Building And Managing Effective Physician Organizations Under Capitation

by Goldstein, Douglas

• ISBN13: 9780834208094
• ISBN10: 0834208091
• Format: Paperback
• Copyright: 1996-08-09
• Publisher: Jones & Bartlett Learning

Summary

This resource offers you a unique Building Block system, a proven-effective tool used by organizations to survive and prosper in an era of different reimbursement schemes, from discounted fee-for-service and primary care capitation, to global capitation and percent of premium payment.

Table of Contents

Contributors	ix	(2)
Acknowledgments	xi	(2)
Introduction--Taking Leadership To Restructure Health Care Delivery	xiii
Part I--Creating the Physician Infrastructure	1	(100)
Chapter 1--Building Effective Physician Equity Alliances and Organizations	3	(30)
Douglas Goldstein
Hank Fanberg, M.B.A.
Introduction	3	(1)
From Medical Practice to Physician Equity Alliance	3	(2)
Six Types of Physician Equity Alliance	5	(20)
Profiling Management Services Organizations as a Central Element	25	(4)
Understanding Evolving Physician Organizations	29	(2)
Today's Market Competition Demands Action and Merger	31	(2)
Chapter 2--System Building Blocks To Manage Capitation	33	(25)
Douglas Goldstein
Introduction	33	(1)
Integrated Communications and Information Systems	34	(4)
Process Measures and Outcomes Reporting	38	(4)
Multispecialty Physician Networks	42	(1)
Demand Management and Disease Management Systems	43	(5)
Continuous Quality Improvement and Clinical Reengineering	48	(1)
Internet and On-Line Services	49	(5)
Cost Reduction and Cost Management	54	(1)
Preventive Medicine and Empowered Consumers	55	(2)
Physician and Executive Leadership	57	(1)
Chapter 3--Strategies for Communicating with Physicians in the Era of Health Care Restructuring	58	(14)
Matthew J. Lambert III, M.D., M.B.A.
Introduction	58	(1)
Market Dynamics and the Role of Communications in Integration	58	(5)
Communication Strategies for Integration	63	(8)
Empower Communication Plan and Physician Leadership	71	(1)
Chapter 4--The Five Stages of Managed Care and Physician Organizations	72	(15)
Russell C. Coile Jr., Ph.D.
Introduction	72	(1)
PHOs--Are They Working and Will They Last?	73	(1)
Twenty-First-Century Health Reform Will Be Physician-Led	74	(1)
Five Stages of Managed Care	75	(8)
Three Scenarios for Integration	83	(2)
Alternative Paths to Integration	85	(2)
Chapter 5--Using Advanced Physician Management Structure To Ensure Clinical Effectiveness	87	(14)
Steven S. Lazarus, Ph.D., F.H.I.M.S.S
John Lucas, M.D.
Executive Summary	87	(1)
Introduction	87	(1)
The LHS Implementation of Advanced Physician Management	88	(3)
The Lovelace Physician Group Population Health Model of Medical Delivery	91	(3)
Information Requirements To Support Advanced Physician Management	94	(4)
Information Systems	98	(2)
Conclusion	100	(1)
Part II--The Merger and Expansion Process	101	(88)
Chapter 6--Expansion Process for Physician Organizations	103	(24)
Douglas Goldstein
Introduction	103	(1)
Conducting Action-Oriented Research	104	(3)
Pursuing Aggressive Business Development	107	(1)
Understanding the Equity Transaction	108	(3)
Using an Aggressive Business Expansion Process	111	(13)
Implementing and Enhancing Systems for Growth	124	(3)
Chapter 7--Structuring a Physician Compensation Plan That Rewards Performance in the Managed Care Environment	127	(17)
Mark Buchanan, M.D.
Introduction	127	(1)
Getting Started	128	(1)
Criteria for a Compensation Plan	128	(1)
Building Blocks for a Compensation Plan	129	(5)
Stories from the Front Lines	134	(2)
Four Scenarios for Income Distribution	136	(3)
General Comments on the Four Plans	139	(1)
When Is Change Appropriate?	140	(1)
Income Division and the Patient	141	(1)
Conclusion	142	(2)
Chapter 8--Capital and Equity Issues in Physician Organizations and Practice Management Industry	144	(17)
Douglas Goldstein
E. James Streator III
Introduction	144	(1)
Market Realities of the Physician Practice Management Industry	144	(1)
Expansion of the Physician Practice Management Industry	145	(4)
Physician Take Leadership	149	(1)
Financial Issues and Capital Sources Related to Growth	150	(3)
Financial Implications of Strategic Alliance Options	153	(6)
Strategic Alliance Decisions	159
Chapter 9--Legal Issues in Organizing and Expanding Physician Organizations	161	(28)
Philip B. Belcher, J.D.
S. Rogers Warner Jr., J.D.
Introduction	161	(1)
