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PubMed2000

Equity MSO (management services organization) benefits hospital and physicians.

Equity MSOs offer an alternative to hospital's employment of physicians and acquisition of their practices. In one example, several primary care physicians, organized into a single professional corporation, entered an agreement with a hospital to establish an equity MSO that was jointly owned by both parties. The partnership enabled the physicians to negotiate managed care contracts more skillfully and improve their bottom line. Under the agreement, the physicians' income is determined by their productivity. The hospital is confident that this new entity will help it sustain relationships with the physicians.

Efficiency↗
PubMed2000

The effects of structure, strategy and market conditions on the operating practices of physician-organization arrangements.

Research to date has documented weak or inconsistent associations between market and organizational factors and the adoption of physician-organization arrangements (POAs) (e.g. physician-hospital organizations, management service organizations and independent practice associations) designed to increase physician integration. We argue that POAs may mask considerable variation in how these entities are operated and governed. Further, because the operating policies and practices of POAs are likely to influence more directly the behaviour of physicians than the structural form of the POA, they may be more sensitive to the market and organizational contingencies that encourage integration. This study attempts to test empirically the relative effects of POA type and market, strategic and organization factors on the operating policies and practices of market-based POAs. Results suggest that type of POA, and market, strategic and organizational factors affect risk sharing, physician selection practices, physician monitoring practices and ways in which monitoring information is used to influence physician behaviour in POAs.

Health Care Sector↗
PubMed1998

Trends in health care practitioner credentialing.

Once a risk management process limited to hospitals, the practice of practitioner credentialing has expanded to include many other health care organizations, including insurers, health maintenance organizations, preferred provider organizations, management services organizations, medical groups, and independent practice associations. Standards set by recognized accreditation bodies, including the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission), National Committee for Quality Assurance (NCQA), and American Accreditation Health Care Commission/Utilization Review Accreditation Committee mandate a substantial effort to properly evaluate the credentials of health care practitioners. A sector of commerce called the credentials verification organization (CVO) industry has undertaken the mission to make the process of practitioner credentialing more consistent and efficient, faster, and less expensive.

Cost-Benefit Analysis↗
PubMed1996

Managed care plans and the organizational arrangements with group practices.

This article addresses the variety of structural and legal arrangements between group practices and health plans. The continuum of relationships will be discussed, including long-term arrangements whereby in exchange for long-term commitments to provide physician capacity, providers are given a capital contribution from managed care plans; management services organizations whereby managed care plans create management companies that provide turnkey management services in exchange for capital, with a commitment by the group practices to provide physician services to the health plan over a long period of time; mixed equity relationships where physicians and managed care plans jointly own the group practice, which group practice also has an ownership interest in the managed care plan itself; and acquisition of the group practice by the managed care plan. Each of these structures will be described, along with the legal issues that may be considered in any of these relationships.

Group Practice↗
PubMed2000

Organizing and managing care in a changing health system.

OBJECTIVE: To examine ways in which the management and organization of medical care is changing in response to the shifting incentives created by managed care. DATA SOURCES: Site visits conducted in 12 randomly selected communities in 1996/ 1997. STUDY DESIGN: Approximately 35-60 interviews were conducted per site with key informants in healthcare and community organizations; about half were with providers. DATA COLLECTION: A standardized interview protocol was implemented across all sites, enabling cross-site comparisons. Multiple respondents were interviewed on each issue. PRINCIPAL FINDINGS: A great deal of experimentation and apparent duplication exist in efforts to develop programs to influence physician practice patterns. Responsibility for managing care is being contested by health plans, medical groups and hospitals, as each seeks to accrue the savings that can result from the more efficient delivery of care. To manage the financial and clinical risk, providers are aggressively consolidating and reorganizing. Most significant was the rapid formation of intermediary organizations, such as independent practice arrangements (IPAs), physician-hospital organizations (PHOs), or management services organizations (MSOs), for contracting with managed care organizations. CONCLUSIONS: Managed care appears to have only a modest effect on how healthcare organizations deliver medical care, despite the profound effect that managed care has on how providers are organized. Rather than improving the efficiency of healthcare organizations, provider efforts to build large systems and become indispensable to health plans are exacerbating problems of excess capacity. It is not clear if new organizational arrangements will help providers manage the changing incentives they face, or if their intent is to blunt the effects of the incentives by forming larger organizations to improve their bargaining power and resist change.

