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PubMed1998

Negotiating roadblocks to IDS-physician equity joint ventures.

Integrated delivery systems (IDSs) may find that forming an equity joint venture relationship with a physician group practice is the best way to integrate physicians into their networks. IDSs have a choice between two basic equity structures: affiliated group practice, in which a management services organization (MSO) handles all practice management infrastructure and the physician group is a physician-only organization; and integrated group practice, in which the physician group encompasses both the physician practice and the administrative infrastructure. The choice of equity structure and how it should be implemented hinge on several legal issues, including the existence of a corporate-practice-of-medicine statute in the IDS's state, compliance with the Federal antikickback statute and Stark laws, and various issues regarding the IDS's tax-exempt status. IDSs also should consider pragmatic issues, particularly those associated with aligning the economic incentives of the two partners.

Delivery of Health Care, Integrated↗
PubMedDate not supplied

How to build a specialty MSO.

The specialty-based management services organization (MSO), with its focus on management support, contracting, information systems and related benefits, is intended to help preserve specialist physician access to patients. It does this by enabling the MSO's physicians to clearly differentiate themselves from other specialist providers. To be successful, however, an MSO must be built on a shared vision of its goals. Considerations of structural, operational, ownership, antitrust and governance concerns should all follow from that ground. All parties should recognize that MSOs are best in the long-term; they are not short-term solutions.

Antitrust Laws↗
PubMed1996

Lessons learned from 10 years of MSO development.

Lessons learned over 10 years of management services organization (MSO) development can help financial managers increase their healthcare organizations' odds of success in such ventures. If administered appropriately, with a focus on managing and retaining covered lives, MSOs can be valuable vehicles for tying community physicians to organizations interested in developing integrated delivery systems.

Capital Financing↗
PubMed1999

Lessons learned from three physician-equity models.

To improve the profitability of group practice ownership, some healthcare organizations have structured arrangements to include a form of physician equity. An equity incentive is designed to encourage physician behavior that supports business operations by tying financial reward to overall organizational performance. Three physician-equity models--third-party integration, joint venture management services organization (MSO), and physician-owned practice management company--have used the physician equity incentive with varying degrees of success. The experiences of three healthcare systems that implemented these models demonstrates that strategies often cannot be executed as planned, growth should not be assumed, and the changing healthcare marketplace is unpredictable.

Connecticut↗
PubMed2002

Treatment outcomes in 3 modes of orthodontic practice.

This study examined differences in pretreatment severity and treatment outcome among orthodontic patients treated in 3 different practice-management modes. Samples of pretreatment (T1) and end of treatment (T2) study casts were selected from traditional private practices (TPP, 3 offices, 81 cases), a dental corporation (COMP, 2 offices, 53 cases), and a dental management service organization (DMSO, 1 office, 36 cases). Orthodontic specialists had treated all patients. Cases were initially selected on a consecutive start basis. From each practice, the first 30 cases satisfying the study criteria were included in the sample. The T1 and T2 study casts were evaluated with the PAR and HLD indexes. The PAR and HLD indexes showed a high level of agreement on T1 cast scores but not on the T2 casts. Mean T1 scores were highest in the COMP cases, followed by the DMSO and the TPP cases. T2 scores were lowest in the TPP cases, followed by the DMSO and the COMP cases. The percentage of PAR score reduction showed that, in all 3 modes, patients were treated to a high standard.

Adolescent↗
PubMed1997

University MSO: an academic medical center's managed care strategy.

In all markets of the country, academic medical centers (AMCs) are organizing their response to increasing managed care penetration. This is true in New York City, home of six academic medical centers, as well as in the New York metropolitan, tristate area with a total of nine AMCs. The adaptable structure of a management services organization (MSO) offers the AMC the mechanism to position itself in the managed care market, to integrate its institutions and physician practices, and to link community physicians, affiliated institutions, and ancillary service providers. This article describes the approach used by New York University Medical Center and its clinical faculty to form an MSO and the MSO's strategic expectations for the future.

