Telling the data story the right way

Effective data-driven analyses of service-line performance require: Buy-in and agreement at the outset from all parties (hospital and physicians) on the validity of the data used to evaluate service-line performance, Actionable data and metrics relevant to physicians, with financial goals tangibly linked to clinical improvement, Transparent sharing of data with physicians to build their trust and support the case for change, A physician champion who can help validate findings and guide how data are presented, Willingness of physicians to acknowledge that the opportunity for improved margin depends largely on the variable costs that they control as individuals.     

Torts, expertise, and authority: liability of physicians and managed care organizations

We examine optimal individual and entity-level liability for negligence when expected accident costs depend on both the agent's level of expertise and the principal's level of authority. We consider these issues in the context of physician and managed care organization (MCO) liability for medical malpractice. Under current law, physicians generally are considered independent contractors and hence MCOs are not liable for negligent acts by physicians. We find that the practice of reviewing the medical decisions of physicians affects their incentives to take care, which in turn implies that it is efficient for MCOs to be held liable for the torts committed by their physicians.     

PHYSICIANS AND RESOURCE MANAGEMENT IN HOSPITALS: AN EMPIRICAL INVESTIGATION

Recent concern has been expressed over the reluctance of physicians in hospitals to take 'resource management to their hearts' (Pollitt et al. 1988, p. 232). This is important as physicians are increasingly becoming organization members with considerable economic and managerial involvement in hospitals. This paper provides some empirical evidence of differences which occur in physician behaviour once they become integrated into hospital management structures. Differences in physician managers' orientations to goals which focus on the organization as a system are compared to senior physicians in the same setting. In addition, a comparison is made between the attitudes and use of budgeting systems, a resource management strategy. The results indicate that changes in physician managers' orientation to management-related goals and organization obligations are reflected in their budgeting behaviour.     

Entry and regulation: evidence from health care professions

In many countries, pharmacies receive high regulated markups and are protected from competition through geographic entry restrictions. We develop an empirical entry model for pharmacies and physicians with two features: entry restrictions and strategic complementarities. We find that the entry restrictions have directly reduced the number of pharmacies by more than 50%, and also indirectly reduced the number of physicians by about 7%. A removal of the entry restrictions, combined with a reduction in the regulated markups, would generate a large shift in rents to consumers, without reducing the availability of pharmacies. The public interest motivation for the current regime therefore has no empirical support.     

Medical foundations: one model for hospital-physician alignment

Some states that enforce a corporate practice of medicine prohibition have created medical foundation statutes allowing hospitals or health systems to own corporations providing physician services. Medical foundations may be useful in the coordination of care through employed or contracted physicians. Medical foundations that qualify as a tax-exempt entities have lower risks associated with tax-exempt rules as long as payments to physicians are reasonable and don't result in private inurement.     

Gauging the financial impact of physicians on hospitals

A study evaluated the impact of physicians on hospital finances in four basic areas of physician care: primary care, medical specialties, surgical specialties, and other specialties. The study highlighted inherent differences in the activity and revenue-generating patterns of physicians to provide insight into the financial implications of the clinical enterprise. The findings offer a useful perspective on hospitalist programs, particularly regarding the point at which a hospitalist program is likely to be financially self-sustaining. Such data could be used to determine the number of physicians needed to support a new or expanded clinical service.     

The drive to survive: independent medical practice

The "hospital of choice" for independent physicians will have the following characteristics: Adequate capital for investment in human resources, technology, and facilities. A strong and sustainable market position based on affiliated primary care practices. The ability to engage physicians as business partners. The availability of performance management information.     

Disclosing Physician Ratings: Performance Effects and the Difficulty of Altering Ratings Consensus

I examine effects of a health care system's policy to publicly disclose patient ratings of its physicians. I find evidence that this policy leads to performance improvement by the disclosed, subjective ratings and also by undisclosed, objective measures of quality. These effects are consistent with multitasking theory, in that physicians respond to the disclosure by providing more of a shared input—time with patients—that benefits performance by ratings and underlying quality. I also find, as predicted by information cascade theory, that the ratings become jammed to some degree near initially disclosed values. Specifically, raters observe the pattern of initial ratings and follow suit by providing similar ratings. Finally, I find evidence that physicians anticipate rating jamming and so concentrate their effort on earlier performance in order to set a pattern of high ratings that later ratings follow. These results demonstrate that the disclosure of subjective ratings can benefit performance broadly but can also shift effort toward earlier performance.     

A new era for hospital liability

Hospitals are no longer merely facilities with equipment where autonomous physicians practice; they owe a direct duty of reasonable care to patients. This dramatic transition for hospitals will ensure a sea of change in the character of hospital medical practice and management.     

