Medical group management journal最新文献

Medical centers throughout the country are employing hospitalists--dedicated inpatient specialists--to care for patients during hospitalization in place of their primary care provider. There has been expansive growth of hospitalist programs as the number of practicing hospitalists has doubled in two years from approximately 1,500 to over 3,000. In July 1997, the department of medicine at University Hospitals of Cleveland, the primary teaching affiliate of Case Western Reserve University, created a hospitalist service. This paper will discuss the design of a hospitalist service at a major academic medical center, the factors that were considered during the design stage and financial feasibility.

Using their sponsored health benefits as a mechanism for change, employers have been able to exert significant influence over the nation's health care system. By examining how employers design, purchase and manage these programs, much insight can be gained. Twenty-five mid- to large-sized companies in a Middle-Atlantic metropolitan area were interviewed during May-July 1998. The study was modeled after a similar effort conducted in 1991, the results of which were published in this journal in 1993. The study found that many of the dynamics in employer-sponsored health insurance are changing. The findings suggest that a more distanced relationship between employers and employees is the major factor underlying the evolution, an intentional change to force a shift in medical care decision-making and responsibility to more of a shared process between the employee and the employer. These trends have important implications for local markets relevance and the national situation.

Increasingly, immediate patient service--whether scheduling an appointment or seeing a physician--is a realistic expectation. Smoothing patient access and hitting service targets takes sophisticated planning and a true scientific approach. The department of medicine at Boston's Children's Hospital has taken a new approach to visit management, using a model that could be applied to any practice in any setting. Staff have set up categories of care and guidelines for scheduling, realigning tasks in order to make better use of provider resources and expertise and restructuring associated supporting operations.

The Balanced Budget Act of 1997 established the new Medicare+Choice program which provides a variety of alternatives to traditional Medicare Part A and Part B, including the provider sponsored organization (PSO). Over the next several years, a significant number of organizations will consider becoming a PSO. The decision requires a thorough and detailed review of critical success factors. This articles outlines those factors and defines some components of a successful PSO.

Strategic planning can help a medical practice take an honest look at itself in light of the changes taking place in its environment and within the practice itself. The objective is for the group to design a plan, or road map, to its envisioned future. For medical practices, strategic planning is a four part process: 1) gaining buy-in for the process itself from the leadership and physicians; 2) gathering pertinent data about the group's environment through external resources, and about the group itself through interviews and surveys of physicians; 3) conducting a facilitated off-site retreat of key physicians and leaders in order to review data, discuss issues and develop a one to two year action plan; and, 4) carrying out the action plan developed at the retreat and measuring its outcomes. A follow-up mini-retreat about six months after the first retreat is highly recommended, as is instituting a process of sharing of the results and outcomes of the plan with all members of the organization.

This desire for health and well-being is driving the rapid growth of the complementary and alternative medicine (CAM) industry and points to a new role for health care professionals, including business opportunities for medical groups. CAM represents the opportunity to grow practice revenues, expand a group's tool kit for assisting patients with health care issues, and retain or increase market share by proactively responding to consumers. With respect to CAM, physician practices can lead their market, follow it or ignore it.

The physician/administrator team is frequently supported as the preferred model for physician group governance. Perhaps an obvious model for large groups, it remains true that the largest percentage of physicians are practicing in groups of 10 or fewer. This article explores the applicability of the physician/administrator team concept for small group practices. The article covers the significance of the physician/administrator team in managed care settings, difference in governance structures between large and small groups, the need for physicians to be willing to share leadership in organizations they own, understanding empowerment in small groups, the manager's need to assume more responsibility and how to form the team.