Hospital-physician relationships: imperative for clinical enterprise collaboration

The need for new venues for physician-hospital collaboration is significant and growing, especially between independent physicians and health systems. Often physicians and hospitals act independently of each other, even though maintaining and sustaining a productive relationship between physicians and hospitals is essential to good patient care and improving the health status of the communities we serve. The tension in physician-hospital relationships is a long-standing and widely acknowledged concern. The old model of hospital-physician relationships, governed by the rules of the organized medical staff structure, doesn't work in the current environment, which has grown increasingly complex as a result of economic, legal, and care-delivery changes. These complexities make relationship management challenging. Hospitals and physicians struggle to align behaviors to achieve cost and quality goals. The need has never been greater for hospitals and physicians to work together as a joint clinical enterprise to improve quality, reduce practice variation, and control the cost of healthcare. This article explores the challenges and some options for improving the physician-hospital relationship in the current environment.     

Managed cooperation, not competition: a proposal for implementing national health reform

National health reform should be implemented in a policy framework that encourages cooperation--not competition--to promote efficiency while extending universal coverage. "Managed cooperation" is defined here as a national health system built on collaborative efforts between purchasers, providers, consumers, and government through voluntary collective action, like the structural cooperation seen in the Japanese economy between government and the private sector. Six partnerships are encouraged: (1) government-industry, (2) purchaser-provider, (3) physician-hospital, (4) public-private data sharing, (5) consumer-provider, and (6) community health. Structural and legal barriers to cooperation, such as antitrust and malpractice reform, should be reduced or eliminated to encourage collaborative initiatives under national health reform.     

Lay midwifery--still an 'illegal' profession

This article reviews the process by which a health collective has organized the home birth service. The legal and political problems and ramifications of the Collective's actions are discussed.     

The effect of hospital control strategies on physician satisfaction and physician-hospital conflict.

This article examines several strategies that hospitals use to control their medical staffs. Such strategies include placing physicians on salary, developing exclusive hospital affiliations with physicians, and involving physicians in decision-making bodies. Using regression techniques, we investigate which hospitals are more likely to utilize these strategies and whether such strategies are effective in promoting physician-hospital integration. Contrary to our expectations, corporate hospital structures (e.g., for-profit hospitals, membership in multihospital systems) generally do not employ these strategies more often and oftentimes employ them less. There is also little evidence that control strategies are effective levers for increasing physician satisfaction or decreasing physician-hospital conflict. We suggest that control strategies are useful for purposes other than promoting physician-hospital integration. Finally, hospital ownership appears to exert the biggest effect on physician satisfaction and conflict.     

Lay Midwifery- Still an 'Illegal' Profession

This article reviews the process by which a health collective has organized the home birth service. The legal and political problems and ramifications of the Collective's actions are discussed.     

Assessing the extent of integration achieved through physician-hospital arrangements

In this article we examine management service organizations (MSOs), physician-hospital organizations (PHOs), hospital-affiliated independent practice associations (IPAs), and hospital-sponsored "group practices without walls" (GPWWs) that allow physicians to retain their practices and link hospitals and health systems to physicians through contractual arrangements. Also examined were medical foundations (MFs), integrated salary models (ISMs), and integrated health organizations (IHOs) that own the physical assets of physician practices and contract with payors for physician and hospital services. The research provides several new insights for understanding the structure and process of physician-hospital integration. It was found that the extent of processual integration in physician-hospital organizational arrangements can be measured along six dimensions: administrative and practice management services; physician financial risk-sharing; joint ventures to create new services; computer linkages; physician involvement in strategic planning; and salaried physician arrangements. These dimensions are consistent with the conceptual and empirical dimensions developed by others. These findings refute the notion raised by some industry observers that the new physician-hospital organizational models simply formalize integrative activities already in place. Earlier studies from the 1980s reported that hospitals integrated physicians through involvement in governance, capital planning, and the provision of practice management services. In contrast, we found that current integration.     

Physician-hospital integration and direct contracting in managed care programs

Requirements for new physician-hospital relationships will include common vision and values, a sound business plan, new organizational and governance structures, and an innovative approach to all operating systems.     

Physician-hospital networking: avoiding a shotgun wedding.

The erosion of the traditional market is forcing hospitals and physicians to reevaluate their historical relationships. One method for addressing the potential conflicts created by current pressures is the formation of physician-hospital networks. These entities are formed and function on the basis of mutual interests and responsiveness to change.     

An interview with: Charlie Pierce on the use of covert CCTV

Charlie Pierce is the founder and president of LRC Electronics Company and LTC Training Center, Davenport, IA. He has 18 years of field, office, seminar, and shop experience in the closed-circuit television industry and frequently lectures about CCTV issues. In this interview, he discusses the use of CCTV technology for covert surveillance applications, the available technology, and the legal ramifications.     

PHOs fall short of expectations. Despite failings, networks may have role as a transition to vertical integration

An estimated 3,000 physician-hospital organizations have formed since the early 1980s, most of them in the last two years. But their slow progress in managed-care contracting has many wondering if they're anything more than an expensive fad. Proponents argue that despite their failings, PHOs may have a role as a transition to vertical integration.     