Academic Medical Centers↗
PubMed2005

Resilient organizations: matrix model and service line management.

Resilient organizations modify structures to meet the demands of the marketplace. The author describes a structure that enables multihospital organizations to innovate and rapidly adapt to changes. Service line management within a matrix model is an evolving organizational structure for complex systems in which nurses are pivotal members.

Economic Competition↗
PubMed1996

Views of implementation approaches by top managers in health service organizations.

This study examined how top managers view the prospects of success and resistance when using four implementation approaches in participative and control cultures that foster climates more or less conducive to change. An accommodation approach was viewed as having the best prospect of success and of lowering resistance in a participative culture. Bargaining and incentive approaches were thought to have successful and low resistance outcomes, which were just below those of accommodation, in a control type of culture. A persuasion approach was thought to be the least effective implementation approach in a control-oriented culture. These preferences differ from prescriptions found in the implementation literature. Assuming that preferences influence behavior, implementation success could be improved if managers selected an implementation approach according to the demands of the situation. More research is needed to appreciate fully the rationale that lies behind the preferences uncovered in this research.

Analysis of Variance↗
PubMed1995

MSOs: key to PHOs and community-based health care systems.

In the '50s and '60s, as you drove through the United States, you could not help but notice the large number of mom and pop businesses--gas stations, groceries, restaurants. The same ride in the '70s and '80s is remembered because of the large number of these businesses that had closed their doors. In the '90s, this could very well begin to happen to doctor's offices and small clinics as medicine comes to look more and more like a business. This decade has already seen a shift in medicine from fee-for-service to more managed types of insurance and payment programs and the beginning of larger physician groups. Proposed health reform initiatives can only serve to accelerate these trends. Those in medicine prepared for changes will survive and perhaps even thrive. The others will wither on the vine. One of the key strategies that will enhance survival is cooperation and organization among the different players--hospitals, insurance companies, and providers. An extremely valuable tool for survival, along with the independent practice arrangement, the integrated delivery system, etc., will be the management service organization.

Community Health Planning↗
PubMed1996

Practice management agreements: the core of the MSO-group practice alliance.

Physician group practices increasingly are negotiating practice management agreements with management service organizations (MSOs). Understanding the issues surrounding the creation and implementation of practice management agreements is critical to maintaining a successful MSO-group practice relationship. The scope of the management commitment must be established and the agreement must provide sufficient flexibility to allow the physicians and MSO to mutually benefit from market-place changes.

Contract Services↗
PubMed1999

MSO development: progress versus pitfalls.

Physicians and hospitals are rapidly organizing integrated systems to compete more successfully in the new health care business arena. The preferred parent structure has been the management services organization (MSO). Notable factors have produced significant progress or pitfalls. Success is driven by the thoughtfulness of planning, the depth of management, and the quality of care.

Decision Making↗
PubMed1998

Consolidation of medical groups into physician practice management organizations.

CONTEXT: Medical groups are growing and merging to improve efficiency and bargaining leverage in the competitive managed care environment. An increasing number are affiliating with physician practice management (PPM) firms that offer capital financing, expertise in utilization management, and global capitation contracts with health insurance entities. These physician organizations provide an alternative to affiliation with a hospital system and to individual physician contracting with health plans. OBJECTIVE: To describe the growth, structure, and strategy of PPM organizations that coordinate medical groups in multiple markets and contract with health maintenance organizations (HMOs). DESIGN: Case studies, including interviews with administrative and clinical leaders, review of company documents, and analysis of documents from investment bankers, the Securities and Exchange Commission, and industry observers. SETTING: Medical groups and independent practice associations (IPAs) in California and New Jersey affiliated with MedPartners, FPA Medical Management, and UniMed. OUTCOME MEASURES: Growth in number of primary care and specialty care physicians employed by and contracting with affiliated medical groups; growth in patient enrollment from commercial, Medicare, and Medicaid HMOs; growth in capitation and noncapitation revenues; structure and governance of affiliated management service organizations and professional corporations; and contracting strategies with HMOs. RESULTS: Between 1994 and 1996, medical groups and IPAs affiliated with 3 PPMs grew from 3787 to 25763 physicians; 65% of employed physicians provide primary care, while the majority of contracting physicians provide specialty care. Patient enrollment in HMOs grew from 285503 to 3028881. Annual capitation revenues grew from $190 million to $2.1 billion. Medical groups affiliated with PPMs are capitated for most professional, hospital, and ancillary clinical services and are increasingly delegated responsibility by HMOs for utilization management and quality assurance. COMMENT: Physician practice management organizations and their affiliated medical groups face the challenge of continuing rapid growth, sustaining stock values, and improving practice efficiencies while maintaining the loyalty of physicians and patients.

