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Biomedical subjects

B R Greene

Publications and source records attributed to B R Greene.

At least 19 recordsLinked to original sources

The American College of Medical Practice Executives' competency study.

This article is the first of two studies conducted by the American College of Medical Practice Executives (ACMPE) that examines the perceived roles of medical practice executives. (Founded in 1956, the American College of Medical Practice Executives is the professional development and credentialing arm of the Medical Group Management Association (MGMA)). This study asked groups of physicians and nonphysician administrators to identify the competencies and associated skills and knowledge for administering group practices in today's changing environment. Those surveyed included administrators who are Fellows in ACMPE and 795 physicians who comprise the Society of Physician Administrators of the Medical Group Management Association. The responses were examined through a framework provided by the Managed Care Process Model. In this model, the focus is on the administrative and clinical processes required by different levels of managed care market penetration. The model progresses from a focus on relatively traditional practice management functions to those activities that are more complex with a greater focus on the integration of both clinical and business processes aimed at the health of populations. The analysis of the perceived competencies indicated that while both executive types perceived the importance of managing the health of populations, that task is not yet being incorporated into their professional roles.

Attitude of Health Personnel↗

Benchmarking medical group practices using claims data: methodological and practical problems.

As claims data for physicians and groups of physicians has improved in quality and quantity, health information vendors have begun marketing information about medical groups' productivity, utilization, and quality. Based on interviews with product developers and our understanding of the evolution of their products, several methodological and practical issues remain. For now and the immediate future, health information vendors will continue to face the limitations of physicians' claims data. Vendors and purchasers should be aware of common data shortcomings such as inadequate monthly enrollment figures, possible physician upcoding to circumvent utilization management restrictions, and incorrect coding when a test is used to rule out a disease. In the longer term, several avenues seem likely to make medical groups' data better and richer because of computer-based medical records and efficiencies possible from the Internet. The field of benchmarking products for group practices is still an immature market. However, several trends suggest such products are highly desirable. Provider organizations which bear medical risk need benchmarking data to help improve their efficiency. There are many important nonprovider organizations that need good information on group practices' utilization patterns and outcomes to help them plan new products and negotiate with physicians.

Benchmarking↗

String theory.

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Elementary Particles↗

Building research capacity into a national physician database.

The range of physician financial arrangements with managed care and insurers, as well as practice arrangements, is becoming increasingly complex. Little is known systematically about these changes, yet there is growing evidence that financial arrangements, utilization management, and other practice characteristics make a substantial difference in treatment patterns, patient mix, and costs of care. Current data systems and surveys frequently do not capture the new information needed to track these changes. New elements of information should be included in national surveys and in a national physician database. A list of recommended data items for a national data base is provided as a starting point for identifying a minimal data set to be included in national statistical systems.

Centers for Medicare and Medicaid Services, U.S.↗

Ambulatory care groups and the profiling of primary care physician resource use: examining the application of case mix adjustments.

A variety of profiling models and tools is utilized by payers, providers, and regulators to evaluate physician work, performance, and resource utilization. In physician profiling, the provider's pattern of practice is expressed as a rate of service or outcome. The article by Tucker, Weiner, Honigfeld, and Parton (this issue) compares the practice-based norms of primary care physicians by adjusting for case mix using ambulatory care groups (ACGs), a population-based classification method. Once the case mix is adjusted, the actual use of resources, as measured by overall charges, is compared with the expected value of resource use. In the Center for Research in Ambulatory Health Care Administration (CRAHCA) Physician Profiling Project, funded by The Robert Wood Johnson Foundation, physicians learn which services other physicians in their specialties perform. Physicians are able to compare their profiles with state and national level medians. The profiling project is one of the first demonstration projects in the field to profile ambulatory care practice patterns and collect patient demographics. An aspect of the project is to test the ACG classification system to data selected from 130 nonacademic practices representing over 5,000 physicians.

Ambulatory Care↗

Understanding the forces driving medical group practice activities: an overview.

This article provides the historical context for examining the current forces driving medical group practice organizations. Prepayment has been around for some groups since the 1930s and the dual objectives of lowering costs and improving the quality of patient care were among the original reasons for forming group practices. Some of the basic issues for group practices today are discussed in light of evolution of this model of service delivery and the intensity of today's changing environment.

