Strategic planning: today's hot buttons.

The first generation of mergers and managed care hasn't slowed down group practices' need for strategic planning. Even groups that already went through one merger are asking about new mergers or ownership possibilities, the future of managed care, performance standards and physician unhappiness. Strategic planning, including consideration of bench-marking, production of ancillary services and physician involvement, can help. Even if only a short, general look at the future, strategic planning shows the proactive leadership needed in today's environment.

Hospital-affiliated practices reduce 'red ink'.

Many complain that hospital-group practice affiliations are a failed model and should be abandoned. The author argues for a less rash approach, saying the goal should be to understand the problems precisely, then fix them. Benchmarking is a good place to start. The article outlines the basic definition and ground rules of bench-marking and explains what resources help accomplish the task.

The state of integration, 1997/1998.

Integration has been around long enough to assess its successes and failures. Of the three main types of integration--between physician groups, between hospitals and medical groups and through physician practice management companies--hospital-physician group mergers have been the least impressive. Hospitals tend to throw money at situations, rather than try to understand group practice. Physician practice management companies, on the other hand, have made great strides by respecting the particularities of group practice and adding value to the practices they buy.

A novel class of small amphipathic peptides affect aerial hyphal growth and surface hydrophobicity in Ustilago maydis.

Ustilago maydis, a fungal pathogen of corn, can alternate between yeast-like and filamentous growth. This dimorphic switch is governed by the mating-type loci. We have identified an abundant class of small SDS-insoluble cell wall proteins, designated repellents, specifically present in the filamentous form. Genetic analysis revealed that these peptides are processed from a single precursor protein, Rep1. Rep1 comprises 652 amino acids with a leader sequence for secretion. A characteristic feature of Rep1 is 12 repeats of a 37 amino acid consensus sequence; 10 of these repeats are separated by Kex2 protease cleavage sites. In (delta)rep1 mutants formation of aerial hyphae and surface hydrophobicity were reduced dramatically. This and the fact that expression of rep1 is regulated by the mating-type loci indicates that repellents play a structural role in the formation of aerial hyphae.

Capital--its application, access and attitudes.

Access to capital for group or network development is generally through one of three sources: current revenue, borrowing, or outside investors. Groups often have not planned well for their financial future, and consequently when integration or managed care opportunities arise, they can be without the necessary funds. This article addresses the acquisition of capital in the context of application (need), access (resources), and attitudes (concerns). Determining capital needs is the starting point, followed by investigating institutional resources, and then investigating the attitudes of the group toward accessing the needed capital.

IS outlook '96: predictions & predilections. Roundtable discussion.

Musings from some of the leading national and international HIT organizations make it clear that the need for a computer-based patient record is approaching the critical point. Half of our respondents identified the CPR as the single most important technology in 1996. One of our participants goes so far as to say that the era prior to the electronic medical record will one day be remembered as the "paper age." Progress in the development of standards--crucial to the CPR--could be dramatic this year, say experts from two of the major standards organizations. For a look at these issues and others, including key government policies to watch this year, read on.

Physician compensation in transition. The market-based alternative.

Current compensation systems are not working for the new and emerging models of health care systems. While there is not a perfect solution, there are alternatives that should be considered. The dynamics that are influencing compensation include: consolidation and integration are creating tighter group infrastructures than have previously existed--groups must place greater emphasis on the manner in which physicians function in support of common goals; the regulatory environment has increased due to the Stark legislation; the marketplace is a force in super-specialties and primary care physician compensation; and managed care is demanding new methods of compensation. Market-based compensation is attracting interest because of the complexity of external pressures. It is defined as the relationship between productivity and compensation and utilizes external benchmarks. Future market-based compensation plans will have five main components: productivity, as measured by dollars or RVUs; resource utilization, as service becomes a cost that is debited against capitated revenue; outcomes will be fundamental; service ratings will be instrumental; and physician "citizenship" will garner a higher profile.

Management Consultant Inc.--how to choose and use.

Robert C. Bohlmann, FACMPE, writes about what a management consultant is, how they should be evaluated and what they should be expected to do for the client. He also offers tips on determining costs and defines the engagement process in terms of scheduling, assessment, on-site activity and reporting, among others.

Control of mating and development in Ustilago maydis.

In Ustilago maydis the a and b mating type loci control pathogenicity as well as sexual development. We review the function of these loci in controlling the cell fusion step, the switch from yeast-like to filamentous growth and subsequent pathogenic development. Our special emphasis will be the role of pheromones and pheromone signaling in these processes.

New group formation and mergers. The qualification and implementation process.

Group practice formation and mergers can open a new--and sometimes very challenging--opportunity for the uninitiated, writes Robert Bohlmann, FACMGA. This article reviews the necessary steps for a successful merger or formation of a new group based on the collective experience of MGMA's Management Consulting team.

A discussion of group practice governance issues.

The following article on group practice governance is followed by four short commentaries from various MGMA members across the country as well as the director of the MGMA Consulting Service. This article, and the commentaries that follow it, are intended to stimulate your thinking regarding the governance structure in your group.

Health care delivery in the 1990s--putting the pieces together.

Robert Bohlmann, FACMGA, well-known for his "Ear to the Ground" column in MGM Update takes an in-depth look at the restructuring taking place in America's health care system. He looks at this restructuring by examining why change is taking place; characteristics of the ultimate health care system; current status of the health care industry; and challenges to maximize the ultimate system.

Learn a lesson from industry. Future planning.

The future need not be viewed as gloomy. In fact, competition creates opportunity. The experience of the manufacturing industry during the last sixty years has been a foreshadowing for the healthcare industry. Successful corporations have emerged from the recession knowing exactly who they are, what their market is, and where they are going. The healthcare industry can learn a great deal from these experiences. The author offers seven steps to medical groups that wish to logically relate to their future.

The numbers game. Introducing a cost-reduction program.

When cost-reduction programs based on theory are introduced, they invariably trigger opposition. It is hard to object, however, to a program based on solid statistical data. A new statistical tool is now available which allows medical group managers to focus on the impact of change: the Group Practice Performance Evaluator (GPPE). Based on GPPE data, the possibilities for cost reduction in one significant area, human resources, are examined.