Accountable clinical management: an integrated approach

Hospitals should move from the traditional siloed approach to managing the clinical side of the enterprise, where finance leaders and clinicians play distinctly different roles without coordination, to an integrated approach that assembles a multidisciplinary team to focus coordinated attention on identifying and pursuing opportunities for clinical process improvement. Senior executives should lead this top-down effort to establish goals and set priorities for action, using an integrated, high-level reporting dashboard that shows overall performance in terms of quality, efficiency, and patient experience. Implementing integrated clinical management requires a clear, consistent communications plan and messaging for physicians and managers to show why it is increasingly necessary for both hospitals and physicians.     

Insurance in a Market for Credence Goods

We study the impact of variations in the degree of insurance on the amount of fraud in a physician‐patient relationship. In a market for credence goods, where prices are regulated by an authority, physicians act as experts. Due to their informational advantage, physicians have an incentive to cheat by pretending to perform inappropriately high treatment levels leading to overcharging patients. Our approach aims on the impact on changes in each, patients' and physicians' incentive structure when the proportional degree of coinsurance varies. It is shown that a higher coinsurance rate may lead to either less fraud in the market and a lower probability of patients searching for second opinions or more fraud and more searches.     

Pattern-of-treatment differences among primary care physicians in alternative systems of care

In a recent study, the average treatment pattern of HMO-based primary care physicians is found to be significantly less expensive than that of indemnity-based primary care physicians. This difference is because the HMO-based physicians' style of medical practice is less hospital-intensive.     

The health care market: can hospitals survive?

Does it sound familiar? Resources are scarce, competition is tough, and government regulations and a balanced budget are increasingly hard to meet at the same time. This is not the automobile or oil industry but the health care industry, and hospital managers are facing the same problems. And, maintains the author of this article, they must borrow some proven marketing techniques from business to survive in the new health care market. He first describes the features of the new market (the increasing economic power of physicians, new forms of health care delivery, prepaid health plans, and the changing regulatory environment) and then the possible marketing strategies for dealing with them (competing hard for physicians who control the patient flow and diversifying and promoting the mix of services). He also describes various planning solutions that make the most of a community's hospital facilities and affiliations.     

Navigating the road ahead: lessons from a pioneer ACO

Genesys PHO in Flint, Mich., is one of 32 ACOs participating in the Pioneer ACO Model initiative administered by the CMS. Genesys PHO' experience suggests that successful ACOs will invest physicians with decision power and focus on strengthening the physician-patient relationship, restoring patients' trust in physicians, and allocating the right human resources to the effort. Organizations that are considering an ACO strategy should evaluate the risk structures of their proposed contracts and their provider groups' willingness to accept the contractual level of risk.     

Medicare payment: how low it will go and how to prepare

Hospitals should begin preparing now for a decade of reductions in Medicare payment with strategies aimed at: Partnering with clinical leadership, Performing detailed margin analysis, Engaging with service line managers and physicians, Revamping care coordination, Ensuring efficient operating room utilization, Improving emergency department operations.     

Cost and effectiveness of physician peer review in reducing medicare overutilization

There has been concern that some physicians within the U.S. Medicare program may be rendering medical attention unecessarily. To help curb this possible overutilization, peer review committees have been formed in certain areas. These committees of practicing physicians examine utilization practices of doctors.The objective of this study is to determine the cost and effectiveness of the peer review process. In order to do this, we compare the costs and benefits resulting from peer review. The benefits are two types. One type is recoverable overpayments, which peer review has established as amounts that were paid for unnecessary medical attention. The other type is the deterrent to physicians against overutilization, due to the presence of peer review.The findings of this study are that each of the benefits of peer review substantially outweigh its costs, and that the benefits due to the deterrent effect of peer review are evident in all review areas considered.     

PHYSICIANS AND RESOURCE MANAGEMENT: THE ROLE OF ACCOUNTING AND NON-ACCOUNTING CONTROLS

Prior research has identified the difficulties associated with encouraging physicians to 'take resource management to their hearts' and has questioned the efficacy of implementing management accounting systems (MASS) in the health care setting. Although physicians are now being integrated into management structures, they typically do not identifjr with managerial values and goals. This creates a potential impediment to the effective implementation of accounting-based controls. No prior research has, however, assessed if this impediment is equally significant in the effective implementation of other non-accounting forms of control. This paper builds on prior research and assesses the extent to which a physician manager's managerial orientation significantly influences the effectiveness of both accounting and non-accounting forms of control. The paper contributes to the literature by simultaneously assessing the effect of managerial orientation on the use and relative importance of three forms of control. The results confirm the importance of an identification with managerial values and norms for the effective implementation of management accounting systems. This orientation, did not, however, appear to be important for the effective implementation of non-accounting forms of control. These findings have direct implications for the design of effective management control systems in hospitals and other organizations dominated by professionals.