Analyzing vendor and supplier contracts

Contracts increasingly govern the way medical groups operate their businesses. While physician employment contracts and contracts with HMOs and PPOs usually receive significant scrutiny and analysis, little attention has been paid to the myriad contractual relationships by which physicians secure services for their own practices.

The manager's checklist: how to keep your group legally up-to-date

Most groups depend on their administrators to lead them through the maze of legal rules, regulations and arrangements that businesses in health care must now confront, writes Keith Korenchuk, J.D., M.P.H. He, therefore, presents an indispensable checklist to aid administrators in systematically keeping their group legally up-to-date.

Giving credit its due in the group practice setting. How credit cards can improve cash flow

The health care industry is moving toward more patient service, and one aspect of service often overlooked is billing, writes Marcia Pear. Some practice managers believe credit cards aren't cost effective. In reality, they can actually accelerate cash flow and allow patients to resolve financial obligations sooner.

Preventive medicine in primary care. Moving from theory to practice

Primary care physicians are in a unique position to offer preventive services. They have access to patients when intervention may be most successful, and they see most patients over a long period, which allows for adequate follow-up. The challenges are choosing the most effective interventions and organizing records and office staff to facilitate delivery of preventive services. Preventive medicine may not be as dramatic or as immediately successful as curative medicine, but it can have a tremendous long-term impact on health and well-being.

Audit and standards in new general practice

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Using a computer database to increase efficiency in the practice setting

A computerized database is an invaluable tool for planning and managing patient care. The design and function of two databases for an ambulatory cardiology setting are discussed in this article. Information about patients with hyperlipidemia and with permanent pace-makers was entered into the custom-designed databases. The benefits of using computers for record keeping, such as improved organization and efficiency, are also addressed.

Patient, revenue and cost analyses for medical practices

Authors Robert Stevens and Thomas Chatham write that revenue and cost analysis can be performed by medical groups from historical data they maintain. Such analysis provides the administrator with a data base for developing realistic objectives and identifying areas which should be more fully developed or even eliminated.

Dealing with reimbursement difficulties in today's payment environment

Medical groups nationally are struggling with reimbursement levels, writes author Suzanne Anderson. Groups effectively dealing with the problem realize the solution is not restricted to the billing office but rather begins prior to providing service and lasts until well after payment is collected.

Responding to managed care proposals

To continue to use the term alternative delivery systems in relation to managed care is inappropriate, writes Darrell Schryver, D.P.A., since these systems are rapidly becoming the predominant method for delivering health care. Because such managed care programs are administered by individuals trained in business, it is imperative that medical practices adopt a similar business attitude to negotiate advantageously with these programs.

Resolving problems in the physician's office

Obviously, physicians prefer to use their office hours practicing medicine, therefore, they may tend to overlook these administrative functions. In today's busy practice, finding time to review procedures often is difficult. However, an office error becomes wholly the responsibility of the physician when it leads to a misdiagnosis or failure to diagnose. Periodic review of office procedures may help improve patient care and avoid litigation.

Managing people

Doctors relate to a wide variety of people including patients and their relatives, medical colleagues and other health-care staff and health service managers. In order for these relationships to be effective, they need to possess a high level of people management skills. This paper identifies the nature of the key relationships and presents a model and description of the skills required.

Ten resolutions to improve your practice management skills

Good management is like good medicine. It is paying attention to details. It is also doing the right things at the right times. We find that most practices do some of the steps that follow. However, many do not do all the steps and therefore their results are not as effective. The well-run practice in 1990 is one that achieves results by closely adhering to most of the following steps. We at Conomikes & Associates hope this will help you get off to a good start.

The nature of physician's services: marketing implications

A specific system for classifying services is applied to physicians' services in an attempt to better understand those services. Other services organizations are identified that are similar to these services along each of the dimensions suggested by the classification system. In addition, marketing insights and implications are offered for marketing physicians' services.

How to buy and sell a group practice

This article reviews the world of mergers, acquisitions and divestitures, providing guidelines for the group practice administrator who is in the position of considering a merger or sale. The importance of strategic planning is discussed, and a set of working tools for buying and selling a medical practice is provided, along with suggestions for ways for groups to compete with industrial health/clinic programs in the area of long-term growth/acquisition programs.

Sell your practice to grow and compete--the synergism of vertical integration

There are many advantages for selling a group practice to achieve vertical integration with a larger entity, including shared medical and management services, and greater efficiency, which results in greater profits. Health care in the 1990s will have a more formalized, structured system, greatly reducing freedoms enjoyed by both physicians and patients. An attractive option for smaller groups or solo practitioners is vertical integration.

Physicians and their hospitals: a marketing partnership

As hospitals accelerate their marketing campaigns in efforts to compete for patients, physicians should recognize the opportunities presented by this trend. This article indicates how a physician may develop his or her own marketing strategy and contends that a hospital/physician marketing partnership can benefit both hospital and physician.

How to promote clinical services ethically and effectively

In spite of an increasingly competitive environment, physicians remain reluctant to engage in consumer advertising. This reluctance stems from misperceptions of advertising, cost considerations, and fear of image erosion. This article offers alternatives to traditional modes of consumer advertising in the electronic and print media. These alternatives are consistent with physicians' desires to attract more patients, yet at the same time, accomplish this in an ethical and cost effective manner.

Use of microcomputers in medical practice management: a practical guide

The decreasing cost and increasing availability of computers have created both concern and desire on the part of the non-computer professional. This article provides basic information to use in the selection of microcomputer hardware and software. It is slanted toward the small practitioner, one to four physicians, and provides practical guidelines, definitions, and examples relevant for a small practice.

The scheduling of repeat cesarean section operations: prospective management protocol experience

There are benefits to patients and a busy obstetric service if repeat cesarean section operations are performed on a scheduled basis. Optimum management avoids prematurity and reduces the need for amniocentesis. Over a period of 20 months repeat cesarean sections were performed at Tripler Army Medical Center while a protocol with the following elements was used: (1) known last menstrual period; (2) landmarks: positive urine human chorionic gonadotropin test by 6 weeks, Doppler fetal heart tone by 12 weeks, date determination by examination before 10 weeks, fetoscope fetal heart tone by 20 weeks, and date determination by size before 30 weeks; (3) date determination by midtrimester sonogram(s); (4) normal third-trimester glucose screening; (5) biparietal diameter of 9.2 or 9.5 cm before scheduling. With two or more clinical landmarks and one date by sonogram or one landmark and date by two sonograms, elective repeat cesarean section was scheduled at 39 weeks if the biparietal diameter was greater than or equal to 9.2 cm (127). If dates by sonogram were less than dates by last menstrual period but greater than 1 week or if last menstrual period was unknown, dates by sonogram and landmarks corresponding to dates by sonogram were used to electively schedule, with biparietal diameters of 9.2 or 9.5 cm respectively required (28). If protocol criteria were not met or earlier delivery was indicated (e.g., vertical scar or diabetes), amniocentesis was performed (42), except when not possible, advisable, or refused when patients either elected labor (20) or were scheduled if three or more criteria for 40+ weeks were met (18). Of 225 patients (70.5%) scheduled by protocol (173), amniocentesis (34), or medical indication (18), 188 (58.9%) were delivered without labor. In the 147 patients (46.1%) delivered electively by protocol without labor or amniocentesis, there were no cases of respiratory distress syndrome and the mean birth weight was 3517 gm. With early care and better patient compliance nearly all repeat cesarean sections can be safely delivered electively with the use of this protocol.