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PubMed1996

Compensation models and issues for a multispecialty group practice.

The methodology employed by a multispecialty group practice to compensate its physicians must complement the group's financial, strategic, programmatic, and operational objectives. Furthermore, the compensation plan must foster the group's corporate philosophy. This article presents several specific compensation models employed by multispecialty group practices and reviews the key implications associated with each model. Among the implications addressed are those associated with the shift to capitated payments, individual and groupwide objectives, the portion of compensation placed at risk, and the implications of the group practice joining an integrated delivery system.

Capitation Fee↗
PubMed1995

Utilization of advanced practice nurses in healthcare systems and multispecialty group practice.

Cost-effective strategies for delivering primary care require the appropriate mix of healthcare providers. The authors define the scope of practice for the advanced practice nurse. Results of a nationwide survey of 26 large healthcare systems and multispecialty group practices are presented. Findings from these practice settings are contrasted with those previously reported in the literature. Implications for the future are discussed.

Cost-Benefit Analysis↗
PubMed1975

Impact of membership in an enrolled, prepaid population on utilization of health services in a group practice.

Members of prepaid group-practice medical-care plans are believed to use more ambulatory, but fewer inpatient, services than populations served by fee-for-service practitioners. It is not known whether these differences are attributable to the prepayment aspects of the plan or to other circumstances. We studied the impact on use of services of only one factor-prepayment at the Marshfield Clinic, Wisconsin--with all other factors, including group practice, held constant. The findings were derived from the experience one year before, and two years after, the initiation of the prepaid program. Results showed that prepayment alone resulted in significant increases in both inpatient and ambulatory care (about 100 per cent in ambulatory-care visits, 75 per cent in hospital discharges, and 60 per cent in hospital days). These increases were far greater than comparable increases in the fee-for-service population served by the Clinic.

Ambulatory Care↗
PubMed1999

Providing capital for physician group practices: new opportunities for hospitals.

As physician group practices grow and consolidate, they have an increasing interest in developing close capital partnerships to ensure access to capital. Yet as many healthcare organizations have sought to divest poorly performing acquired physician practices, physicians have seen their pool of potential capital partners shrink. Under these conditions, hospitals have a new opportunity to present themselves to physician group practices as attractive capital partners. To understand the nature of this opportunity, one needs to know why group practices seek capital, how groups approach their investment strategies, and what criteria they use to compare prospective capital partners. To build stronger relationships with physicians, hospitals should focus on turning around their poorly performing acquired physician practices and pursue strategies such as collaborating with physician practice management companies and developing new models for partnering with physicians (e.g., special purchase agreements and more advanced management services organizations).

Capital Financing↗
PubMed2001

Meeting the challenge of a group practice turnaround.

Many healthcare organizations that acquired group practices to enhance their market share have found that the practices have not met their financial goals. Turning around a financially troubled, hospital-owned group practice is challenging but not impossible for healthcare organizations that take certain basic actions. Direction, data, desire, dedication, and drive must be present to effect the financial turnaround of a group practice. The healthcare organization needs to evaluate the practice's strategy and operations and identify the issues that are hindering the practice's ability to optimize revenues. Efforts to achieve profitable operations have to be ongoing.

Financial Management, Hospital↗
PubMedDate not supplied

Assessing the cultures of medical group practices.

BACKGROUND: The culture of medical group practices is gaining increasing attention as one of the most important organizational factors influencing the costs and quality of health care. Based on organizational theory, we propose that the culture of the practice differs depending on size, ownership, location, and the number of medical specialties. METHODS: A survey was sent to 1223 physicians in 191 clinics in the upper Midwest. The clinic response rate was 77%. The survey instrument identifies 9 culture dimensions, each with 3 to 6 measurement statements. RESULTS: Smaller clinics had higher scores on 6 of the 9 dimensions. Physician-owned clinics had higher scores on 4 of the 9 dimensions, whereas system-owned clinics had a higher score on only 1 dimension. Only 1 dimension differed among the locations. Single-specialty clinics had higher scores on 4 dimensions and multispecialty clinics had higher scores on 2 dimensions. CONCLUSION: Our data confirm the contention that the culture of medical group practices varies considerably; to a degree, this variance is as predicted by organizational theory. The culture changes as group practices become larger and more complex through diversification into multispecialty practices or become part of larger health care systems.

Ambulatory Care Facilities↗
PubMed1986

Group practice in Yugoslavia.

Group dental practice depends to a considerable extent on the social system of the state in which it exists. In the Socialist Federal Republic of Yugoslavia it is therefore based on the principles of the central system of socialist self-management. Private dental practice is the exception; dentistry is normally practised in particular health care organizations. Within these organizations, the members of the group independently take the decisions relevant to their activity, mutual rights and obligations, and material affairs. Special agreements arrived at and other decisions are taken in a highly democratic manner with this intention. The legislator has provided only certain frameworks or foundations for their decisions.

