PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Independent Practice Associations”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMedDate not supplied

Independent practice association physician groups in California.

We surveyed independent practice association (IPA) physician groups in California about their approaches to staffing, physician payment, and governance. Most IPAs desired more primary care physicians but not more specialists. Capitation was the major mode of remuneration for primary care physicians in 77 percent of IPAs, and for specialists in 30 percent of IPAs. Most IPAs also used financial incentives related to use of referral or ancillary services. Boards of directors were dominated by physicians, but governance tended to be centralized rather than highly democratic. We found that IPAs mirror many of the broader trends in physician staffing and physician payment that exist in managed care organizations.

California↗
PubMed1996

The development of independent practice associations and related groups in New Zealand.

AIMS: Independent practice associations (IPAs) have become an important feature of New Zealand's primary care system in the past two years and now represent nearly 60% of general practitioners. This survey was undertaken to document this important development. To determine the extent of the development of IPAs, their goals and barriers to achieving these goals, their policies, financing and contracting development. METHODS: Questionnaire sent to 42 IPAs and related groups in October 1994 with a supplementary questionnaire in April 1995. RESULTS: There were 34 responses, representing the views of 1263 general practitioners. Most important goals were "achieving better health outcomes for patients", "making better use of primary care resources" and "improving the health of the community you serve". Significant barriers to achieving these goals were "lack of time" and "lack of clear RHA policies". There was little support for financial risk sharing or for members personally retaining savings from budget holding. Although there had been significant progress with budget holding considerable frustration was expressed about contracting relationships with RHAs. CONCLUSION: The survey shows that general practitioners are seeing IPAs as ways of achieving professional goals, better quality health care and improving health status outcomes rather than as a means of personal gain. However, protecting and advancing the status of general practice was also important. IPAs expect to move progressively into both budget holding and managed care with the gradual assumption of secondary care services purchasing. This has important implications for the future of RHAs including the need for them to adopt a more strategic purchasing role.

Attitude of Health Personnel↗
PubMed1990

The effect of independent practice association plans on use of pediatric ambulatory medical care in one group practice.

We compared the use of pediatric ambulatory medical care of 640 children who switched from a traditional Blue Cross plan to more comprehensive independent practice association plans with that of matched patients who remained with Blue Cross in one large, suburban pediatric practice in Rochester, NY. A quasi-experimental, retrospective cohort design was used. Use of pediatric ambulatory medical care by patients in the independent practice association plan and control patients was determined by medical chart review for 1 year before and 1 year after each patient's switch. During the baseline year, patients who would join the independent practice association plan already had 19% more acute-illness visits than control patients. During the second year, patients in the independent practice association plan averaged 42% more acute-illness visits, 22% more well child-care visits, 93% more chronic-illness visits, 27% more after-hours visits, 53% more weekend visits, 185% more laboratory studies, and 70% more referrals. The shift toward independent practice association plans in this open-market setting increased use of ambulatory medical care for pediatric patients.

Ambulatory Care↗
PubMed1993

Recent developments in HMO malpractice liability: Chase v. Independent Practice Association.

The court's decision in Chase demonstrates that an HMO or independent practice association need not incur liability for the negligence of a physician if the arrangement between the entity and the physicians who provide services on its behalf is properly structured and maintained. IPA's successful defense of this lawsuit was based upon: (1) careful structuring of an independent relationship with the medical group, including appropriate wording in the contract establishing the relationship; and (2) careful maintenance of the relationship consistent with the terms of the contract to avoid giving patients any reason to believe that an agency relationship existed.

Contract Services↗
PubMed1993

Comparing surgical efficiency in independent practice association HMOS and traditional insurance programs.

This study examines the effect of Independent Practice Association (IPA) HMO membership on hospital total charges, ancillary charges and length of stay (LOS) for surgical patients. Intrahospital comparisons of IPA and traditional insurance patients are made after adjusting for surgical procedure, admission severity of illness, age, sex and year of admission. Our multiple regression model indicates that IPA patients undergoing 12 frequently occurring surgical procedures have lower resource use. Eight (80%) of the 10 study hospitals exhibit a negative IPA beta coefficient for total charges, ancillary charges and LOS. Five (50%) hospitals have statistically significant (p < 0.05) negative coefficients for total charges, while one (10%) hospital has a significant positive coefficient. IPA patients exhibit adjusted total charges that are 6% lower than traditional insurance, ancillary charges that are 4.3% lower, and LOS that is 10% shorter.

