Cutting to the chase: what physician executives need to know about HIPAA

All health care providers, plans, and clearinghouses will be affected by the federally mandated uniform standards for administrative transactions. This article presents distilled core information about the Health Insurance Portability and Accountability Act (HIPAA) legislation--the standards, penalties for violations, and status of final rules. It also raises several key unsolved issues of which clinicians, executives, and health care providers must be aware so they can prepare and plan for the upcoming changes. HIPAA is intended to improve the efficiency and effectiveness of the health care system, as well as to increase the protection and confidentiality of individually identifiable health information. The costs of making the transition to the legislated standards and processes remain a worrisome factor. Although there are two years before these standards must be implemented, and cost and compliance issues resolved, work has already begun in many health institutions to identify and address them.     

Implementing TQM in a medical school department

In a modest way, our medical school department has succeeded in applying continuous quality improvement and TQM methods to its ambulatory practice. We are close enough to our experience not to have forgotten what Rosabeth Moss Kanter calls the "messy, mistake-ridden, muddling stage." This article is a narrative of some of our stumbling attempts to change the way our practice works. The lessons we have learned are relevant to other ambulatory practices, both inside and outside the academic world.     

Seven lessons in medical management

In more than 15 years of functioning as a medical director, addressing the needs and wants of patients, physicians, hospitals, and ancillary health care suppliers, I have accumulated pieces of ?wisdom? that I now feel I should share with others in medical management. The concepts are fairly simple, but they are of significant value in the ?real-life? management of people. The seven simple ideas outlined in this article are not meant to be the end-all to management philosophy. Books have been written about each idea, and there are hundreds of good ideas in many sources I do not touch on here. However, I have found these seven items of significant value in dealing with others and hope others find them similarly useful.     

Encouraging women and minorities to enter medical management.

Women and minorities are underrepresented in medical management. If we use our personal knowledge of physician managers we know, it should be clear that the profession is dominated by white males, mainly middle-aged. But the evidence is more conclusive.     

Twelve questions to ask about your outcomes monitoring system--Part I

Outcomes monitoring is an integral part of any decision maker's information resources--the cornerstone of a provider's commitment to quality improvement or of a purchaser's strategy for seeking value. In their eagerness to obtain useful information about provider performance, purchasers and consumers naively may accept flawed evaluations and thereby create perverse incentives for providers that undermine the very qualities they wish to foster. Inaccurate or misleading information about provider performance will lead managers to reward the wrong behavior and so induce more of it. Inaccurate information also can discourage better providers whose performances are not recognized and can lead all providers to distrust and denounce clinical monitoring in general. When these things happen, the great value of outcomes monitoring systems as a tool for quality improvement is lost.     

Survey shows medical involvement in risk management.

Late in 1985, an AAMD InterCOM survey questionnaire was sent to hospital-based members of the Academy. The subject of the survey was risk management programs, and the goal was to obtain information on how members planned and implemented this function within their institutions. Of the 632 surveys mailed, 192 usable responses were returned. Where two or more responses were received from the same institution, the combined response was used. If the responses were incompatible, the institution was deleted from the returns. In this article, we summarize the major findings of the survey.     

浅析从严治理与人本管理在公务员管理中的契合

当前,从严治理公务员队伍,改进公务员作风,严惩公务员腐败,已经成为公务员管理的主题。如此同时,在现代人本管理的总体潮流的影响下,在公务员管理中注入人本管理的理念和方法,体现人性化关怀与尊重,保障他们的合法权利对于调动公务员的工作积极性与创造性是十分必要的,因此,本文就如何实现从严治理与人本管理在公务员管理中实现完整的契合和互补进行探讨。     

Risk management in an IPA setting--Part I

Over the past several years, HMO enrollment has grown the most in independent practice association (IPA) and network models. HMOs in general have expanded as a means to control the cost of health care. Key customers, including large employers and government agencies such as the Health Care Financing Administration (HCFA), require such control. IPA and network models retain a greater sense of choice on the part of participating physicians and patients than do closed-panel group- or staff-model programs. As physician and patient choice increases, however, the HMO's control over health care diminishes. Thus, customers require HMOs to manage health care. The HMO must market, develop delivery systems, meet regulatory requirements, and make profits. It must control both the quality and the cost of health care. Doing so without the level of control found in staff-model HMOs has created unique challenges for IPA HMO managers. IPA-model HMOs adapt quality improvement programs to this lesser level of control. Staff-model HMOs and hospitals closely link quality assurance to risk management. Programs designed to improve quality will naturally also reduce the risk of providing care below standards. This relationship is less clear in IPA- and network-model HMOs, in which the HMO does not provide the care. Thus, IPA-model quality improvement programs often do not address their risk management implications. This two-part article examines the differences between staff-model and IPA-model HMOs in liability and in ability to manage risk. In the first part, the nature of the risks is described. In the next issue of the journal, the management of those risks will be discussed.     

Improving medical decision-making with a management science game theory approach to liver transplantation

Even though nowadays medicine is necessarily linked with technology, it is still a service involving human interaction, which frequently requires the help of management science tools. Indeed, a medical consultation can be an extremely complex example of human interaction. Management science, operations research and in particular game theory may play a key role in helping to improve the results of medical decision-making processes. Game theory is widely used in a large variety of decision-making studies, but there is little application to health care issues, namely the doctor-patient relationship. This paper uses game theory to model the liver transplantation consultation for patients suffering from Alcoholic Liver Disease. This disease is very delicate, and patients at its end-stages require special dedication where management science tools are of utmost importance. They may try to deceive doctors, which may lead to bad outcomes. The Nash equilibrium behaviors by doctor and patient are obtained. Results show some health policy and managerial implications on the decision-makers’ parameters and on the order of play so as to achieve, for instance, higher rates of patient’s cooperation.     

An introduction to the theory of constraint and how it can be applied to medical management

This overview of a new way of thinking about medical management problems could help physicians executives think about those problems differently.     

Part 2, Conflict management. How to shape positive relationships in medical practices and hospitals

Managing workplace conflict is one of the most important, stressful, and time-consuming tasks faced by today's physician leaders. In Part 1 of this article series, the authors describe how to assess an organization's interpersonal dynamics. True change comes from interventions that help an organization to become a positive interpersonal culture, one that fosters cooperation and collaboration. Part 2 offers seven steps to solving the disruptive physician problem: (1) provide protection to complainants; (2) listen, empathize, and avoid communication triangles; (3) confront offenders with data, authority, and compassion; (4) if needed, get outside help; (5) offer workplace training and experiences that foster positive relationships; (6) follow-up; and (7) practice what you preach. The self-assessment and intervention guidelines discussed in this series of articles can help physician executive move beyond struggling with episodes of conflict to shaping stress-resilient medical organizations.     

Capital views: highlights of perspectives in medical management 1994

Washington, D.C., where health policy is currently being debated, served as an appropriate backdrop May 4-7 for the College's annual "Perspectives in Medical Management" conference. Some of its federal buildings served as classrooms for those interested in learning the legislative process through participation in the "Health Policy Institute," which was held simultaneously. Although it is impossible to report on all that transpired during the four-day conference, this article will briefly describe the comments of a few of the speakers.     

Conflict management, prevention, and resolution in medical settings

Everything about conflict is difficult for physicians, who are by nature and conditioning quite confrontation adverse. But conflict is inevitable, and conflict management skills are essential life skills for effective people. The keys to conflict management are prevention, effective communication, and anger management, skills that can be learned and polished. Conflict management skills can enhance all aspects of life for physicians, as well as those who work or live with them.