PubMed Health⌕ Search

Biomedical subjects

G A Niederman

Publications and source records attributed to G A Niederman.

8 recordsLinked to original sources
PubMed1993

Establishing a group practice "without walls".

The group practice "without walls" has become a health care delivery system that is preferred by an increasing number of physicians. This article traces the experience of Premier Medical Group, PC, a "second generation" clinic without walls in the Denver Metropolitan area, to highlight the potential benefits and the key issues related to the development and implementation of a group practice-without-walls model of health-care delivery. The model promises to address physician business and professional needs by building on the best aspects of a traditional group practice, in an overall organizational structure that maximizes each physician's autonomy, individual practice style, and practice identity. The successful implementation of a group practice without walls depends upon physician leadership and impetus, clear goals-and-objectives, competent professional staff, and legal-and-financial guidance.

Ambulatory Care Facilities↗
PubMedDate not supplied

Recent developments in 'any willing provider' legislation.

Because of recent state-level legislation, many health care networks may not be allowed to choose between qualified member providers. Gerald A. Neiderman, J.D., Jay D. Christiansen, J.D., and Kelly Phillips, J.D., of the health care practice group of Fagre & Benson, update the background, trends and potential impacts of any willing providers laws.

Medical Staff Privileges↗
PubMedDate not supplied

Integrated provider networks--a primer.

Integrated provider networks are burgeoning. With acronyms like MSO, IPA, PHO, IPN, etc., integration can be confusing to the uninitiated. Gerald A. Niederman, J.D., of Faegre & Benson, and Bruce A. Johnson, J.D., M.P.A., of the MGMA Management Consulting Services, offer a primer on integrated provider networks.

Foundations↗
PubMedDate not supplied

Anticipating state regulation of physician-hospital organizations. What the future may hold.

Faced with a regulatory void, state insurance officials are now considering whether and how physician-hospital organizations (PHOs) should be treated under state law. One main focus is the extent to which PHOs accept "risk" that health care services which the PHOs are contractually obligated to arrange may not be adequately funded from revenues received prior to actual delivery of patient care. From a regulatory perspective, the risk that consumers may not receive contracted services is arguably the proper function of insurance companies or other licensed entities. From the PHO viewpoint, however, the risk concerning a PHO's obligation to arrange for the delivery of services may only be a business risk which should not be burdened by costly insurance law requirements. Important factors in analyzing the question include the identity of the party contracting with a PHO and whether that party is itself a licensed insurer. In a rapidly changing regulatory environment, many states are likely to consider model legislation now being developed by the National Association of Insurance Commissioners, which imposes risk-based capital reserve and solvency requirements upon certain PHO arrangements to address these issues.

Capitation Fee↗
PubMedDate not supplied

New Stark regulations: Key issues for health care decision-makers.

On Jan. 9, 1998, The Health Care Financing Administration (HCFA) issued long-awaited Proposed Regulations for what has become known as Stark II. The regulations are subject to a comment period and later refinement. However, they lay out HCFA's basic understanding of what kinds of practices constitute an illegal kickback. In general terms, the law prohibits physicians from referring Medicare or Medicaid patients to entities with which they (or an immediate family member) have a "financial relationship" for the delivery of a specific list of designated health services. There are, however, exceptions also included in the new proposal. Group practices will want to pay special attention to HCFA's new definition of group practice.

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