Community Health Services↗
PubMedDate not supplied

Capitated contracting of integrated health provider organizations.

This paper examines global capitation of integrated health provider organizations that link physicians and hospitals, such as physician-hospital organizations and management service organizations. These organizations have proliferated in recent years, but their contracting activity has not been studied. We develop a conceptual model to understand the capitated contracting bargaining process. Exploratory multivariate analysis suggests that global capitation of these organizations is more common in markets with high health maintenance organization (HMO) market share, greater numbers of HMOs, and fewer physician group practices. Additionally, health provider organizations with more complex case mix, nonprofit status, more affiliated physicians, health system affiliations, and diversity in physician organizational arrangements are more likely to have global capitation. Finally, state regulation of provider contracting with self-insured employers appears to have spillover effects on health plan risk contracting with health providers.

American Hospital Association↗
PubMed1988

Case-management practice in an AIDS service organization.

Case management is widely used in various settings that require advocacy, coordination of services, and authorization or financing of services. The authors discuss case-management services as they apply to persons with AIDS and AIDS-related complex.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Differential staff perceptions of service organization and management in drug treatment.

Dissonance among 23 professional and 7 paraprofessional staff of drug service agencies toward case record management of addicts was investigated. Analysis showed that these paraprofessionals, former drug addicts now in a treatment role, tend to be more critical of how case records are dealt with than professional staff. The data favour the hypothesis that the greater the diversity of staff's background characteristics, the greater are the chances for disagreement and discord in organization and management.

Attitude of Health Personnel↗
PubMedDate not supplied

Beyond HMOs: understanding the next wave of change in health-care organization.

The growing strength of managed care has diminished the financial and clinical autonomy of many orthopaedic surgeons. In part to offset these negative trends, new relationships are being developed to define doctors' methods of contracting with health-maintenance organizations. These include physician practice management companies (PPMs), independent practice associations, management service organizations, and physician-sponsored organizations. Each entity offers distinct advantages and disadvantages. While the PPM is the most popular new vehicle to offset adverse market trends, it carries with it some of the greatest potential pitfalls. In every case, before negotiating to join one of these new entities, it is important for a physician to have a solid understanding of the competing claims made by each entity, as well as insight into the fiscal health of the particular company in question. For some doctors, these arrangements offer a solution to current woes. For others, PPMs interpose another meddlesome intermediary in a market already bloated by layers of bureaucracy.

Contract Services↗
PubMed1994

Managing health services organizations with an educational mission: the case of Canada.

Teaching hospitals represent a major segment of the Canadian health system, accounting for a disproportionate number of beds, patient days, and separations. Thus, although only six percent of hospitals are classified as teaching hospitals, they are responsible for about 36 percent of total hospital operating expenses. While affiliation with a medical school presents unique opportunities for the teaching hospital and increases its prestige, there are clear costs associated with affiliation. Administrators have less control over resource allocation decisions, including the types of teaching programs offered. Teaching hospitals cannot unilaterally design their own teaching programs around specialties and subspecialties of their own choosing; decisions related to teaching programs have a direct impact on the services provided by the hospital and may negatively affect the hospital's ability to fulfill its patient care mission. As education budgets are constrained, teaching hospitals are expected to assume outstanding teaching-related expenses. Teaching hospitals are also expected to shift some of their teaching to alternative settings, such as the community. Thus, teaching hospital administrators will require a strong background in finance as well as negotiation and political skills.

Budgets↗