California↗
PubMed1985

Restructuring health services in Canada: challenges for policy makers, planners and managers in the eighties.

Is downsizing the latest jargon word applied to rationalization, a new concept or a different manifestation of a long term trend in health services management? At present, Canada is struggling to implement feasible reductions of expansionary pressures in the health care system. While provincial governments tend to see the issue as one of controlling chronic excess demand, federal government is still concerned to ensure free access to care on an equitable basis. Thus the problems of downsizing can be expressed by the provinces in terms of an ideological struggle with an unfeeling central government which does not understand their problems; although all know they are really about the feasibility of continuing to provide a service to meet demand. The present economic recession enables provincial governments to appeal to their voters for supporting a new way. Earlier, the appeal was to consumers to become involved in health service organization management and this policy succeeded, to a degree, where there were fluorishing grass roots communities; albeit that the service continued to be driven by professionals. Now the appeal is to taxpayers for their strong support in cost cutting. This has been more successful. Provincial governments are now permitted to 'touch the untouchables', that is to downsize the medical profession and previously sacrosanct health care institutions. They also are exploring the feasibility of introducing a two-tier system which would provide basic care for everyone and extra care for those able to pay, thus side-stepping federal conditions. By reorganizing support in this way, provincial governments have extended the range of policy choices, and two types of planning, the rational and the political, have now become combined into strategic management activity.

Canada↗
PubMedDate not supplied

Developing MSOs in small markets. The community balance sheet approach.

The creation of management services organizations (MSOs) has been a phenomenon of the 1990s. MSOs allow for partnering of health care providers for multiple purposes, including managed care contracting, practice acquisition and management, and achieving financial and administrative economies of scale. Hospitals and physicians can come together to form successful joint ventures if certain critical elements are present, and if success can be defined by the use of a community balance sheet.

Capital Financing↗
PubMed1999

Providing capital for physician group practices: new opportunities for hospitals.

As physician group practices grow and consolidate, they have an increasing interest in developing close capital partnerships to ensure access to capital. Yet as many healthcare organizations have sought to divest poorly performing acquired physician practices, physicians have seen their pool of potential capital partners shrink. Under these conditions, hospitals have a new opportunity to present themselves to physician group practices as attractive capital partners. To understand the nature of this opportunity, one needs to know why group practices seek capital, how groups approach their investment strategies, and what criteria they use to compare prospective capital partners. To build stronger relationships with physicians, hospitals should focus on turning around their poorly performing acquired physician practices and pursue strategies such as collaborating with physician practice management companies and developing new models for partnering with physicians (e.g., special purchase agreements and more advanced management services organizations).

Capital Financing↗
PubMed2004

An international constant: The crucial role of policy competence in the effective strategic management of health services organizations.

In view of the pervasive impact of government policies on health services organizations worldwide, policy competence is an increasingly important element in the successful strategic management of these organizations. This article discusses a conceptual perspective of policy competence, including three intertwined components of this competence. Firstly, policy competence is built upon understanding the government policies that affect health services organizations, as well as understanding the process by which such policies are made and the forces that can affect the process and its outcomes. Secondly, policy competence helps strategic managers anticipate and lead responses of health services organizations to the opportunities and threats emanating from their policy environments. Finally, policy competence assists strategic managers to participate effectively in shaping the policy environments of health services organizations to the benefit of these organizations.

Efficiency, Organizational↗