Browsing: Medicine & Business

As managed care plans step up their cost containment efforts and scrutiny of physician performance, it is wise to understand the ways in which they may attempt to shrink their panel of physicians. Board certification, utilization management, patient satisfaction and preventive health programs are criteria with which health plans use to do so.

HCFA has released the long-awaited guidelines for coding of evaluation and management services by specialists. In light of the rapidly expanding number of federal coding audits, the new guidelines send important messages about the expectations for scope of work in and documentation of patient examinations.

Making the right career choice demands that you self-test for solo practice, partnership and equity relationship potential. Consider your ideal balance of flexibility, autonomy, risk and income.

One of the key threshold issues any medical group must face is what kind of management is needed to make the practice successful. By having a good office manager and delegating managerial responsibilities, physicians can find relief from many of the aggravating day-to-day hassles.

Rapid development and disintegration of physician partnerships and changing alliances among physicians and institutions often fail to secure optimal cultural fit, or consider leadership succession, or anticipate ease of integration into a network. Three phases of organizational development are attentive to these problems: pre-deal, during the transaction and post-affiliation.

Patient care management can be made more cost-effective while affording a reasonable lifestyle for physicians and maintaining quality of care by adding a physician extender to the practice’s team. Consider the economic rationales, as well as licensure and reimbursement parameters.

If you are a specialist, consider the advantages offered by single specialty networks, which include increased control in a managed care environment, enhanced negotiation clout with health plans or primary care groups, shared administrative resources and marketing leverage.

The merger of physicians or their acquisition by hospitals often encounter logistical and bureaucratic obstacles to meaningful unity. Those problems can be overcome by consolidating sites into strategically located ambulatory care centers, an approach that has competitive advantages to the sponsoring organization.

The first step is identifying high-risk enrollees with self-administered surveys. The authors discuss population-based screening instruments and probability of repeat hospitalizations surveys. The second step is following the at-risk patient. Interviews and case management programs are appraised.

How to weigh advantages and disadvantages of practice mergers. Specific traps to watch out for include ownership, governance, compensation, liability, fraud and abuse, reimbursement, taxation, benefits, antitrust and personnel.