Dental Health Services↗
PubMed1987

Effect of an academic group practice on patient show rates: a randomized controlled trial.

Ambulatory medical clinics at academic centers are reputed to be expensive, inefficient, and poorly regarded by the medical residents who staff them. In an effort to address these problems, some centers have reorganized their traditional clinics into group practices. These group practices are thought to be more effective for teaching and providing services than are the traditional clinics. This is a report on the results of a study in which the authors reorganized two of four firm clinics into group practices in order to test the influence of the organizational changes on the various aspects of ambulatory care. During this controlled prospective trial of the group practice model, higher show rates were observed for patients in the group practices than in the traditional clinics (70% vs 65%, P less than 0.0005). The possible reasons for the higher rates are discussed.

Academic Medical Centers↗
PubMed1996

Managed care plans and the organizational arrangements with group practices.

This article addresses the variety of structural and legal arrangements between group practices and health plans. The continuum of relationships will be discussed, including long-term arrangements whereby in exchange for long-term commitments to provide physician capacity, providers are given a capital contribution from managed care plans; management services organizations whereby managed care plans create management companies that provide turnkey management services in exchange for capital, with a commitment by the group practices to provide physician services to the health plan over a long period of time; mixed equity relationships where physicians and managed care plans jointly own the group practice, which group practice also has an ownership interest in the managed care plan itself; and acquisition of the group practice by the managed care plan. Each of these structures will be described, along with the legal issues that may be considered in any of these relationships.

Group Practice↗
PubMed1991

Nursing group practices in hospital settings.

As hospitals continue to face problems with nursing shortages and difficulty in retaining experienced nurses, they are forced to examine the environment of nursing practice to determine how that environment can be improved. At Henry Ford Hospital, a planning process is underway to establish a more truly professional practice environment for nursing. This professional practice environment is based on a group practice model for inpatient nursing. The group practice model offers the potential for greater clinical and administrative autonomy and collaborative practice with physicians, but may require significant changes in internal budgeting and accounting systems. Several different inpatient group practice models and their implications are discussed.

Group Practice↗
PubMed1991

Uncompensated and discounted Medicaid care provided by physician group practices in Wisconsin.

A survey of a sample of physician group practices in Wisconsin was undertaken to determine the amounts of charity care, bad debt, and discounted Medicaid care that were provided in 1988. Overall, the physician group practices in the sample reported dollar amounts of uncompensated care and discounted Medicaid care that averaged approximately 7.6% of their total billings for the year (1.6% of charity care, 3.0% of bad debt, and 3.0% of discounted Medicaid care). From the dollar totals reported, it was calculated that the individual physicians represented by this sample of group practices were responsible for, on average, +4300 of charity care, +9100 of bad debt, and +7500 of Medicaid discounted services, for a yearly per-physician total of +20,900 of uncompensated care and discounted care provided to uninsured and indigent patients. The results indicate that a majority of the group practices provided more charity care in 1988 than they had 5 years earlier and suggest that the burden of providing uncompensated care tends to fall disproportionately on those group practices that are also providing relatively high levels of service to Medicaid recipients.

Charities↗
PubMed1986

The cost implications of academic group practice. A randomized controlled trial.

We evaluated the reorganization of a general medical clinic into several group practices, using equivalent groups of patients and physicians in a randomized controlled trial. The group practice, unlike the traditional clinic, provided decentralized registration, clinic coverage five days a week, and telephone coverage at night and on weekends. Residents worked in small groups with an attending physician, nurse practitioner, and receptionist. All financial activity involving a sample of 2299 patients was followed during the 11-month intervention. The total hospital charges per patient were 26 percent lower for the patients seen in the group practice than for those seen in the traditional clinic (P = 0.003). This difference was primarily attributable to inpatient charges, which were 27 percent lower per patient hospitalized (P = 0.004). The mean length of stay was 8.3 days among group-practice patients and 10.5 days among traditional-clinic patients (P = 0.011). We conclude that organizational changes to improve outpatient access and to integrate inpatient and outpatient services can decrease medical charges.

Academic Medical Centers↗
PubMed1990

Job satisfaction among stayers and leavers of dental group practices in The Netherlands.

Working in group dental practices has increased during the last few decades. In the present study all the dentists (n = 82) who had participated in group practices in the Netherlands for at least 10 years were interviewed and questioned about the nature of their practices, their working conditions and their 'job satisfaction'. Most of them (78 per cent) had a second appointment, besides that in the group practice. During the past 10 years 32 per cent of the dentists had left the group practice because of personal conflicts, the wish to change to solo practice or a different appointment, organisational problems, or dissatisfaction with practice space. Eighty-two per cent of them declared that they were, in general, (very) satisfied with their work; these included 94 per cent of the 'stayers' and 63 per cent of the 'leavers'. The main motives for joining a group practice rather than working in a solo practice were: being less isolated, having the possibility of mutual consultation, the stimulation of working with colleagues, and the more efficient use of staff and equipment. These motives were satisfactorily realised, according to the 'stayers'; and 'leavers' scored less favourably, but still at a high level. The same picture was also seen in the other features studied; the 'stayers' were very satisfied with their working conditions and the future possibilities of the group practice, while the 'leavers' reacted less positively, but, on average, not negatively.

