Ambulatory surgery: next-generation strategies for physicians and hospitals.

Physicians' interest in investing and practicing in independent ambulatory surgery centers (ASCs) has grown. In the face of physician involvement in ASC development, healthcare organizations must contend with possible loss of surgical volume and revenues as well as decreased physician support and loyalty to the organization. Healthcare organizations can encourage physicians to remain in the organization by addressing physicians' concerns about the financial prospects and efficiency of independent and hospital-based ambulatory surgical arenas.

From primary care physician employment to private practice: easing the transition.

In most cases, the practice acquisition and employment strategy of the 1990s has backfired, with acquired physician practices losing in the range of $50,000 to $100,000 or more per physician annually. There are two alternatives for addressing the operating deficits incurred from practice ownership and physician employment: (1) restructuring through the implementation of network-wide and practice-specific initiatives to improve financial performance; or (2) wholesale (i.e., all practices) or selective practice divestiture, depending on the individual practice financial performance and "fit" with the physician network strategic priorities. Unraveling a decade's worth of physician-health system relationships that are grounded by the notion of acquisition and employment is going to be a complex process for both parties. But given the magnitude of financial losses on acquired practices and the inability of health care providers to sustain future losses, there simply are not options beyond restructuring or divesting these relationships.

Using compensation to improve primary care.

Progressive primary care networks are now placing significant portions of physician salaries at risk by linking compensation to quantifiable measures such as net medical revenue (collections), reduced practice expenses, cost and utilization, quality of care and patient satisfaction. For most networks, a combination of productivity increases and expense reductions are critical to ensure financial survival. This case study illustrates how one network's unique incentive compensation program targeted higher productivity levels by incentivizing desirable behaviors.

Creating a financially sound primary care network.

Primary care networks can play a pivotal role in the delivery of healthcare services and are much sought after by integrated delivery systems that are attempting to attract managed care contracts. However, not all primary care networks are attractive prospects for affiliation; some lack the ingredients for financial success that integrated delivery systems require. A primary care network can ensure its financial soundness and thereby become an attractive candidate for affiliation by meeting the requirements of effective networks. These requirements include reaching consensus on the role the network will play in the delivery system, consolidating network practice sites, paying justifiable practice acquisition prices, using nonphysician practitioners appropriately, assuming risk, offering physicians participation packages, providing incentive compensation plans, implementing integrated information technology, securing multiple payer contracts, and implementing quality assurance standards.

From crisis to success. Turning around a family practice residency program.

On Match Day in 1991, Broadlawns Medical Center in Des Moines, Iowa, learned that no residents had matched for the family practice residency program. In the 1992 match, the medical center filled all its residency positions, and repeated the success in the 1993 and 1994 matches. Broadlawns affected this impressively rapid turnaround through a strong commitment to bring its program to a level competitive with leading family practice residency programs, substantive changes to the structure and curriculum of the program, and significant expenditures of time, resources and personal energy. The Broadlawns' case illustrates the need for family practice residency programs to position themselves as strong competitors in the residency market.

Satellite centers help academic facilities tap outpatient market.

Academic medical centers have had difficulty adjusting to the shift from inpatient to outpatient services. They have been slow to provide care in a readily accessible, easy-to-use setting. Satellite ambulatory care centers can help make large teaching hospitals more customer oriented as well as help them attract inpatients.