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Biomedical subjects

J Kralewski

Publications and source records attributed to J Kralewski.

At least 19 recordsLinked to original sources
PubMed2000

Primary care physician incentives in medical group practices.

CONTEXT: Although medical groups are adapting to changes in financing health care, little is known about individual physician incentives in this environment. OBJECTIVES: To describe methods group practices use to compensate primary care physicians in a managed care environment and to examine the association of revenue sources for the group practice from all patients and primary care physician incentives. DESIGN: We surveyed by mail group practice administrators for practices that had at least 200 members continuously enrolled in 1995. SETTING: Group practices that had contractual arrangements with Blue Cross/Blue Shield of Minnesota. PARTICIPANTS: One hundred of 129 group practices returned usable surveys. RESULTS: Most groups had some portion of primary care physicians' compensation at risk, although 17 groups compensated them through fully guaranteed annual salary. Seventy-one groups used productivity, 4 groups used quality of care, 1 group used utilization, and 30 used group financial performance. Factors reported to significantly influence primary care physician compensation included billings or charges, overall group practice performance, and net revenue or profit. Groups that had a higher proportion of income from various types of fee-for-service arrangements used lower proportions of base salary for primary care physician compensation and were more likely to relate physician income to measures of productivity. CONCLUSIONS: Substantial variation exists in the types of primary care physician incentives implemented by medical groups. Base salary, individual productivity, and group financial performance were most frequently used to determine compensation. Physician personal financial risk was higher overall in group practices that derived more revenue from fee-for-service contracts.

Adult↗
PubMed2000

Does mothering a doll change teens' thoughts about pregnancy?

OBJECTIVE: To determine the effect of age on the efficacy of the computerized, infant simulator doll Baby Think It Over (BTIO) for increasing middle school girls' knowledge about the responsibilities of parenthood and discouraging plans for teen childbearing. We hypothesized: 1) 8th grade students would be less apt than 6th grade students to equate BTIO care with mothering because they would rationalize that their infant would be easier to care for than BTIO; and 2) BTIO would be a more effective teen pregnancy prevention program with 6th grade students than with 8th grade students. METHODS: Nulliparous 6th (n = 68) and 8th (n = 41) grade girls attending an urban middle school in a predominantly lower socioeconomic, Hispanic, neighborhood were asked to care for BTIO for 3 days and 2 nights. Responses to a self-administered questionnaire were used to assess the girls' understanding of the responsibilities and difficulties associated with parenting, their feelings about the similarity of BTIO care and real infant care, and their childbearing intentions before and after caring for BTIO. RESULTS: Only 32 (29%) of the 109 girls thought that real infant care would be like BTIO care. Although 8th grade students were less apt than 6th grade students to equate BTIO care with real infant care (17% vs 37%), 6th grade students were more likely than 8th grade students to endorse statements suggesting that real infant care would be easier than BTIO care (37% vs 24%). Multivariate analyses revealed that this was largely because 6th grade students found BTIO care more difficult than did 8th grade students. Also, regardless of age or grade, the more difficult a girl found it to care for BTIO than anticipated, the more likely she was to endorse statements indicating that it would be easier to care for her own infant than it had been for her to care for BTIO. Little learning about the difficulties of parenting took place during the study. On average, the 6th grade students did not find BTIO care more difficult than anticipated and the 8th grade students actually found it easier than anticipated. Finally, caring for BTIO had no affect on the intent of students to become teen parents; 13 (12%) of the 109 students wanted to be teen parents before they cared for BTIO and 16 (15%) wanted to be teen parents after they cared for the doll. CONCLUSION: The results of this study demonstrate that the propensity of people this age for rationalizing their own immunity to the nocuous aspects of potentially desirable situations (the personal fable of omnipotence) allows those who perceive parenthood to be attractive to overlook the negative aspects of any parenting experience they have.

Adolescent↗
PubMed1998

Variations in the management of primary care: effect on cost in an HMO network.

OBJECTIVE: To determine the relation to cost of different aspects of the management of primary care among group practices within a health maintenance organization network. MEASURES: A cross-sectional survey study of medical practices conducted with Blue Cross Blue Shield of Minnesota, St Paul. The subjects were group practices accepting financial and administrative responsibility for primary care services in the managed care plans of Blue Cross Blue Shield of Minnesota. One hundred twelve primary care practices and 153397 enrollees were included in this analysis. The principal resource use measure in this study was nonhospital cost per member per year estimated from payments to providers plus subscriber-eligible liability. RESULTS: The medical directors' responses revealed considerable variability in the management of primary care in these 112 practices. Group practice characteristics consistently associated with lower nonhospital cost were patient identification of a primary care physician, cost of care profiling, more frequent physician profiling, more patients per hour in the clinic, a higher proportion of primary care physicians in the specialty of family or general practice, and a greater number of physicians in the group practice. CONCLUSIONS: Results of this study demonstrate substantial variation in the management of primary care among group practices participating in a health maintenance organization network. These differences are associated with significant variation in the nonhospital cost of care for enrollees.

Adolescent↗
PubMed1995

Managed care in the Twin Cities: what can we learn?

Minneapolis/St. Paul, because of its history of health maintenance organization development and active employer participation in the health care arena, is often cited as a community in which managed competition has been tested to some degree. This paper reviews the historical development of the Twin Cities health care market and summarizes findings from past studies of this market. It also describes the recent consolidation of providers in the Twin Cities, as well as the activities of large purchasing coalitions. Finally, it assesses the elements of the Twin Cities experience that seem most relevant to managed competition-based health care reform proposals.

