Are Independent Physician Organizations beneficial to the "healthcare crisis"? Independent Physician Organizations: They are a group of private physicians joining together in an association to contract with a managed care organization. (“Healthcare….risk”). Although they were initially formed for physicians to group up together to talk with health insurers, but the most successful ones developed the capability to take the financial risk for the cost of their patients care and to be rewarded in return. Through 1990s many of them failed as they were unable to handle the risk, and rest vanished as risk bearing ability became less common (“Independent…”2017) The Guiding Principles for Independent Physician Organizations • They should be able to bring up a health care delivery system …show more content…
Optimally functioning Independent Physician Organizations offer benefits like the following: Financial incentives of physicians are properly aligned The practice administration and management are efficient Political influence in the medical and provider community Support from the peers Facilities are Optimized The ability to negotiate satisfactory agreements with other entities such as radiology, laboratory, and hospital systems is enhanced. The local financial and care management control in managed care are autonomous. The services like expanded hours, urgent care, and outreach services for prevention, telephone triage, and follow-up expertise are improved. The risks of Independent Physician Organizations include the following: The risk of significant losses / bankruptcy is higher along with the Underfunded capitation revenue. A decrease in the payments made by the payer. The physician would have conflicts of interest between financial gain and optimal care for the patient. Collective bargaining by the physicians from Federal Trade Commission and Department of Justice are
113-117. Retrieved April 21st, 2011 from website: http://secure.cihi.ca/cihiweb/products/physicians_payment_aib_2010_f.pdf. D. Squires, The Commonwealth Fund, and others, International Profiles of Health Care Systems, The Commonwealth Fund, June 2010. Retrieved April 20th, 2011 from website: http://www.commonwealthfund.org//media/Files/Publications/Fund%20Report/2010/Jun/1417_Squires_Intl_Profiles_622.pdf. Johns, M. L. & Co. (2010). The 'Standard' of the 'Standard'.
The health care organization with which I am familiar and involved is Kaiser Permanente where I work as an Emergency Room Registered Nurse and later promoted to management. Kaiser Permanente was founded in 1945, is the nation’s largest not-for-profit health plan, serving 9.1 million members, with headquarters in Oakland, California. At Kaiser Permanente, physicians are responsible for medical decisions, continuously developing and refining medical practices to ensure that care is delivered in the most effective manner possible. Kaiser Permanente combines a nonprofit insurance plan with its own hospitals and clinics, is the kind of holistic health system that President Obama’s health care law encourages. It still operates in a half-dozen states from Maryland to Hawaii and is looking to expand...
"In the past two decades or so, health care has been commercialized as never before, and professionalism in medicine seems to be giving way to entrepreneurialism," commented Arnold S. Relman, professor of medicine and social medicine at Harvard Medical School (Wekesser 66). This statement may have a great deal of bearing on reality. The tangled knot of insurers, physicians, drug companies, and hospitals that we call our health system are not as unselfish and focused on the patients' needs as people would like to think. Pharmaceutical companies are particularly ruthless, many of them spending millions of dollars per year to convince doctors to prescribe their drugs and to convince consumers that their specific brand of drug is needed in order to cure their ailments. For instance, they may present symptoms that are perfectly harmless, and lead potential citizens to believe that, because of these symptoms, they are "sick" and in need of medication. In some instances, the pharmaceutical industry in the United States misleads both the public and medical professionals by participating in acts of both deceptive marketing practices and bribery, and therefore does not act within the best interests of the consumers.
It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed One being the Health Maintenance Organizations (HMO), which was first proposed in the 1960s by Dr. Paul Elwood in the "Health Maintenance Strategy”. The HMO concept was created to decrease increasing health care costs and was set in law as the Health Maintenance Organization Act of 1973, after promotion from the Nixon Administration. HMO would, in exchange for a fee, allow members access to employed physicians and facilities. In return, the HMO received market access and could earn federal development funds.