Group Practice↗

Graduate education in health services administration. Integrating business with clinical perspectives.

Health services administration continues to evolve in response to environmental changes in reimbursement, technology, demographics, and health care reform. These changes encourage further integration of business skills in health services, an emphasis which often conflicts with the perspectives of clinicians. The balance between business and clinical perspectives must be developed such that administrators and clinicians foster the survival and growth of their organizations while assuring comprehensive and quality health services to patients and the community. This paper describes education in health services administration, and uses a survey of one program's graduates to assess the usefulness of the current educational model in balancing business and clinical perspectives.

Curriculum↗

Trends, issues, and models in health services and health policy programs in business school settings.

This article briefly examines the evolution and convergence of graduate programs in health services administration in business school environments. Some of the problems along the way are identified through the discussion of the different tasks of professional as compared to academic knowledge. The underlying point is the degree to which the professions should be able to draw on academic knowledge from the disciplines to frame and analyze future problems and situations. Alternative models are present which build on the generic M.B.A. curriculum.

Curriculum↗

Long-term monitoring of psychosocial stress and symptomatology in inflammatory bowel disease.

Eleven subjects with inflammatory bowel disease (IBD) participated in a longterm self-monitoring investigation of the relationship between psychosocial stress and IBD symptomatology. Two measurement instruments, the IBD Symptom Diary and the Psychosocial Stress Diary, were completed by each subject for 7 consecutive days each month for one year. Pooled time-series analysis of the influence of daily stress on IBD activity revealed a significant effect. A positive concurrent relationship was found between both daily and monthly psychosocial stress and IBD activity. Investigations of temporal relationship among variables revealed a negative effect of previous month stress on IBD. Results suggest a monthly rebound effect whereby IBD symptom severity is negatively responsive to the severity of the previous month stress. The effects of stress upon IBD were not found to be modified by behavioral coping strategies. These results support the prevailing impression that psychosocial stress contributes to the clinical course of IBD, and specifically suggest an influential role of daily and monthly stress. A pattern matching IBD's characteristic waxing and waning clinical course emerges when the association between stress and IBD is examined from a monthly viewpoint. Refinement of our knowledge of the IBD-stress model calls for replication and explanation of the monthly rebound effect as well as investigations into type of stressor and coping strategy that may influence IBD activity.

Adaptation, Psychological↗

Psychological aspects of irritable bowel syndrome: comparisons with inflammatory bowel disease and nonpatient controls.

Patients with irritable bowel syndrome (IBS) (n = 121) were compared to 46 patients with inflammatory bowel disease (IBD), and to 45 nonpatient controls on a variety of psychological tests and on symptomatology. The most consistent finding was the ordering of group psychological test means such that, on 11 of 14 measures, IBS patients scored higher than IBD patients, who in turn scored higher than the nonpatient controls. The two patient groups differed significantly only on measures of anxiety with the IBS patients scoring significantly higher on all three measures. IBS patients also reported significantly more severity of abdominal pain than the IBD patients; while IBD patients reported more episodes of diarrhea, they did not rate them as significantly more severe than did the IBS patients. Various other parameters of the IBS population are also explored and implications for treatment and future study are discussed.

Adaptation, Psychological↗

Alexander's dilemma: conflict between professionalism and entrepreneurialism in health services administration.

Potential philosophical and socioeconomic conflicts between entrepreneurialism and the mandate of community service are raising difficult questions for health care administrators today. As those involved in the quickly evolving health care field examine the knowledge base and future direction of their professional roles, ways must be found to reconcile the increasing economic pressures on the industry with the values traditionally associated with high-quality personal care. This article describes some of the ethical problems inherent in a health care system that is being run increasingly like a purely economic enterprise, and cites historical and sociological sources indicating that entrepreneurialism cannot be the primary motivation in the field of health care. The author suggests that "outsider entrepreneurialism" and self-interest have no place in health care delivery, and that the public trust and the professional identity of the health administration field depend upon a successful blend of personal social responsibility and effective and efficient community service.

Conflict, Psychological↗

DRGs: the long view.

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Costs and Cost Analysis↗