Biomedical subjects

David Gans

Publications and source records attributed to David Gans.

4 recordsLinked to original sources

PubMed2004

Managing patient care cost in Minnesota medical group practices.

This study was designed to identify the mechanisms employed by medical group practices in Minnesota to control the costs of care. Several studies have found that health care costs in Minnesota are lower than in many other states, but no one knows why. We explore this issue by analyzing the factors in Minnesota medical group practices considered to be essential to cost control and, to the degree possible, by comparing those data with national data. It appears that Minnesota practices are somewhat less efficient than national averages--as measured by relative value units or procedures per full-time equivalent physicians--but that Minnesota practices have lower per-member, per-month (PMPM) costs. It also appears that the lower PMPM costs result from structural factors such as electronic information systems, physician profiling, and use of clinical guidelines rather than from financial incentive systems. This article also reports physician compensation and revenue trends, most notably that there appears to be a shift away from fixed salaries and toward productivity-based compensation; and there is a shift away from capitation payments and toward modified fee-for-service payments.

Contract Services↗

PubMed2002

The impact of financial incentives on physician productivity in medical groups.

OBJECTIVE: To estimate the effect of financial incentives in medical groups--both at the level of individual physician and collectively--on individual physician productivity. DATA SOURCES/STUDY SETTING: Secondary data from 1997 on individual physician and group characteristics from two surveys: Medical Group Management Association (MGMA) Physician Compensation and Production Survey and the Cost Survey Area Resource File data on market characteristics, and various sources of state regulatory data. STUDY DESIGN: Cross-sectional estimation of individual physician production function models, using ordinary least squares and two-stage least squares regression. DATA COLLECTION: Data from respondents completing all items required for the two stages of production function estimation on both MGMA surveys (with RBRVS units as production measure: 102 groups, 2,237 physicians; and with charges as the production measure: 383 groups, 6,129 physicians). The 102 groups with complete data represent 1.8 percent of the 5,725 MGMA member groups. PRINCIPAL FINDINGS: Individual production-based physician compensation leads to increased productivity, as expected (elasticity = .07, p < .05). The productivity effects of compensation methods based on equal shares of group net income and incentive bonuses are significantly positive (p < .05) and smaller in magnitude. The group-level financial incentive does not appear to be significantly related to physician productivity. CONCLUSIONS: Individual physician incentives based on own production do increase physician productivity.

Cross-Sectional Studies↗

PubMed2002

Measuring efficiency of physician practices using data envelopment analysis.

PURPOSE: Medical-group practices are becoming increasingly common-place, with more than a third of licensed physicians in the United States currently working in this mode. While previous studies have focused on physician practices, little attention has been focused specifically on the contribution of internal organizational factors to overall physician practice efficiency. This paper develops a model to help determine best practices of efficient physician offices while allowing for choices between inputs. Measuring how efficient practices provide services yields useful information to help improve performance of less efficient practices. DESIGN: Data for this study were obtained from the 1999 Medical Group Management Association (MGMA) Cost Report. In this study, 115 primary care physician practices are analyzed. Outputs are defined as gross charges; inputs include square footage and medical, technical, and administrative support personnel. METHODOLOGY: Data envelopment analysis (DEA) is used in this study to develop a model of practice outputs and inputs to help identify the most efficient medical groups. DEA is a linear programming technique that converts multiple input and output measures to a single comprehensive measure of efficiency. These practices are used as a reference set for comparisons with less efficient ones. CONCLUSION: The overall results indicate that size of physician practice does not increase efficiency. There does not appear to be extensive substitution among inputs. Compared to other practices, efficient practices seem to manage each input well.

Benchmarking↗

PubMedDate not supplied

Medical groups' adoption of electronic health records and information systems.

We surveyed a nationally representative sample of medical group practices to assess their current use of information technology (IT). Our results suggest that adoption of electronic health records (EHRs) is progressing slowly, at least in smaller practices, although a number of group practices plan to implement an EHR within the next two years. Moreover, the process of choosing and implementing an EHR appears to be more complex and varied than we expected. This suggests a need for greater support for practices, particularly smaller ones, in this quest if the benefits expected from EHRs are to be realized.

Data Collection↗