In the United States, healthcare fraud and abuse are significant factor associated with increasing health care costs. It is estimated that federal government spends billions of dollars on the health care cost (Edwards & DeHaven, 2009). Despite the seriousness of fraud and abuse offenses, increasing numbers of healthcare providers are seeking new and more profitable ways to build business relationships. These relationships include hospital mergers, hospital-physician joint ventures, and different types of hospital-affiliated physician networks to cover the rising cost of health care (Showalter, 2007, p 111-114). When these types of arrangements are made, legal issues surrounding the relationship often raise. There are five important Federal fraud and abuse laws that apply to the relationship and to physicians are the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the Physician Self-Referral Law (Stark law), the Exclusion Authorities, and the Civil Monetary Penalties Law (CMPL) and (Office of Inspector General (OIG), 2010). Out of five most important laws that apply to the relationship and the physicians, we are going to focus on the Anti-Kickback Statute (AKS) and the Physician Self-Referral Law (Stark law).
Providers must act in the best interest of the patient and their basic obligation is to do no harm and work for the public’s wellbeing. A physician shall always keep in mind the obligation of preserving human life. Providers must communicate full, accurate and unbiased information so patients can make informed decisions about their health care. As a result of their recommendations, providers are responsible for generating costs in health care but do not generate the need for those expenses. Every hospital has both an ethical as well as a legal responsibility to provide care, even if the care may be uncompensated.
Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.
doctors that are available to cover for each other. However, there are some negative aspects to
increases in patient satisfaction, which in a hospital setting is important not only for our
WellStar Health Systems is currently the preeminent and largest health care provider in Metro Atlanta. WellStar Health Systems is a not-for-profit institution that is composed of 5 hospitals and an abundance of physician groups. Physician specialty groups included within WellStar are: ENT, Psychiatry, Endocrinology, Pulmonary Medicine, Infectious Disease, General Surgery, Rehabilitation, Pathology, and Rheumatology. WellStar’s organizational design is composed of internal and external factors that define the organization’s size, organizational structure, and processes. Internal and external factors are the basis for influencing managerial conclusions in decision-making. These factors vary from organization to organization and are the rationale for understanding WellStar’s strengths, weaknesses, opportunities, and threats. Understanding these variables is a necessity for the sake of WellStar’s survival
One article points out that in order to compensate for higher premiums, physicians have to increase their fees. And not only that, but health insurance premiums for everyday citizens are on the rise as well (“Medical Malpractice”). The combination of more expensive fees and premiums and a decreasing availability of physicians has made healthcare more difficult to attain in today’s society. Rather than cultivating the health care system, medical malpractice litigation has managed to impede it.
Arguably, all three situations met by the end of the 20th century. The rise of managed care, the increase of health care costs, and the growing number of uninsured patients place economic and political pressures on individuals (and governments) to find a cost-containment resolution. Additionally, since the late 1970s, the medical profession has faced the dominating principle of patient independence as a challenge – first to medical paternalism and then extending even to the principle of beneficence. More so, the usage of the Internet and other global media has expanded the ability of patients to access an...
This will help to allocate funds needed in other programs. It also contributes to achieve and improve patient centered health
retrospect to its governing authority (Shi & Singh, 2012). However, private and public agencies are the controlling constituent in today’s business. Free markets allow patients to choose providers without the prior approval of insurance companies. The current system offers a proposed plan of limited physicians in exchange for payment of services. Because the potential has been given to the payers, they regulate the cost of services rendered through contractual
With the explosive growth in the 1990s of managed care that were sold by health insurance companies, physicians were suddenly renamed “providers.” That began the deprofessionalization of medicine, and within a short time patient became “consumers” (The New York Times). The shifts in American medicine are clearly leading to physicians' losing power, which results in deprofessionalization. The subsequent deprofessionalization of physicians should not surprise Americans. Although many people spend time and effort evaluating the present state of medicine, they fail to integrate an important piece of information: physicians and sociologists predicted all of today's events more than ten years ago (Hensel, 1988).