Bridging the gap between managed care and academic medicine: an innovative fellowship.
Numerous challenges face academic medicine in the era of managed care. This environment is stimulating the development of innovative educational programs that can adapt to changes in the healthcare system. The U.S. Quality Algorithms Managed Care Fellowship at Jefferson Medical College is one response to these challenges. Two postresidency physicians are chosen as fellows each year. The 1-year curriculum is organized into four 3-month modules covering such subjects as biostatistics and epidemiology, medical informatics, the theory and practice of managed care, managed care finance, integrated healthcare systems, quality assessment and improvement, clinical parameters and guidelines, utilization management, and risk management. The fellowship may serve as a possible prototype for future post-graduate education. (+info)
The effects of group size and group economic factors on collaboration: a study of the financial performance of rural hospitals in consortia.
STUDY QUESTIONS: To determine factors that distinguish effective rural hospital consortia from ineffective ones in terms of their ability to improve members' financial performance. Two questions in particular were addressed: (1) Do large consortia have a greater collective impact on their members? (2) Does a consortium's economic environment determine the degree of collective impact on members? DATA SOURCES AND STUDY SETTING: Based on the hospital survey conducted during February 1992 by the Robert Wood Johnson Hospital-Based Rural Health Care project of rural hospital consortia. The survey data were augmented with data from Medicare Cost Reports (1985-1991), AHA Annual Surveys (1985-1991), and other secondary data. STUDY DESIGN: Dependent variables were total operating profit, cost per adjusted admission, and revenue per adjusted admission. Control variables included degree of group formalization, degree of inequality of resources among members (group asymmetry), affiliation with other consortium group(s), individual economic environment, common hospital characteristics (bed size, ownership type, system affiliation, case mix, etc.), year (1985-1991), and census region dummies. PRINCIPAL FINDINGS: All dependent variables have a curvilinear association with group size. The optimum group size is somewhere in the neighborhood of 45. This reveals the benefits of collective action (i.e., scale economies and/or synergy effects) and the issue of complexity as group size increases. Across analyses, no strong evidence exists of group economic environment impacts, and the environmental influences come mainly from the local economy rather than from the group economy. CONCLUSION: There may be some success stories of collaboration among hospitals in consortia, and consortium effects vary across different collaborations. RELEVANCE/IMPACT: When studying consortia, it makes sense to develop a typology of groups based on some performance indicators. The results of this study imply that government, rural communities, and consortium staff and steering committees should forge the consortium concept by expanding membership in order to gain greater financial benefits for individual hospitals. (+info)
Why primary care physicians join HMOs.
OBJECTIVE: To determine the reasons why primary care physicians affiliate with health maintenance organizations (HMOs) and assess how these reasons vary with personal and practice characteristics. STUDY DESIGN: A 1996 national telephone/mail survey of primary care physicians who were affiliated with at least 1 HMO plan for more than 9 months. METHODS: Survey responses were assessed according to geographic region, age, income, level of involvement in managed care, and HMO penetration rate. The sample consisted of 210 primary care physicians who played a role in the decision to affiliate. RESULTS: The overwhelming reason primary care physicians affiliated with an HMO was to retain patients. Eighty-three percent reported this as one of the reasons for affiliating and 59% reported it as the primary reason. Physicians with the greatest portion of income from managed care and physicians practicing in areas with high HMO penetration were most likely to report quality of life issues--such as more personal time, more predictable work hours, or reduced administrative burden--as the rationale for HMO plan affiliation. CONCLUSIONS: These findings support the view that the majority of HMO-affiliated physicians join HMOs to avoid a perceived penalty associated with lack of affiliation, rather than for positive reasons. The data also suggest that physicians with managed care experience affiliate more often for quality of life reasons. (+info)
Nursing facilities and managed care.
OBJECTIVE: To examine the extent to which Illinois nursing facilities have developed relationships with other healthcare providers, particularly managed care organizations (MCOs). STUDY DESIGN: A cross-sectional survey of nursing facilities designed to determine: 1) relationship objectives; 2) obstacles to developing relationships; 3) currently available services; 4) staffing for these services and; 5) nursing facility approaches to networking. The survey was sent to a census sample of 867 nursing facilities serving the elderly in Illinois. Descriptive and multivariate logistic regression analyses of relationships determined to be formal/risk-sharing were performed. STUDY POPULATION: The sample included 523 Illinois nursing facilities. A total response rate of 60% was achieved (523/867). RESULTS: Higher strategic goals, urban location, nonprofit ownership status, higher percentages of private pay and/or Medicare clients (vs Medicaid), and provision of home care and subacute services were all significant predictors of formal or risk-sharing relationships with MCOs. CONCLUSIONS: Facilities with more relationships and higher goals have more formal/risk-sharing relationships with MCOs. Facilities in urban areas have more relationships, likely due to the fact that rural facilities have fewer options and operate in different markets. In addition, nursing facilities rely on Medicare referrals from hospitals, and these Medicare patients, especially those in urban areas, are increasingly controlled by MCOs. (+info)
A profile of the members of FASEB societies: NIH awards, degrees, and institutional affiliations, 1999.
