When is a physician network a group?

Developing a network of physicians into a high-performing group requires a cultural transformation. The hallmarks, as well as the obstacles, to achieving this are reviewed by two experienced consultants. The requirements of highly successful physician organizations range from sharing a common mission, vision, and values to developing an effective infrastructure to having visionary leadership. Barriers to successful physician groups include a lack of clarity of purpose and goals, lack of quality standards, and an absence of shared learning. A blueprint on how to become a successful physician group is provided.

Ensuring adequate return on investment for primary care networks.

Developing and managing a successful primary care network requires a vision of what that network must accomplish, realistic performance objectives, well-designed management and support systems, and methods to reverse adverse performance trends if they occur. This article offers suggestions for fulfilling each of these requirements to help a healthcare organization achieve its long-term financial goal in a healthcare environment dominated by managed care.

A 10-point strategic checklist for rural health care systems.

A checklist format is used to provide a framework for rural hospital executives and community members for gauging the health and stability of rural hospitals and rural hospital systems. Benchmarks are provided for financial and operational performance and emphasis is placed on medical staff size and physician recruitment. Physician/hospital organizations and regional partnerships are used as examples of strategies available to rural providers. The importance of market knowledge and regional strategic alliances also is stressed. In an era of dwindling resources and tight reimbursement, rural providers are encouraged to consider cooperative clinical programming and technology consolidation.

Valuing the primary care patient base.

This analysis, albeit limited, can help clinics and integrated health systems with their medical staff planning, and it demonstrates the importance of the primary care patient base as a foundation for health services planning and economic and market strategies. It is important to note, however, that when primary, specialty, subspecialty, surgical, and hospital care are well planned and marketed, it is virtually impossible to identify the relative contribution of each to the overall success of the system. Consequently, primary care physicians should not attribute the value discussed here solely to their efforts. Hospital executives should be mindful of two related issues: First, some administrators remain focused on inpatient services when outpatient services may offer greater economic potential over time. Ambulatory interventional diagnostics and therapeutic procedures (e.g., outpatient surgery) are often undervalued or overlooked in medical staff development plans. The net profits available from additional ambulatory surgical cases can be significant. Second, success in developing a medical staff plan requires more than calculating physician supply and demand ratios. A balance must be struck between meeting the hospital's needs for additional physicians and meeting the needs of the existing medical staff. A number of hospital executives have found that devoting all physician-related resources to recruiting new staff can create resentment among physicians who have remained loyal to their hospitals without financial and other practice incentives and inducements. We encourage multispecialty group practices to become students of primary care development as well and urge them to guard against focusing on the high overhead costs of primary care without recognizing the value of an organized primary care strategy.(ABSTRACT TRUNCATED AT 250 WORDS)

The physician as organizational leader.

The physician manager is becoming more common. Given the need to bridge the gap between the business and the practice of medicine and given the transformations taking place in health care, physicians will likely play an increasingly important role as leaders in clinics, hospitals, HMOs, and other health care organizations. As yet, a job description for a "leader" remains elusive. However, understanding the framework described here may help build the proper foundation for successful physician leaders.

Medical practice management as a profitable investment.

As the 1990s unfold, the challenges facing medical group practices are not likely to lessen. Traditional territorial boundaries will be blurred, and significant power shifts between physicians, hospitals, and other health care providers will likely occur. The well-managed group will be positioned to anticipate and react to abrupt changes in the rules and to take advantage of opportunities that typically accompany a dynamic market.

Patient satisfaction and selected physician behaviors: does the type of practice make a difference?

This study was designed to show what specific physician characteristics lead to patient satisfaction and to compare satisfaction of patients using either prepaid or fee-for-service modes of payment within the same settings. We surveyed 1142 patients in five family practice clinics in rural and suburban areas of the North Central United States. Regression analysis of a seven-item satisfaction scale showed four significant factors that accounted for variance: sensitivity, is on time for appointments, follows up promptly, and provides personalized medical care. No meaningful differences were found between health-maintenance-organization and fee-for-service patients on these satisfactions. This study expands findings from previous research and raises more questions about reliable rating scales for complex physician/patient relations. Our methods can be used to investigate the effects of newer types of prepaid plans (including individual practice associations and preferred provider organizations) on patient satisfaction. The challenge for future investigations is to test and build reliable predictive models showing how physician characteristics, patient satisfaction, and quality of medical care affect each other in these more complex models of practice and reimbursement.

Aptitude X treatment interactions: implications for patient education research.

Aptitude x treatment interaction (ATI) has been used only rarely in patient education research. This research paradigm incorporates individual differences (aptitudes) into experimental studies exploring differences in information strategies (treatments). ATI has great potential for applications to patient education research. It identifies patient characteristics and optimal instructional treatments, it is compatible with psychological theories and clinical approaches alike, and it offers a specific methodology for approaching existing problems in a new way. This article presents studies in which ATI has illuminated specific patient needs and treatments, and suggested further applications. Three studies (in addition to those reviewed) are examined in depth. One study determined general guidelines for designing instructional literature to accompany medication (drug package inserts), that would satisfy the requirements of a group of patients with varied reading ability. Another study examined the effect of patients' "prior knowledge" on their participation in a health education program. A third study explored the interaction between patients' view of self-control over their health and the use of different media for health-care instruction. Guidelines and considerations for conducting further ATI-based research are presented and discussed.

Quality assurance as a management tool.

Quality assurance activities are no longer merely a luxury of the research-minded group practice. They have become essential in the face of today's federal laws, accreditation requirements, and competitive market. The authors examine the traditional lack of enthusiasm for quality assurance programs (QAPs) and seek to determine how the ambulatory medical care facility can maximize returns on the investment of the quality assurance dollar. An analysis of the working system of the Park Nicollet Medical Center in Minneapolis provides a list of attributes of a successful program as well as sample problems to be addressed and benefits to be accrued. Not only will the quality of patient care services be improved through the implementation of a practical QAP, but an organization can save itself from the waste of operating inefficiencies.

Improving hypertension control in a private medical practice.

Hypertension is one of the most common diseases seen by the practicing physician. Yet, because of noncompliance, conditions of many hypertensive patients are not effectively controlled by treatment. The purpose of this study was to test the efficacy of a patient education program in reducing the blood pressure (BP) of hypertensive patients in a private, solo medical practice. The intervention program focused on three behavioral objectives-pill taking, appointment keeping, and dietary sodium reduction while stressing the need for taking responsibility for one's own care. It was hypothesized that patients receiving an educational intervention stressing self-care would benefit more than those receiving the usual medical care. A substantial reduction in BP was considered to be the measure of successful treatment. Thirty-nine hypertensive patients receiving drug therapy from a private, solo medical practice were randomized into either a treatment group or a control group. A comparison of means disclosed no pretreatment differences between the groups' average BPs. After following up both groups for six months, mean changes in BP were compared for both treatment and control patients using a two-sample t test for independent samples. The BP fell in the treatment group (-13 mm Hg, systolic; -8 mm Hg, diastolic) but rose slightly in the control group (3 mm Hg, systolic 0.5 mm Hg, diastolic). The difference in changes was significant for both the systolic and diastolic BP.