-year student. Students also attend patient care conferences, where treatment points of view and sequences are discussed. In this way, students have a first-hand glimpse of what a career in orthodontics might be like.
Education, Dental↗
Structural characteristics of medical group practices.
This study of 247 medical group practices explores the structural characteristics of these emerging organizational forms. As size and complexity of services increase, group practices tend to increase the number of hierarchical levels of authority and become more formal and bureaucratic. Complexity of services was found to have more influence on the formation of subdivisions, while size was more influential in terms of levels of administration. Large group practices, and especially large multispecialty groups, appear to engage in a highly organized corporate style of medical practice. In these organizations, important professional decisions are shifted from the clinician to the administrator.
Analysis of Variance↗
Rescuing the hospital-sponsored group practice.
Underperforming hospital-sponsored group practices can achieve reasonable financial performance without sacrificing morale among the group's physicians and office staff if six key elements for success can be implemented. These key elements involve formalizing physician leadership and governance, clearly allocating risk, communicating expectations regarding pay for performance, providing meaningful information, keeping overhead expenses under control, and putting an experienced management team in place. Implementing these six elements can help struggling hospital-sponsored group practices achieve a successful turnaround.
Financial Management↗
Patterns of dental practice in the United States: solo vs group practice.
This overview of selected characteristics of group and solo practices provides baseline information on the dimensions and structures of two general practice types in the United States. It appears that although a dentist spends no more hours or sees no more patients on the average in a group practice, the structure in terms of use of auxiliaries, appointment flexibility, and structured programs provides the dentist in a group practice more opportunity to participate in other professional activities and generate a higher income. Further analysis on the interrelation of these variables will provide a more conclusive comparison of group and solo practices. Also, more conclusive research on variations among different types of group arrangements is needed to appreciate differences in partnerships, groups, and incorporations.
Allied Health Personnel↗
Strength in numbers. Hospitals that encourage group practice development may have a strategic advantage in the 1990s.
Group practices have become increasingly popular among physicians in recent years. And as competition increases and operating margins become perilously thin, hospitals with significant group practice participation among medical staff appear to be in an enviable position. Before deciding to promote group practices, however, hospital managers should be become familiar with their advantages and disadvantages and determine whether a market exists for group practice development at their facility. The advantages for hospitals include more effective recruiting and a more stable patient base. Among the disadvantages are the fact that groups give physicians a stronger power base from which to request concessions from the hospital and that a preponderance of group-affiliated physicians on staff may discourage referrals from nongroup physicians. A number of considerations are involved in preparing for and coordinating group practice development. In the planning stages open communication with physicians is critical. Physician leaders and a cross section of active staff should participate. Planners should discourage formation of "groups without walls," in which hospitals manage group practices of physicians who remain at different sites. A hospital may, however, choose group-like arrangements (e.g., limited partnerships) without necessarily promoting group practice. Hospitals may also help a group purchase a facility of its own or even create the facility and allow the group to build equity in it.
Evaluation Studies as Topic↗
Risks of a large group practice: a personal experience.
Formation of a large orthopaedic group practice and practicing within this group carries many risks that are not present in a small group practice. The current authors will discuss the complexity of merging groups, forming corporate policy, hiring executive administrative staff, contracting issues with insurance companies, expanding services and developing ancillary income sources, and the complex interpersonal relationships of a large group practice.
Group Practice↗
General practitioners' attitudes to the development of midwifery group practices.