Efficiency↗
PubMed1991

Comparing hospital length of stay in independent practice association HMOs and traditional insurance programs.

This study compares length of hospital stay in Independent Practice Association (IPA) HMOs and traditional insurance programs. Hospital admissions from 10 IPAs are compared with admissions to the same hospital of persons covered by Blue Cross and Blue Shield Plans or commercial insurance programs. Admissions of patients under age 65 to the adult medical service for the 10 most frequently occurring DRGs are included. Regression equations are estimated using length of stay as the dependent variable and IPA membership and hospital and patient characteristics as control variables. All 10 IPAs exhibit shorter lengths of stay as indicated by negative beta coefficients, and in 6 of the 10 IPAs this coefficient is statistically significant (p less than .05). This IPA effect occurs for 7 of the 10 study DRGs, and for MedisGroups Admission Severity Groups 0, 1, and 2.

Age Factors↗
PubMed1993

Independent practice associations: are they viable?

As managed care systems grow along with the efforts of health care reform, independent practice associations (IPAs) will develop and grow. Their success is dependent on efficient management, enrollment, computer systems, a strong medical director, and case management. The IPA is an effective organization to deliver care through a capitated payment system.

Capitation Fee↗
PubMed2003

Smoking status identification: two managed care organizations' experiences with a pilot project to implement identification systems in independent practice associations.

OBJECTIVE: To determine whether managed care organizations (MCOs) can effectively promote the sustained use of smoking status identification systems among independent practice associations. STUDY DESIGN: Quasi-experimental design measuring smoking status documentation before and after an intervention. METHODS: A chart review of the MCOs' patients at 4 participating primary care clinics determined the baseline for smoking status documentation before intervention. Baseline data were unavailable from a fifth participating clinic. Two quality improvement personnel were sent by the MCOs to help the clinics chose and implement a system for identifying smoking status. All of the clinics chose a sticker system. The change in smoking status documentation was assessed by chart reviews of patients enrolled in the MCOs who were seen during the period between 3 and 16 months after implementation of the system. RESULTS: Following the intervention, a significant increase in smoking status documentation was noted among participating clinics. The proportion of patients whose smoking status was identified and documented by any method increased from 50% to 87% (P < .01) at the 4 clinics with baseline data. By clinic, the increase varied from 6% to 60%. The sticker system was the method by which most patients' smoking status was documented (77%). There were no controls, so the influence of outside factors, including a regional smoking cessation campaign that coincided with this study, cannot be quantified. CONCLUSIONS: Managed care organizations may be an effective change agent for implementing the guidelines for tobacco use and dependence treatment.

Blue Cross Blue Shield Insurance Plans↗
PubMed1994

Health maintenance organizations, independent practice associations, and cesarean section rates.

OBJECTIVE: This study tests two hypotheses: that a given delivery is less likely to be by cesarean section (c-section) in an HMO (closed-panel health maintenance organization) or IPA (independent practice association), than in other settings; and that where HMO and IPA penetration is high, the probability of a c-section will be reduced for all deliveries, whether in prepaid groups or not. DATA SOURCES AND STUDY SETTING: A data set consisting of 104,595 obstetric deliveries in New York state in 1986 is analyzed. STUDY DESIGN: A series of probit regressions is estimated, in which the dependent variable is either the probability that a given delivery is by c-section, or that a given delivery will result in a c-section for dystocia or fetal distress. DATA COLLECTION/EXTRACTION METHODS: The Live Birth File is linked with SPARCS hospital discharge data and other variables. PRINCIPAL FINDINGS: HMO setting reduces the probability of a cesarean section by 2.5 to 3.0 percentage points. However, this result is likely to be partly an artifact of offsetting diagnostic labeling and of choice of method of delivery, given diagnosis; a better estimate of the effect of HMO setting is -1.3 percentage points. IPA setting appears to affect the probability of a cesarean section even less, perhaps not at all. And HMO and IPA penetration in a region, as measured by HMO and IPA deliveries, respectively, as a percent of all deliveries, has relatively large depressing effects on the probability of a cesarean section. CONCLUSIONS: Ceteris paribus, the probability of a c-section is lower for an HMO delivery than for a fee-for-service delivery; however, HMO effects are smaller than previously reported in the literature for other types of inpatient care. For IPA deliveries, the effects are still smaller, perhaps nil. However, HMO and IPA penetration, possibly measuring the degree of competition in obstetrics markets, have important effects on c-section rates, not only in HMO/IPA settings, but throughout an area. These results appear to have important implications for public policy.

