Primary care units in Emilia-Romagna, Italy: an assessment of organizational culture.

This study investigates the organizational culture and associated characteristics of the newly established primary care units (PCUs)-collaborative teams of general practitioners (GPs) who provide patients with integrated health care services-in the Emilia-Romagna Region (RER), Italy. A survey instrument covering 6 cultural dimensions was administered to all 301 GPs in 21 PCUs in the Local Health Authority (LHA) of Parma, RER; the response rate was 79.1%. Management style, organizational trust, and collegiality proved to be more important aspects of PCU organizational culture than information sharing, quality, and cohesiveness. Cultural dimension scores were positively associated with certain characteristics of the PCUs including larger PCU size and greater proportion of older GPs. The presence of female GPs in the PCUs had a negative impact on collegiality, organizational trust, and quality. Feedback collected through this assessment will be useful to the RER and LHAs for evaluating and guiding improvements in the PCUs.

Implementing the physician quality reporting system in an academic multispecialty group practice: lessons learned and policy implications.

The Centers for Medicare and Medicaid Services (CMS) introduced the Physician Quality Reporting System (PQRS) in 2007. PQRS was developed as a value-based, pay-for-reporting initiative intended to increase quality and decrease costs. Jefferson University Physicians (JUP) was an early participant in this voluntary program. In this article, the policy context for CMS's launch of PQRS and JUP's implementation strategy, lessons learned, and an account of benefits and barriers to participation are reviewed. In 2010, JUP achieved 94% provider participation and an average incentive of $772 per participating provider. Net incentives earned across JUP in 2010 topped $171 000, although these earnings were significantly offset by implementation and maintenance costs. PQRS represents CMS's first step toward aligning quality and cost in the ambulatory care setting. Faculty practice plans must be prepared to meet this challenge in order to avoid future penalties and to advance quality of care.