Physician practice acquisitions: preparing for the transaction.

Hospitals embarking on acquisitions of physician practices should lay the groundwork for these transactions by: Building a framework for consistency. Preparing for possible exceptions to the framework. Broadly assessing the practice before advancing to the thorough valuation of the practice. Being alert for red flags and potential deal breakers and ready to address them.

Doing the math on physician employment.

When assessing the costs and benefits of a physician employment strategy, it's important to consider not only the direct costs and benefits of the strategy, but also its indirect benefits, such as increased revenue as a result of eliminating admission-splitting by employed physicians. The indirect risks of physician employment, such as eliminating independent physicians, can be minimized by adjusting timing to match the market's physician employment stage. The strategy will work if the combined direct and indirect benefits are significant enough to outweigh the direct costs.

Foster children with special needs: The Children's Aid Society experience.

Children in foster care have many health needs. This article presents the model of the Children's Aid Society (CAS) of New York City in addressing these needs. In addition to their regular foster care program, CAS developed the Medical Foster Care (MFC) in response to the growing number of boarder babies (children with medical conditions who are abandoned at hospitals), and the Therapeutic Foster Care (TFC) for foster children with emotional and behavioral mental health problems. The MFC serves 145 children considered medically fragile, as evidenced by congenital diseases such as heart disease, renal agenesis, cerebral palsy, seizure disorders and mental retardation. The TFC serves 50 children with severe levels of emotional and behavioral symptomatology. As is indicated by the extensive services offered through CAS's regular foster care program, as well as MFC and TFC, these children require specialized treatment. In addition, systems of information maintenance and exchange surrounding the health care of foster children need to be improved. Often agencies are ill-equipped to do adequate background checks on these young people and as a result deliver them to foster care situations where their health needs are not revealed and therefore not addressed. Health care providers also need to stay informed on the overall subject of foster care, as their voices will probably be crucial in ensuring that the extensive needs of these children are adequately represented to government, medical and other service providers.