Cesarean Section↗
PubMed1995

The independent practice association in theory and practice. Lessons from experience.

This article examines an advanced managed care area, the San Francisco East Bay Area in California, for basic organizational issues posed by managed care for the medical profession. Of the three basic structures found, the independent practice association (IPA) model is theoretically most promising. Unlike the integrated health plan, the IPA seeks to retain traditional practice autonomy. Unlike the isolating direct gatekeeper model, the IPA assembles physicians in self-directed groups to invent and implement solutions and to exert political influence upward. In practice, however, it has proved difficult to balance practice autonomy with IPA authority. Both large, successful East Bay Area IPAs show signs (perhaps inevitably) of favoring authority over autonomy, as shown by their policies on governance, membership, and administration. Several policies are suggested to help redress this balance. Medical leaders must act now, before all the evidence is in, or the institutions of the past--hospitals and insurance companies--will control our future.

Decision Making, Organizational↗
PubMed2000

Organizational systems used by California capitated medical groups and independent practice associations to increase cancer screening.

BACKGROUND: Patients in health maintenance organizations (HMOs) appear to have higher utilization of cancer screening tests than patients with fee-for-service insurance. METHODS: The authors surveyed the medical directors of 174 physician organizations in a California network model HMO to obtain information regarding their organizational structure, implementation of guidelines, and use of systems to increase cancer screening. RESULTS: The majority of independent practice associations (IPAs) and medical groups (IMGs) in this California HMO had guidelines and office systems aimed at improving cancer screening. These activities were reported more frequently for mammography and Papanicolaou (Pap) smears than for colorectal carcinoma screening. IMGs reported using flow sheets more often than IPAs. Chart audits were performed more frequently for mammography (48% for IMGs and 40% for IPAs) and Pap smears (45% and 40%, respectively) than for colorectal carcinoma screening (38% and 30%, respectively). Approximately 50% of IPAs and IMGs reported mailing reminders to patients for mammography and Pap smears, but only a few did so for colorectal carcinoma screening. Annual fecal occult blood testing was believed by most medical directors to be a reasonable strategy for managed care patients (86% of IPAs and 96% of IMGs); however, fewer believed that screening sigmoidoscopy for patients ages 50-70 years was a reasonable expectation (71% and 78%, respectively). CONCLUSIONS: The majority of IPAs and IMGs in this California HMO reported using both guidelines and office systems to improve cancer screening rates. Further research is needed to understand the effect of these systems, as well their complex interactions with competing incentives, on cancer screening in managed care patients.

Adult↗
PubMed1996

Dermatology independent practice associations.

The American health care system is undergoing a profound reorganization and realignment that is primarily driven by a free-market corporatization of health care. Physicians are extremely concerned that these changes will affect their ability to be autonomous, to retain the free use of their clinical judgment, and finally to be paid adequately. In some instances the changes are already affecting the free choice of ancillary specialties such as dermatopathologists. Indeed, in many areas of the country, managed care is quickly becoming the dominant vehicle for health care delivery and appears in many ways to be affecting physician autonomy for both private practice and academic physicians. Independent practice associations (IPAs) have been developed across the country to meet the needs of managed care cost-effectiveness while attempting to preserve both clinical and financial physician autonomy. This article focuses on dermatology-specific IPAs, including functional models, the potential advantages and disadvantages for individual physicians, and for the specialty, antitrust implications, and finally introduces an IPA model that may benefit dermatologists and the dermatologic community as a whole.

Antitrust Laws↗