Integrated Group Practice--Merger of Medical Groups	161	(11)
Independent Practice Association	172	(7)
Other Affliations	179	(10)
Part III--Advanced Information Systems Issues	189	(40)
Chapter 10--Selecting Information Systems for Managing MSOs and Large-Scale, Integrated Ambulatory Networks	191	(14)
Mary de Lourdes Winberry, M.P.H.
Introduction	191	(1)
A Look at the Big Picture	192	(1)
Infrastructure Needs	193	(4)
Selecting an Information System	197	(4)
Staying Competitive	201	(4)
Chapter 11--Managing the Planning and Start-Up Operations for Advanced Practice Management Information Systems	205	(12)
Steven S. Lazarus, Ph.D., F.H.I.M.S.S.
Executive Summary	205	(1)
Introduction	205	(1)
Planning the Information Systems	206	(2)
Major Information Systems Applications	208	(1)
Information Systems Budget and Financial Considerations	208	(2)
Conversion to a New Information System	210	(3)
Managing Change	213	(1)
Value Added	214	(1)
Anticipating Future Needs	215	(1)
Conclusion	216	(1)
Chapter 12--Applying Outcomes Research To Increase Quality	217	(12)
Sanford R. Hoffman, M.D.
Mary de Lourdes Winbery, M.P.H.
Introduction	217	(1)
History of Outcomes Research	217	(1)
Outcomes Research Today	218	(1)
Outcomes Data--What Are They?	219	(1)
Gathering the Data--The Survey	220	(1)
Utility Assessment--Patient Preferences	220	(1)
Accountability--Its Impact on Practice Guidelines	221	(1)
Once You Have Outcomes Measurements, What Do You Do with Them?	221	(1)
Who Is Collecting the Data?	223	(1)
Diease Management	223	(1)
The Demand for Outcomes	224	(1)
Getting Started	224	(1)
Future Trends	225	(4)
Part IV--Managing Managed Care and Capitation	229	(78)
Chapter 13--Managed Care Contracting and Reimbursement for Physician Organization in a Capitated and Risk-Sharing Environment	231	(20)
Richard Ferreira, M.D., J.D.
Introduction	231	(1)
Contracts	231	(10)
Reimbursement Methodologies for Managed Care	241	(7)
Risk Sharing	248	(3)
Chapter 14--Legal Issues Associated with Managed Care Contracting	251	(27)
Irwin M. Birnbaum, J.D.
Executive Summary	251	(1)
Legal Issues Important to Competitive Policies and Procedures	251	(12)
Understanding the MCO Contract	263	(13)
Conclusion	276	(2)
Chapter 15--Critical Issues in Negotiating Capitated Contracts	278	(29)
Kerry McDonald
Introduction	278
The Business Environment	278	(1)
Preparing for Negotiations	279	(1)
Strategy for the Negotiations	280	(1)
Negotiating the Lenguage	280	(6)
Negotiating the Rate	286	(7)
Preparing the Organization for Capitation Negotiations	293	(7)
Conclusion	300	(1)
Appendix 15-A--Cost System Definitions	301	(2)
Appendix 15-B--Variable Costing Income Statement Format	303	(1)
Appendix 15-C--Data Sources, Elements, and Specific Statistics	304	(3)
Part V--Taking Leadership	307	(46)
Chapter 16--Developing and Operating Physician-Driven HMOs	309	(8)
John Pollard, M.D.
Introduction	309	(1)
Basic Requirements	310	(1)
Initial Steps	311	(2)
Start-Up	313	(1)
Operational Issues	314	(2)
Operational Issues	314	(2)
Conclusion	316	(1)
Chapter 17--Organizing and Managing Specialty Networks for Capitaion	317	(21)
Richard W. Krohn, M.B.A.
Introduction	317	(1)
Specialty Networks--Development and Strategic Choices	317	(3)
The Framework of Specialty Risk Contracting	320	(1)
Making Risk Contracting Work in Specialty Networks	321	(2)
Understanding the Capitation Contract	323	(3)
Infrastructure Requirements of Successful Risk Contracting	326	(2)
Success Factors of Risk-Based Specialty Networks	328	(3)
The Bottom Line--What Specialists Should Expect from Their Network	331	(3)
A Successful Specialty Carve-Out Network--SalickNet	334	(3)
Winning through Adaptation	337	(1)
Chapter 18--Multispecialty Physician Organizations: The New Force in Medicine	338	(10)
Nancy McDermott
Charles Hollander, M.D.
Richard Garber, M.B.A.
Steven Wolfson, M.D.
Introduction	338	(1)
The Benefits of a Multispecialty Organization	339	(1)
Creating Multispecialty Organizations	341	(5)
Bridging the Gap Between Primary Care Physicians and Specialists	346	(1)
New Relationships Sprouting from Multispecialty Organization Development	347	(1)
Summary	347	(1)
Chapter 19--Creating the Future through Today's Vision and Actions	348	(5)
Douglas Goldstein
Introduction	348	(1)
Competitive Advantage through System Building Blocks	348	(1)
Track Tends and News in the External Environment	349	(1)
Competitive Advantage through Thinking and Leadership	350	(3)
Index	353