摘要:

This article provides the historical context for examining the current forces driving medical group practice organizations. Prepayment has been around for some groups since the 1930s and the dual objectives of lowering costs and improving the quality of patient care were among the original reasons for forming group practices. Some of the basic issues for group practices today are discussed in light of evolution of this model of service delivery and the intensity of today's changing environment.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

There is increasing market pressure to deliver ambulatory care in a most traditional manner, that is, with a high level of service and personal touch. The ambulatory care providers of the future will meet this demand. However, they will do so with approaches and support systems that are anything but traditional. Care is Increasingly being delivered in large, integrated systems. Extraordinary service levels are being made feasible again–this time through a combination of new support systems, including total quality management task forces, patterns of care software, consolidated phone centers that can provide access from anywhere anytime, electronic data interfaces, and the Internet.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

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.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This article examines physician compensation models in medical groups and the factors affecting physician compensation and their impact on individual physician behavior and group practice performance. Four categories of physician compensation models are identified: (1) production-based compensation, (2) salary, (3) group-based compensation unrelated to individual physician productivity, and (4) capitation-based compensation. The statistics and the economic incentives of different compensation methods are presented. Finally, the impacts on health resources consumption, changes in medical group procedures for utilization and care management, and quality of care are discussed.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Profiling is a technique that large, multispecialty group practices, like many insurers, can use to monitor and improve quality and efficiency. Groups can examine physician performance by calculating ratios of medical Inputs to patient or population outputs. Physician control can help to achieve balance between clinical benefits and economic considerations. Profiles need to reflect a group's multiple missions, such as clinical care, research, and education; philosophy of care; and organizational ethos regarding physician compensation systems. Groups may need to customize standard approaches because of their emphasis on early utilization of specialists and the atypical case mixes often found in referral practices.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

On January 1,1992, the Medicare program implemented a new payment system for physician services based on the Resource Based Relative Value Scale (RBRVS). The RBRVS has been widely accepted as a rational and systematic approach to measuring the resource costs associated with physician services. In addition to deriving physician payment rates, the RBRVS provides a useful metric that allows the measurement and comparison of provider utilization rates and productivity across physicians performing a varied mix of services. In this study we describe the measurement of physician work, discuss alternative ways in which work values can be used to monitor physician service utilization (e.g., profiling physician practice patterns), measure physician productivity, and determine physician compensation.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

An overview of the applications and limitations of the Center for Research In Ambulatory Health Care Administration (CRAHCA) Profiling Project database funded by The Robert Wood Johnson Foundation is presented. The Profiling Project collects data from 77 practices and links organizational, provider, and patient demographics to administrative data. The Project's database has the capability (1) to profile physicians based on the Resource Based Relative Value Scale (RBRVS) relative value units as a measure of work and (2) to identify practice patterns as defined by procedures used by physicians with the same diagnosis. The Project will further explore variations between physicians and specialties based on systems of care, physician specialty, and patient differences. The comparative reports generated from these data provide comparisons on selected indicators for participating practices.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Clinical and health services research will play a more Important role in group practice organizations because it provides a vehicle to identify and answer critical questions. Study initiatives can identify, describe, quantify, and help predict trends in clinical practice. Systematic investigation is a means to link structure and processes of care to clinical parameters, patient outcomes, and cost variables. Findings can be used to support sound clinical, quality of care, and educational decision making. The ultimate goal of research is to promote the appropriate access and delivery of quality care In a cost-effective manner.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Intervening to improve the quality of medical care is an essential component of an effective quality improvement program. Although interventions may take many forms, most have some educational component. This article discusses different types of educational strategies that may be used in group practices and describes our experience with a continuing medical education (CME) program based on the results of clinical performance measurement. Data are presented showing the effectiveness and acceptability of the educational intervention in the DEMPAQ project.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This article examines how state health care policy affects new ventures involving medical group practices. It will review briefly traditional state authorities related to the health care sector In general and physician organizations in particular. The article will then discuss state policies related to a range of physician organizations, including those aligned with larger provider systems. State policies related to physician organization in the competitive marketplace include several topics: referral practices, tax exemption, corporate practice of medicine, and antitrust and Insurance regulation. Finally, it will discuss the implications of these trends for future enterprises undertaken by medical group practices.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID