Primary care networks: choose your physicians wisely

As hospitals and health care systems maneuver for a position in the integrated health care delivery system, no initiative is more important than building an effective and competitive primary care network. Yet this critical initiative is fraught with potential pitfalls. In their haste to develop primary care networks, hospitals and health care systems may fail to thoroughly evaluate network participants and in turn create large, inclusive, and inefficient primary care networks that don't come close to breaking even, much less repay practice acquisition costs. In an effort to become more efficient, practitioners often find themselves in the unenviable position of "de-selecting" peers retrospectively. The author presents criteria for evaluating and selecting network physicians.     

How practicing physicians are adjusting to managed care

Managed care is here to stay. In fact, for the foreseeable future, health care will become increasingly more managed each year. The purpose of this article is to help physician leaders and executives understand how clinicians are reacting and adjusting to managed care. Those of us who are doing primarily management activities have our own set of problems and adjustments. Sometimes we can be insensitive to the problems that physicians who are primarily treating patients can have as a result of managed care. Health care executives who are managing physicians or attempting to influence their behavior must attempt to understand clinicians' feelings, reactions, and coping mechanisms.     

Purchasers and the impact of managed care on physicians

In much the same way that demands by managed care organizations are shaping the way physicians practice, health care purchasers impact how managed care organizations operate. Corporations purchase managed health care through their employee benefits programs, and understanding the language, objectives, and limitations of these purchasers is essential to grasping the forces influencing managed care organizations and the modern practice of medicine. The emergence of value-based purchasing as a strategic corporate approach to health benefits programs will dictate the forces on physicians, hospitals, and managed care organizations for years to come. These forces have already led to price reductions, health plan accreditation, employee-directed report cards, outcomes management, and organized systems of care, and they will determine the broad outlines of the emerging U.S. health care system.     

A manual for managed care physicians: why needed, how developed, and how used

This article describes the development of and rationale for a "Physician Manual" in a managed care setting. The article begins with introductory information on the use of similar documents in industry generally and then provides background information on the author's organization. The contents of the manual are given in outline form, with additional details provided as necessary. The need to regard the manual as a "living" document is emphasized, and probable reasons for change are noted, along with recommendations for intervals at which review and change are appropriate.     

Customized clinical case management for chronically ill patients. Health system sees remarkable results with teams of case managers,physicians, patients

Securing excellent care and positive outcomes for seriously ill, high-risk patients requires extraordinary measures. A health system in Georgia is experiencing strong results by taking a team approach to health care with case managers, physicians and patients working together.     

Share,like, twitter,and connect: Ecological momentary assessment to examine the relationship between non-work social media use at work and work engagement

Non-work social media use at work has seen a dramatic increase in the last decade and is commonly deemed counterproductive work behaviour. However, we examined whether it may also serve as a micro-break and improve work engagement. We used ecological momentary assessment across 1 working day with up to 10 hourly measurements in 334 white-collar workers to measure non-work social media use and work engagement, resulting in 2235 hourly measurements. Multilevel modelling demonstrated that non-work social media use was associated with lower levels of work engagement between persons. Within persons, non-work social media use was also associated with lower concurrent work engagement. However, non-work social media use was related to higher levels of work engagement 1 hour later. While more extensive non-work social media use at work was generally associated with lower work engagement, our advanced study design revealed that the longer employees used social media for non-work purposes during 1 working hour, the more work engaged they were in the subsequent working hour, suggesting that employees turn to social media when energy levels are low and/or when they (temporarily) lose interest in their work. This behaviour may serve as a break, which in turn increases work engagement later during the day.     

Fighting fire with fire: physicians blazing new paths to autonomy

Thousands of physicians around the country have stopped complaining about being burned by the system and have started reengineering their destinies. They're building super IPAs, forming and operating HMOs, and joining unions to represent their rights in a growing grassroots physician effort to regain control. These physicians have thumbed their noses at managed care companies they say have drastically cut reimbursements, arbitrarily dropped them from panels, dictated utilization, and cost them patients. They're tired of working harder and earning less and frustrated by sacrificing quality in the name of cost reduction. And they have learned that there are ways to prevail.     

Physician strives to create lean,clean health care machine. Studies of manufacturing processes may one day help make your practice more efficient

Elisabeth Hager, MD, MMM, CPE, is teaming up with scientists and industrialists to teach physicians how to apply principles of lean, total-quality manufacturing to their practices. She believes innovation and efficiencies can help doctors resurrect their profession's image and their control over it--and perhaps even reinvent American health care.     

Managing unmanageable physicians: leadership, stewardship and disruptive behavior

Physician executives would undoubtedly prefer to spend the bulk of their time inspiring great employees and building productive teams instead of struggling with disruptive physician behavior. Explore ways to diminish the frequency and intensity of disruptive behavior in your organization and identify your role, rights, responsibilities and accountabilities as a physician leader.     

The past,present and future of health care quality. Urgent need for innovative,external review processes to protect patients

There are three paths to quality health care standards: the regulatory route, the "learning science" route, and the futuristic "management science" route. The regulatory path leads to punishment and blame. The learning science path splits, with one road leading back to harsh regulations and the other to the halls of academic medicine. And the management science path, while short, will be the road to success as American health care struggles to improve quality and overcome well-publicized and deadly medical errors.     

A historic, geographic, cultural, and economic guide to Australian health care

This is the first in a series of articles that will explore the health care systems of countries around the world. To begin the series, the President of the Royal Australian College of Medical Administrators describes the current status of the health of his country's people, its health care delivery system, and how it has responded to historic, geographic, cultural, and economic factors that characterize the growth and development of Australia.     

Planning end-of-life care for patients with dementia: roles of families and health professionals

We examined families' end-of-life decision making and their interactions with health professionals. Twenty-eight family members of institutionalized dementia patients participated in four focus groups. We found that participating family members were not well prepared for their decision-making roles, and that they: 1) experienced substantial burdens and loss in caring for institutionalized elders; 2) had limited understanding of the natural progression of dementing conditions; 3) were uncomfortable in setting goals for their relatives' end-of-life care; 4) had little experience with death, and were ambivalent about the anticipated death of their relative; and (5) reported that they had little substantive communication with health professionals regarding end-of-life care planning. We concluded that many of the needs of such families could be addressed through improved application of the principles of advance care planning, including regular structured discussions, involvement of surrogate decision-makers, and anticipation of clinical decisions. Health professionals should take the lead in 'normalizing' the discussion of death.