Data from the FASEB Directory of Members and NIH were used to develop a statistical profile of the members of FASEB Societies. For the U.S.-based scientists (exclusive of retired and student members), the most frequently reported degree was a research doctorate (69. 6%). A substantial fraction, however, reported medical degrees (19. 2%) or both research and medical degrees (8.0%). The majority of members of FASEB Societies listed academic affiliations in the directory. Industrial affiliations were reported, however, in 9.7% of the entries with smaller fractions listing associations with hospitals, independent research institutes, and government agencies. Just over one-fourth of the members of FASEB Societies were principal investigators on NIH research grants. These investigators received one-half of all NIH grants and nearly 60% of the RO1 grants. (+info)
Variation in the use of alternative levels of hospital care for newborns in a managed care organization.
OBJECTIVE(S): To assess the extent to which variation in the use of neonatal intensive care resources in a managed care organization is a consequence of variation in neonatal health risks and/or variation in the organization and delivery of medical care to newborns. STUDY DESIGN: Data were collected on a cohort of all births from four sites in Kaiser Permanente by retrospective medical chart abstraction of the birth admission. Likelihood of admission into a neonatal intensive care unit (NICU) is estimated by logistic regression. Durations of NICU stays and of hospital stay following birth are estimated by Cox proportional hazards regression. RESULTS: The likelihood of admission into NICU and the duration of both NICU care and hospital stay are proportional to the degree of illness and complexity of diagnosis. Adjusting for variation in health risks across sites, however, does not fully account for observed variation in NICU admission rates or for length of hospital stay. One site has a distinct pattern of high rates of NICU admissions; another site has a distinct pattern of low rates of NICU admission but long durations of hospital stay for full-term newborns following NICU admission as well as for all newborns managed in normal care nurseries. CONCLUSIONS: Substantial variations exist among sites in the risk-adjusted likelihood of NICU admission and in durations of NICU stay and hospital stay. Hospital and NICU affiliation (Kaiser Permanente versus contract) or affiliation of the neonatologists (Kaiser Permanente versus contract) could not explain the variation in use of alternative levels of hospital care. The best explanation for these variations in neonatal resource use appears to be the extent to which neonatology and pediatric practices differ in their policies with respect to the management of newborns of minimal to moderate illness. (+info)
The National Nursing Home Survey: 1995 summary.
OBJECTIVE: The 1995 National Nursing Home Survey (NNHS) was conducted to collect data on nursing homes and their current residents. This report presents detailed data on the characteristics of the nursing homes including ownership, certification, bed size, location, affiliation, and services provided. Data on current residents are presented by basic demographics, living arrangement prior to admission, functional status, and other health and personal characteristics of the residents. METHODS: The 1995 NNHS is a sample survey consisting of a two-stage design with a probability sample of 1,500 nursing facilities in the first stage and up to six current residents from each facility in the second stage. RESULTS: About 1.5 million residents were receiving care in an estimated 16,700 nursing homes in 1995. Nearly 1.8 million beds were available and facilities operated at about 87 percent of their capacity. Nearly 90 percent of the residents were 65 years and over. They were predominantly female and white with a large portion needing assistance in the activities of daily living (ADL's) and instrumental activities of daily living (IADL's). (+info)
The influence of organizational structure on physician satisfaction: findings from a national survey.
BACKGROUND: The term managed care encompasses a variety of organizational arrangements between physicians and health plans. At one extreme, physicians are plan employees; at the other, physicians have contracts with multiple plans. How these arrangements affect physicians' satisfaction with managed care is not well known. OBJECTIVE: To explore the effect of organizational structure on physician satisfaction. DESIGN: Telephone survey of 751 practicing internists. The response rate for the 15-minute survey was 64%. SAMPLING STRATEGY: The random sample was taken from the membership of the American College of Physicians-American Society of Internal Medicine. Federal employees, retirees, physicians, and students who spent less than half of their time in patient care were excluded. RESULTS: 689 Physicians indicated that they were affiliated with a managed care plan: 9% were salaried employees, 6% had an exclusive contract with one plan, and 85% had a variety of nonexclusive arrangements with multiple plans. Among plan employees, 32% reported they were very satisfied with the managed care organization in which they worked. The corresponding figure was 19% among physicians with an exclusive contract and 5% among those with multiple contracts. A similar pattern of responses was seen when physicians were asked about their perception of the commitment of managed care to quality. Although 64% of plan employees responded that there was a great deal of commitment, the corresponding figure was 35% among physicians with an exclusive contract and only 7% among those with multiple contracts. CONCLUSIONS: Physicians who are salaried employees of a staff- or group-model HMO report the highest satisfaction with managed care. (+info)