Just how integrated are integrated delivery systems? Results from a national survey

This article examines three emergent processes in physician-hospital integrated delivery systems (IDSs). We find these processes are underdeveloped based on data gathered from a national sample of hospitals drawn from nine health care systems. These processes are also loosely coupled with the structures used to integrate physicians and hospitals, as well as with the environmental context in which they occur. Such loose coupling entails both advantages and disadvantages for IDSs.     

"Virtual" health care organizations and the challenges of improving quality

This article examines the challenges of improving health care quality continuously within and across "virtual" provider organizations such as independent practice associations and physician-hospital organizations. It draws on recent research and theory about interorganizational networks in other fields to develop recommendations for securing physicians' commitment to quality improvement strategies in today's health care environment.     

Medical Records: More Than the Health Insurance Portability and Accountability Act

It is the responsibility of each organization, including private practice businesses, to maintain a comprehensive medical records retention policy. While registered dietitian nutritionists (RDNs) are qualified and competent business owners, navigating through the challenges of proper medical record management can be difficult without a sound policy. A comprehensive medical record retention policy consists of 4 major components: creation, utilization, maintenance, and destruction as well as a retention schedule. Successful implementation of a comprehensive medical record retention policy promotes positive clinician-patient interaction and avoidance of potential legal ramifications.     

Specialty contact capitation

Contact capitation is an emerging new payment method for risk contracts that aligns incentives among physicians, protects individual physicians from their colleagues' less efficient practice patterns, and allows physicians to share in the rewards of their own clinical effectiveness. Contact capitation is working in a variety of settings and developing a track record as a payment method to help ailing independent physician associations, physician-hospital organizations, health plans, and other risk-bearing entities.     

Driving forces behind integration: weigh your options

Collaborative relationships between hospitals and physicians can take many forms. Before you choose your strategy, consider the benefits and drawbacks of each. Many of America's hospitals and physicians are rushing to integrate their services through a variety of collaborative options. Their haste has been encouraged by many factors. Before hospitals and physicians react to the driving forces around them, they should carefully consider the pros and cons of four types of collaborative options: 1. management service organizations, 2. physician-hospital organizations, 3. practice acquisition models, 4. equity models.     

Temporary nursing service agencies: double jeopardy--who is at risk?

The nature of temporary nursing service agencies and the employer-employee relationship with its implications for job performance, Workers' Compensation liability, and unemployment benefits risks have been discussed here. Also explored were the issues surrounding the controversies involved in temporary nurses' provision of care. There are moral, ethical, and legal issues surrounding temporary nurses and the agencies providing them that have an impact on patients, practitioners, and administrators of institutions using them. While no clear-cut answers have been put forth, increased awareness of the ramifications of the use of temporary agency nurses brings caution to all concerned.     

The new competitive enterprise: the behavioral healthcare PHO

The physician-hospital organization (PHO), whether in a general medical context or in the specialty of behavioral healthcare, represents an intermediate step or model in the process of integration required by current market forces in healthcare. This article describes both general medical and behavioral healthcare PHOs and analyzes the model's competitive advantages in the behavioral healthcare arena. The ways in which behavioral PHOs interface with other practice delivery models is described, along with their advantages and the factors leading to their success.     

Consolidation and restructuring: the next step in managed care

Rising expenditures on health care in the U.S. have been facilitated by the fundamental problems of asymmetric information and insurance-induced moral hazard. If managed care is to succeed, it must take both into account through strategies such as information-based consumer education and provider risk-sharing. Because larger networks offer significant advantages in implementing such strategies, hospital mergers, physician-hospital alliances, and economies of scale are major trends in the evolution of managed care.     

Periodontal effects and dental caries associated with smokeless tobacco use

The prevalence of smokeless tobacco use has been increasing in the United States with concomitant social, medical, legal, and regulatory ramifications. This paper examines the association between the use of smokeless tobacco and the occurrence of periodontal disease and dental caries. Existing literature consists primarily of case reports and cross-sectional studies among teenagers. The limited evidence suggests an association between smokeless tobacco use and gingival recession. There is insufficient evidence to support any associations between smokeless tobacco use and gingivitis, periodontitis, or dental caries. Methods to improve future epidemiologic research to examine possible associations between smokeless tobacco use and periodontal effects or dental caries are discussed.     

A capture-recapture study of the prevalence and implications of opiate use in Dublin.

BACKGROUND: To date there have been no studies estimating the hidden prevalence of opiate use in Dublin. METHODS: A multisource enumeration followed by the application of the capture-recapture method with log-linear modelling including age and gender stratification to remove heterogeneity was implemented to provide an estimate of the unknown size of the opiate-using population. Two medical and one legal data sources were used. RESULTS: It was found that the ratio of known to unknown opiate users was 1:1.15 with a total of 13,460 (95% CI: 12,037-15,306) users estimated in Dublin in 1996. CONCLUSION: The findings of this study have important ramifications for service delivery.