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PubMed1988

Practice management.

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Practice Management, Dental↗
PubMed1998

Developing standards and quality measurements for case management practice.

Case management is a service offered in most health care and social service settings, but a universal definition and standards for practice, applicable to the various case management models, do not exist. Without nationally accepted standards and quality measures for community-based long-term-care case management, many agencies are scrambling to create them in order to justify their services to payers. This article describes the method followed by one county agency serving low-income elders and people with disabilities to create process standards and quality measures for case management practice. The project involved experienced case management staff who created measurement tools encompassing measures of 12 case management activities. Their goal was to justify the importance of the service being offered, to set minimum practice standards, and to raise the awareness and level of quality of case management practice.

Case Management↗
PubMed1998

Structure and process: the relationship between practice management and actual clinical performance in general practice.

OBJECTIVES: The precise relationship between practice management (structure) and the doctor's actual performance (process) in general practice is tenuous. Analysis of their mutual relationship may yield insight into the way they contribute to outcome and into corresponding assessment procedures. METHOD: In a cross-sectional study, consultations of 93 GPs were videotaped in their own practice and assessed by peer-observers on medical performance and on communication with patients, followed by a practice visit by a non-physician observer using a validated Visitation Instrument to assess Practice management and organization (VIP). Pearson correlations (observed and disattenuated for unreliability of the instruments) between scores on 22 practice management dimensions and scores of 16 selected cases on medical performance and communication were calculated. The predictive value of specific practice management aspects for actual performance was determined by multiple regression analysis, with performance scores as dependent variables and scores on the 22 management dimensions and GPs' professional characteristics as independent variables. RESULTS: Nine practice management dimensions correlated significantly with medical performance and so did five dimensions with actual communication. Overall, most associations were weak. Combined with demographic variables (age for medical performance and working single-handedly for communication), 26% of variance in medical performance scores could be explained by only three practice management dimensions. One practice dimension (delegation of medical tasks to the practice assistant) explained 11% of variance in communication with patients. Organization of quality assessment activities explained most of the variation in medical performance. CONCLUSIONS: Practice management (structure) and actual performance (process) seem to be largely autonomous constructs. Quality improvement and assessment activities should emphasize that practice management is different from actual performance. Structure and process may contribute to patient outcome independently of each other.

Adult↗
PubMed1994

Incongruence of existing practice management curricula content and actual medical practice need.

BACKGROUND AND OBJECTIVES: Practice management is an important, but often overlooked, element of medical training, especially for physicians in primary care. The objective of this study was to evaluate our program's practice management curriculum to determine if it meets the needs of its graduates. METHODS: A questionnaire, developed and sent to 1986-1991 graduates of the residency program (n = 76), determined their perceptions of how well the practice management curriculum prepared them to operate a practice. Fifty (65.8%) usable surveys were returned. RESULTS: The respondents perceived deficits in areas of preparing for office management, starting and building a practice, using professional services (especially in the areas of financial decisions and use of professionals), and reimbursement procedures. CONCLUSIONS: Physicians need an understanding of business fundamentals such as economics, organization management, contract evaluation, negotiation and mediation skills, methods of allocation of limited resources, information science, and consumerism. This article offers a process through which other family practice residency programs can begin evaluating and restructuring their practice management curricula to meet these needs.

Curriculum↗
PubMed1997

Conducting a practice management review.

A practice management review can be used by a physician practice to identify problems within the practice, introduce operational improvements, and ensure that the practice is being run as profitably and efficiently as possible. Such a review involves scrutiny of nearly every aspect of a practice's operations--from reimbursement to personnel issues. Before deciding to have a practice review performed, the practice's management team must establish objectives for the review and must ensure that physicians and practice staff understand the review process. Once the review process is initiated, the steps that must be taken to identify and diagnose problems within a practice include conducting interviews, collecting data, analyzing data, and suggesting remedies.

Accounting↗
PubMed1999

Teaching practice management during residency.

