Corporate compliance programs: risk management for the future

The Department of Justice has estimated that the government loses $100 billion annually in health care fraud. Consequently, the government's health care fraud enforcement activities with respect to all health care providers and suppliers continue to grow. Last year alone, the government collected more than $8 billion in settlements, fines, and penalties involving health care fraud. Recent settlements with the government have begun to include corporate compliance programs that require continued government oversight of the health care organization as an essential part of the settlement. The first section of this article describes the legal significance of health care companies' having corporate compliance programs. The second section provides a sample list of topics that should be included in any corporate compliance program. Finally, we describe various issues related to the creation and implementation of corporate compliance programs.     

The mandate for investigational cancer therapies

The heated national health care reform debate of the summer of 1993 has now simmered down, but pieces of the debate are still percolating along at the state level. Within the past year, numerous states have introduced bills that would mandate insurance coverage for investigational cancer therapies--in particular high-dose chemotherapy and bone marrow transplant for breast cancer. The problem with these initiatives, well-intended though they may be, is that they threaten to spread unproven technologies at a rapid rate and at the same time miss the opportunity to collect data that would prove the safety and effectiveness of the methods. The author explores these issues and suggests how managed care companies can play a more aggressive role in parrying the threat.     

The ascendancy of primary care: permanent or temporary?

The conventional wisdom strongly suggests a health care provider food chain for the future: Primary care physicians (PCPs), principally family practitioners, on the top playing the lead role, distantly followed by specialists, with hospitals and other ancillary services even further down the line. Is this a reasonable expectation? Will PCPs dominate the new systems? Or will they be but one of many equally necessary components of these developing integrated health care delivery organizations? Looking at the various models now developing, it would seem that future integrated delivery systems will utilize both PCPs and specialists, but with strong augmentation from a diverse assortment of other health care professionals, including nonphysician providers, educators, and administrators. To separate the illusion of primary care dominance of the coming health care system from the likely reality, we should first determine what is driving the apparent present demand for primary care physicians. Next, we will examine the possible and probable reactions to that demand from an economic standpoint and from the points of view of both health care professionals and the public. Finally, we must try to picture how health care provider organizations of the future are likely to look and how they will integrate their health care professionals.     

A comparison of quality and utilization problems in large and small group practices

Physicians practicing in large, multispecialty medical groups share an organizational culture that differs from that of physicians in small or independent practices. Since 1980, there has been a sharp increase in the size of multispecialty group practice organizations, in part because of increased efficiencies of large group practices. The greater number of physicians and support personnel in a large group practice also requires a relatively more sophisticated management structure. The efficiencies, conveniences, and management structure of a large group practice provide an optimal environment to practice medicine. However, a search of the literature found no data linking a large group practice environment to practice outcomes. The purpose of the study reported in this article was to determine if physicians in large practices have fewer quality and utilization problems than physicians in small or independent practices.     

Tissue Dosimetry, Pharmacokinetic Modeling, and Interspecies Scaling Factors

Interspecies scaling factors (ISFs) are numbers used to adjust the potency factor (for example, the q1* for carcinogens or reference doses for compounds eliciting other toxic endpoints) determined in experimental animals to account for expected differences in potency between test animals and people. ISFs have been developed for both cancer and non-cancer risk assessments in response to a common issue: toxicologists often determine adverse effects of chemicals in test animals and then they, or more commonly risk assessors and risk managers, have to draw inferences about what these observations mean for the human population. This perspective briefly reviews the development of ISFs and their applications in health risk assessments over the past 20 years, examining the impact of pharmacokinetic principles in altering current perceptions of the ISFs applied in these health risk assessments, and assessing future directions in applying both pharmacokinetic and pharmacodynamic principles for developing ISFs.     

Mirror, mirror on the wall: reflections from failure to establish a truly uniform national health care policy

When the author gazed into the proverbial mirror and asked if the U.S. health care system was the fairest of them all, it shattered. In this article, Thompson tells why the system is broken and what failure to fix it means to physician executives. He suggests that we, as Americans, must reinvent ourselves by realigning our value systems and and stifling our obsession with profit before trying to reinvent health care.     

Trans-ideological business values in international codes of conduct

Traditionally, scholars of international business have been unconcerned with ethics and values, in part due to the widely-held belief that standards vary across cultures and ideologies. Recently, however, business ethicists have considered whether there are some business-related values that are shared across cultures. Through an analysis of the codes of conduct for multinational enterprises of four international organizations, five trans-ideological business values are discovered. They are national sovereignty, social equity, human rights, market integrity and organizational autonomy. The consensus in values is critically important for both scholarship and management.An earlier version of this paper was presented at the Second Annual Meeting of the International Association of Business and Society (March 1991). The author would like to thank three anonymous reviewers for their helpful comments on earlier drafts.     

The Need to Reconcile Concepts that Characterize Systems Facing Threats

Desirable system performance in the face of threats has been characterized by various management concepts. Through semistructured interviews with editors of journals in the fields of emergency response and systems management, a literature review, and professional judgment, we identified nine related and often interchangeably used system performance concepts: adaptability, agility, reliability, resilience, resistance, robustness, safety, security, and sustainability. A better understanding of these concepts will allow system planners to pursue management strategies best suited to their unique system dynamics and specific objectives of good performance. We analyze expert responses and review the linguistic definitions and mathematical framing of these concepts to understand their applications. We find a lack of consensus on their usage between interview subjects, but by using the mathematical framing to enrich the linguistic definitions, we formulate comparative visualizations and propose distinct definitions for the nine concepts. We present a conceptual framing to relate the concepts for management purposes.     

Consolidation and fragmentation in environmental scanning: A review and research agenda

Environmental scanning is a broadly defined concept, having first received attention from scholars in the late 1960s. Over the years a number of similar and overlapping constructs have emerged in management literature. The aim of this study, via a systematic review and thematic analysis of relevant empirical research, is to consolidate foundation environmental scanning knowledge, demonstrate how scanning research has developed and fragmented over time, and propose an agenda for future research. The first contribution of our review is a new typology of environmental scanning research made up of five discrete research views, which provides a more comprehensive and contemporary overview of the field than previous studies. The second is a proposed agenda for future research that explicitly acknowledges the role of technology, an area that is presently underdeveloped in foundation scanning literature. The third contribution is to signpost future directions for research on scanning and organisational performance using a number of theoretical perspectives. The overall outcome of our review is to move scanning research on from increasingly incremental contributions concerned with context to a place where the changing role of technology and the mechanisms through which environmental scanning contributes to competitive advantage can be more thoroughly understood.     

Ranking of the Most Prolific Authors,Universities, and Organizations in the Journal of Organizational Behavior Management

ABSTRACT

Over the years, reviews in behavior analysis have sought to identify the most prolific researchers and institutions. The goal of these reviews was to offer one resource for behavior analysts to identify experts in behavior analysis and quality graduate programs. However, most of these reviews omitted the Journal of Organizational Behavior Management (JOBM), making the results less relevant to those who work in organizational behavior management. The purpose of this review was to extend previous findings and identify the most published researchers, academic institutions, and organizations in JOBM since its inception. Furthermore, we calculated the citation rate (per year, per article) for each of the top 20 most published authors. The results, implications, and opportunities for further analysis are discussed.