Group Purchasing↗
PubMed1995

Rural hospital networks: implications for rural health reform.

This article summarizes the perspectives gained in the course of evaluating a 4-year demonstration program that supported rural hospital networks as mechanisms for improving rural health care delivery. Findings include: (1) joining a network is a popular, low-cost strategic response for rural hospitals in an uncertain environment; (2) rural hospital network survival is enhanced by the mutual resource dependence of members and the presence of a formalized management structure; (3) rural hospitals join networks primarily to improve cost efficiency but, on average, hospitals do not appear to realize short-term economic benefit from network membership; and (4) some of the benefits of these networks may be realized outside of the communities in which rural hospitals are located.

Community Networks↗
PubMed1994

The emerging role of the physician in administration.

Physicians often find it difficult to determine the type of training needed to prepare themselves for administrative roles in health services organizations. Without extensive knowledge about organizations and how they function and how administrators contribute to organizational performance, physicians tend to view management roles as either overwhelmingly complex, or, conversely, simply a matter of using good judgment. In an attempt to help clarify this issue, we have outlined six management problems that an entry-level physician executive should be able to deal with successfully without asking for help. If physicians find that they are unable to deal with these issues, they should seek additional training before considering a management role.

Career Mobility↗
PubMed1994

Prescription drug utilization review in the private sector.

With increased coverage of prescription drugs by health insurance plans, utilization data are now becoming available and there is renewed interest in drug utilization review (DUR) programs. This article describes the DUR programs now being conducted by private sector firms for health insurance plans. The programs were found to be highly automated and very efficient. Most firms estimate at least two to three dollar direct savings for each dollar invested in DUR. Much of this results from controlling overutilization and gaining compliance with drug formulary guidelines. In addition, the firms report finding drug therapy problems in about two to three percent of the enrollees receiving prescriptions.

Chemistry, Pharmaceutical↗
PubMed1991

The structure and characteristics of rural hospital consortia.

Rural hospital consortia are relatively new organizations that have been developed to help improve the viability of participating hospitals. This paper describes the characteristics of rural hospital consortia in the United States and develops and tests a measurement model of their underlying structure. The measurement model, which characterized consortia structure in terms of degree of member commitment, degree of complexity, scale of operations, and degree of formalization, provided a good fit to the sample data. Most consortia appear to have followed a relatively conservative course that involved the development of programs that had limited sensitivity and financial risk for individual hospitals. This suggests that rural hospital consortia may not become a model for major structural change in the rural health care system. Future research should examine the evolution of rural hospital consortia from an organizational life cycle perspective.

Data Collection↗
PubMed1990

Effects of HMOs on the creation of competitive markets for hospital services.

Why do health maintenance organizations (HMOs) use particular hospitals, and do they concentrate patients in hospitals where they obtain low prices? We answered these questions with a study of six HMOs in four large metropolitan areas in 1986. A two-part model was estimated for the probability that a hospital would be used and the demand for general inpatient admissions at hospitals that were used. Four staff-network plans in our study do shop for hospital services on the basis of price more than was generally believed. However, two independent practice association (IPAs) plans use more hospitals in the community and do not concentrate patients effectively at hospitals that offer the lowest prices.

Bed Occupancy↗
PubMed1990

Contracts between hospitals and health maintenance organizations.

This article describes the contractual relations that are emerging between health maintenance organizations (HMOs) and hospitals. Six HMOs in four large metropolitan areas provided information on 102 hospital contracts. The authors found that the HMOs are becoming more aggressive in placing hospitals in competition with each other for HMO patients. Staff and network HMOs are able to obtain a higher concentration of patients and substantially larger discounts for inpatient services than are individual practice association (IPA) plans in this study.

Competitive Bidding↗
PubMed1989

Health maintenance organizations: the beginning or the end?

This article describes the changes taking place in a mature HMO market that has been identified as a bellwether HMO community, the Minneapolis-St. Paul metropolitan area. We describe how this market--previously characterized by traditional HMOs and traditional fee-for-service plans--has been transformed within the past five years into a market with a variety of plans competing on the dimensions of premiums, provider choice, and coverage. Among the most significant changes are the evolution of the local Blue Cross and Blue Shield plan into a form resembling an individual practice arrangement (IPA) with broad coverage and broad provider choice, and the appearance of preferred provider plans sponsored by the HMOs. We suggest that such changes have blurred the distinction between health plan types, making traditional plan designations no longer valid for either health policy analysis or health services research. For example, studies contrasting the performance of HMOs and fee-for-service plans should concentrate instead on the various dimensions of these plans, such as coverage and openness of provider choice. The article is intended to stimulate discussion and to suggest a new framework for describing health plan competition.

Fees, Medical↗
PubMed1988

Profit vs. public welfare goals in investor-owned and not-for-profit hospitals.

A study of goal formation in a matched sample of investor-owned and not-for-profit hospitals was conducted to determine differences in the perceptions of employees regarding their hospitals' commitments to patient/community welfare goals versus profit maximization. These perceptions were compared to available operating data for the same hospitals. While the investor-owned hospitals as a group generally were found to emphasize patient/community welfare values less than their not-for-profit counterparts, this did not hold true when matched pairs were analyzed. In some of the matched subsets, the not-for-profit hospitals were much more profit-oriented than the investor-owned hospitals. This research reveals that strong patient/community service values do not universally characterize not-for-profit hospitals, and conversely investor-owned hospitals cannot always be characterized as profit maximizers.

Analysis of Variance↗