BACKGROUND AND OBJECTIVES: Practice management is a required component in family practice residency education. A few studies have reported that recently graduated primary care physicians indicated that their practice management training was inadequate. Our study describes the current nature of practice management education in family practice residencies and the perceptions of residency directors about the effectiveness of their program's practice management curriculum. METHODS: Surveys were mailed to 421 family practice residency directors, who were asked about their program's curriculum approach to teaching practice management, as well as their evaluation of the effectiveness of the curriculum. After two mailings, 213 surveys (51%) were returned. RESULTS: Eighteen percent of the respondents provided less than the required 60 hours of practice management curricular time. Residency directors indicated that managed care has had a significant effect on their curriculum. Directors' ratings of the effectiveness of their curriculum were associated with more curricular time and specifically with active learning activities. Although directors reported that managed care had affected how they teach practice management, managed care penetration was not associated with perceived curriculum effectiveness. CONCLUSIONS: Family practice residency program directors described a variety of approaches to teaching practice management. Active learning strategies seem to be important curricular components, although further study is needed about the most-effective methods to prepare physicians for post-residency practice.

Curriculum↗
PubMed1996

Understanding practice management: a qualitative study in general practice.

Reports a qualitative study of practice managers' roles and responsibilities in eight practices in the Grampian region of Scotland. Observes wide variations in the roles and responsibilities of managers associated with the size and fundholding status of the practice. Notes that larger practices had better developed management structures allowing the managers to delegate tasks and undertake a more proactive planning and executive role, and that medium and smaller practices had less well developed management structures and managers were more likely to act as practice administrators with limited autonomy. Concludes that practice managers are playing an increasingly important role in general practice. Also that the influential role of the practice manager in the development of practice policies and the transfer of administrative responsibilities from the partners to the manager have all contributed to a change in general practitioners' perceptions of the practice manager.

Administrative Personnel↗
PubMed1999

Quality management practices in Medicaid managed care: a national survey of Medicaid and commercial health plans participating in the Medicaid program.

CONTEXT: Rapid expansion of Medicaid managed care has raised concerns about the capacity and willingness of health plans enrolling Medicaid beneficiaries to provide high-quality care. Recently, legislation has facilitated market entry of Medicaid plans, health plans that draw most of their enrollment from the Medicaid population. OBJECTIVE: To characterize and compare the organizational characteristics and programs related to quality of care of commercial and Medicaid health plans that participate in the Medicaid program. DESIGN: Cross-sectional survey conducted September 1997 to April 1998. SETTING: The Medicaid program in 11 states and the District of Columbia. PARTICIPANTS: All 154 health plans in these localities that provided prepaid general medical care to Medicaid beneficiaries during June 1997, of which 130 (84%) responded to the survey. MAIN OUTCOME MEASURES: Health plan reports of structural characteristics, services offered, performance measurement and feedback, disease management programs, information systems capabilities, and provider network composition and relationships. RESULTS: Half of the respondents were Medicaid plans, with 75% or more of enrollees drawn from the Medicaid population. Medicaid plans tended to be smaller and newer than commercial plans that also served the Medicaid population and had more enabling programs targeting the special needs of the Medicaid population, such as inadequate transportation (85% of Medicaid plans vs 62% of commercial plans; P = .003) and illiteracy (66% vs 38%, respectively; P = .002). Overall, 71% of Medicaid plans vs 43% of commercial plans had enabling programs targeted at 6 or more of the 8 special needs we specified (P = .001). While commercial plans had a higher proportion of board-certified primary care physicians (81% vs 73%; P = .01), we found no major differences between Medicaid plans and commercial plans in collection and dissemination of performance measures, designation of specific areas for quality improvement, or use of disease management programs targeted at conditions prevalent in the Medicaid population. Neither commercial nor Medicaid plans reported high success in improving quality of care. CONCLUSIONS: Based on our survey, while Medicaid plans resemble commercial plans serving the Medicaid population in many aspects of quality management, they are more likely to target programs directed to the specific needs of the Medicaid population. Neither commercial nor Medicaid plans have notably strong records in actual quality improvement.

Certification↗
PubMed1977

The physician as manager. "What" and HOW" OF PRACTICE MANAGEMENT EDUCATION.

Management science and application play a pivotal role in preparing physicians for effective and efficient office practice. Integration of management theory into practice management education of family physicians may be accomplished by developing and maintaining a well-organized model practice, involving residents directly in management decisions and problem solving, using a variety of resource people in and outside the model unit, and providing quantitative analysis of practice performance. After three years of development, the Family Practice Center of Akron City Hospital has instituted a practice management curriculum whereby residents become actively involved in the management and supervision of the model practice, conduct research study into management problems, and receive training and supervision as they develop leadership and organizational skills.

Audiovisual Aids↗