BACKGROUND: The report Changing childbirth (1993) has led to the development of midwifery-led schemes that aim to increase the continuity of maternity care. AIM: To determine the impact of midwifery group practices on the work of general practitioners (GPs) and their perceptions of midwifery group practice care. METHOD: Postal questionnaires were sent to 58 GPs referring women to the care of midwifery group practices (group-practice GPs), and a shorter questionnaire was sent to the remaining 67 GPs (non-group-practice GPs) within the same postcode area as a comparison group. In-depth interviews were conducted with 12 GPs. RESULTS: Questionnaires were returned by 71% of group-practice GPs and 81% of non-group practice GPs. One third of the group practice GPs felt that they were seeing group practice women too few times, and 50% thought midwives discouraged women from visiting their GP for antenatal checks. Over 80% of group practice GPs believed that midwives had the skills to detect deviation from the normal, and 66% would confidently refer women to their care. However, only 14% of group practice GPs believed that their own role was clear, while 64% agreed that communication with group practice midwives was poor, and concerns were expressed about the level of consultation before establishing schemes. Of the non-group practice GPs, 87% said they would consider referring women to the care of a midwifery group practice in the future. CONCLUSIONS: General practitioners were generally positive about the quality of care provided by midwifery group practices but identified issues that require addressing in developing this model of care.
Attitude of Health Personnel↗
The effect of a group practice on rural health attitudes and behavior.
The opportunity to join a group practice has been identified as a successful inducement for physicians to locate in rural areas. Less is known of the effects of group practice on the health attitudes, behavior and status of the rural communities in which they are established. A random survey of households was conducted in 1972 in a rural Midwestern area, prior to the establishment of a community-sponsored multispecialty primary care group practice, and again on the same households in 1977, after establishment of this group practice (a total of 292 households representing 829 persons). Perceived access to health services before the establishment of the group practice did not significantly predict use of the group practice. Neither previous use of medical services nor health status measured by several indices was associated with eventual use of the group practice. The apparent impact on the community of the group practice was a significant improvement in access to physician services, shown by shorter average travel time to the place of primary care and a 62 per cent improvement in the ability to make a same-day appointment. Furthermore, a significant shift in the distribution of physician services was noted over the study period. The introduction of physician assistants significantly decreased the prior positive attitudes toward them. Despite improvement in access to care, no changes in population health status or receipt of preventive services were noted. Current users of the group practice appear similar to those utilizing conventional medical care sources in regard to access to services, use of services, as well as health status, attitudes and costs.
Adolescent↗
A health care anomaly: a successful community hospital-affiliated group practice.
Many hospital-affiliated group practices have had significant problems. Failures are common. Sturdy Memorial Associates, a hospital affiliated group practice functioning out of twelve sites in the greater Attleboro area in Massachusetts, has been a success. Two senior managers discuss the history and the reasons why.
Catchment Area, Health↗
[Is there any way to go from private practice through a partnership to group practice?].
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Group Practice, Dental↗
General medical care and the education of internists in university hospitals. An evaluation of the teaching hospital general medicine group practice program.
Fifteen general internal medicine group practices in university teaching hospitals were studied to evaluate their primary care services and education. Data were collected over 9 months from physicians, patients, and medical records, and by observation. All institutions had closed their general medical clinics. Many patients being treated in group practices were very sick; 57% had hypertension; 21% were diabetic; and 45% could not work. Most were satisfied with their care. Care for acute problems from a health care provider in the practice was available quickly; regular physicians were harder to see. House staff and faculty spent little time in the practices. Few practices used teams; most used traditional attending and house staff models. Practice physicians could not easily determine when patients were seen in the institution's emergency department or were hospitalized. Quality of care standards were not uniformly met. Finally, the structure of academic centers appeared to inhibit the practices' performance, suggesting a need for further appraisal of relationships between university hospitals and their ambulatory care units.
Appointments and Schedules↗
Group practices tie hospital, physician objectives.
Group practice arrangements can underlie a hospital's strategy to recruit physicians and ensure steady patient volumes. Because physicians largely control where their patients are treated, many hospitals are considering ways to more closely align practitioners with their programs and services. Models for developing group practices range from asking young physicians to join an established practice to helping merge the practices of a retiring physician and an established practitioner.
Financial Management↗
Physicians and group practice: balancing autonomy with market reality.
Developing or joining multispecialty group practices is emerging as a premier competitive strategy for physicians. "Physicians and Group Practice: Balancing Autonomy with Market Reality" explores the driving forces causing the restructure of physician services into multispecialty group practices. The growth and characteristics of group practices are outlined as well as the advantages and trade-offs inherent in a group practice.
Capitation Fee↗