Group Practice, Dental↗
PubMed1986

Group practice in the Netherlands.

A survey was carried out on successes and failures in dental group practice in the Netherlands. The results provided insight into such matters as job satisfaction, remuneration and how time was spent by colleagues working in group practices as well as in the construction and organization of group practices themselves. A sharp increase in the creation of new group practices in 1971 was followed by a sudden decline after 1979 due to a variety of factors. The results of the survey show that four important aspects have to be discussed seriously and regularly by dentists working in a group practice. These are: cost, composition; cooperation; and character. 'Failures' in group practices are always in relation to one or more of these factors.

Group Practice, Dental↗
PubMed1975

New organizations out of old ones: teaching group practices out of private practice and outpatient departments.

A private group practice and a traditional hospital medical clinic are joined together as a teaching group practice for primary care (Internal Medical Associates). Responsible for revenues as well as costs, the practice is administered by a board of managers composed of physicians, nurses, and administrators in the practice. This decentralization of practice from the clinical department and hospital administration has resulted in (1) a reduction in the numbers of physicians needed for the practice, (2) a greater visit census with increased physician productivity, and (3) a reduced operating deficit and better understanding of transient and educational costs. The matrix organization of the board of managers has resulted in better communication and a commitment of the staff to common goals. Public demand for a single standard of care for patients of all backgrounds, professional aspirations to work in groups, and educators' interest in training outside the hospital converge to make such reorganizations of practical necessity.

Ambulatory Care↗
PubMedDate not supplied

Integration: opportunities and issues for medical group practices.

McManis Associates, a health care management consulting firm, recently gathered several medical group practice leaders for an informal discussion of integration and other key trends affecting medical groups. The goal of this "Forum for Medical Group Practice Leaders" was to elicit candid discussion among a small group of executives (who are in key positions in medical group practices), identify some of the key strategic issues they are facing and encourage them to share their opinions and experiences. The forum participants come from diverse backgrounds, a wide range of geographic locations and many different types of professional settings, including a single specialty medical group; independent, physician-owned multispecialty groups; an integrated medical center with its own hospital; the physician component of a large, integrated, multi-hospital system; and the leadership of the Medical Group Management Association (MGMA). The discussion was facilitated by Gerald L. McManis, president of McManis Associates, Inc., Louis Pavia Jr., senior vice president, and F. Kenneth Ackerman Jr., FACMPE, principal associate with the management consulting firm. This article provides a summary of the forum's proceedings, and the executive views and opinions of some of the key issues and challenges facing medical group practices today, including integration initiatives, governance, access to capital, critical success factors for group practices, as well as trends and projections for the future.

Capital Financing↗
PubMed1998

Effects of a low-cost protocol on outcome and cost in a group practice setting.

STUDY OBJECTIVE: To investigate, in a group practice setting, the effects of combining information about drug costs with adoption of a voluntary low-cost protocol. DESIGN: Prospective before-and-after intervention comparison study. SETTING: Private practice anesthesiology group (certified registered nurse-anesthetists and anesthesiologists) of a large midwestern for-profit hospital. MEASUREMENTS AND MAIN RESULTS: Clinical outcome and anesthesia-related drug cost were examined for coronary artery bypass grafts (CABG), laparoscopic cholecystectomy (LC), and lumbar laminectomy (LL). There were no restrictions on the use of any drug if warranted by the patient's condition. 135 consecutive prospective (P) cases performed by the anesthesiology group after the intervention were retrospectively matched by surgery type and surgeon to cases done 9 months prior to the protocol to form the retrospective control group (R) resulting in a total sample of 270 subjects. Significant cost reductions were seen in LC-(57%), LL-(42%), and CABG-(37%). The largest cost reductions were opioids (78%), induction drugs (50%), and muscle relaxants (41%). There were no differences in pain, nausea, or hypertension scores between the P and R groups, but there were minor differences in recovery room, oxygen therapy, and dismissal times between the R and P groups of LC and LL patients. There were no differences in anesthetic outcome for CABG patients between the P and R groups. A follow-up survey completed 4 months after the study demonstrated that muscle relaxant costs and fresh gas flow rates and costs had returned to preintervention levels, while opioid and induction drug savings were maintained. CONCLUSIONS: A private practice anesthesia group that followed a voluntary protocol could significantly reduce drug cost with little change in clinical outcome. However, the savings may not be completely maintained after the monitoring period.

Aged↗