This chapter defines a management services organization (MSO), and discusses the goals and objectives of hospitals and physicians in creating an MSO and the advantages and disadvantages of an MSO. It stresses the necessity of developing a business plan in the formation of an MSO and discusses organizational forms and MSO activities, such as managed care contracting, billing, information systems, utilization management and review, the provision of supplies, medical office space, equipment, staff, and turnkey arrangements. In addition, it discusses the structuring of MSO fees and a number of organizational structures for MSOs and legal issues affecting them.
This is a case study of Mercy Medical Foundation of Sacramento and its affiliation with Medical Clinic of Sacramento, Inc. It provides background on the development of the foundation, factors leading to the affiliation, evaluation of models, and analysis of how the organizational structure was developed. Finally, it discusses how the model is operating and the implications for the parent corporation.
This chapter discusses tax exemption of integrated delivery systems, including the requirements for exemption, the charitable purposes test, the private inurement and private benefit tests, and an application to integrated delivery systems. It also discusses the structure of the Friendly Hills and Facey Nonprofit Medical Foundations, including the analysis of the Internal Revenue Service. Finally, it discusses the process for obtaining tax exemption.
Hospitals and physicians have a mutually dependent relationship. Although both are responsible for patient care, conflicts arise as physicians attempt to maintain professional autonomy and hospitals attempt to maintain organizational stability. In recent years the outcomes measurement movement has influenced this relationship in a variety of ways. This review chapter traces the major sociological, historical, theoretical, and political influences that have contributed to these conflicts. Additionally, based on an analysis of these trends, speculation is offered on the future of the hospital-physician relationship as society increasingly holds both groups responsible for outcomes of care.
Today, customers are holding hospitals accountable for improving clinical outcomes and cost containment in ways that require the cooperation and collaboration of physicians. This chapter examines four strategies for influencing physician practice patterns: financial risk sharing, utilization management, performance feedback, and continuous quality improvement/total quality management (CQI/TQM). The strengths and weaknesses of each strategy are explored, along with real-life examples of how each has been successfully applied.
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