Professional integration and the type selected for many healthcare organizations will determine their success when they begin implementation of the Patient Protection and Affordable Care Act (PPACA). Cuellara & Gertlerb (2006) list the five most common arrangements in use: Independent Physicians Associations (IPAs), Open Physician–Hospital Organizations (OPHOs), Closed Physician–Hospital Organizations (CPHOs), Management Service Organizations (MSOs), and Fully Integrated Organizations (FIOs). Each of these five types of professional integration has proven successful however there have been many failures, which ultimately led to a degraded access and quality of health care in those communities.
Major Points of Two Selected Types of Physician-Hospital Arrangements
The two types of physician-hospital partnerships that I have selected are the IPA and FIO. IPAs and FIOs are arrangements at the opposite end of the professional integration spectrum. The major points for each type are described below.
Independent Physicians Associations (IPAs)
IPAs are a group of physicians who own a practice and are not employed by another healthcare organization such as a hospital or health maintenance organization (HMO). IPA physicians form a legal corporation, partnership, or foundation and contract as a group to provide their services. Some IPAs contract with HMOs while also seeing non-HMO patients. The IPA shares economic risk but not overhead costs.
Fully Integrated Organizations (FIOs)
Under the FIOs structure the healthcare enterprise purchases a physicians practice to include the physician’s services. Physicians become salaried employees and in some organizations they share governance with healthcare management. However, FIO...
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Cuellara, A. E. & Gertlerb, P.J. (2006). Strategic integration of hospitals and physicians. Journal of Health Economics, 25(1), 1-28. Retrieved February 21, 2011, from http://members.cox.net/mshachar/Cuellar_2006_via_TUI.htm.
Fraschetti, R. L. & Sugarman, M. (2009). Successful Hospital-Physician Integration: Shared governance and decision-making help a California integrated health care network thrive. Pivot Health website. Retrieved February 21, 2011, from http://www.pivothealth.com/userfiles/pdf/090701%20Bob%20Fraschetti%20Michael%20Sugarman%20Successful%20Hosiptal-Physician%20Integration%20Trustee.pdf.
St. Jude Heritage Medical Group Home Page. (2011). St. Jude Heritage Medical Group Awarded Top Honors. St. Jude Heritage Medical Group website. Retrieved February 23, 2011, from http://www.sjhmg.com/.
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...
Integrated services help arrange services that are easy for users to scroll through. It provides financial and medicine management to work together on a goal and make the most of resources provided in the hospital (World Health Organization, 2008). For instance in the case study the hospital had a health food store, a physiotherapy clinic, an alternative medicine clinic, a pharmacy, and a home health care store under one management, making it a lot more easier for patients to access. Overall integrated services in health care can escalate the quality of care, enhance access to services and lower overall health care expenditures. Due to the fact that is more economically efficient to share human resources than have health care systems be dedicated to one particular disease, and it makes more sense to deal with all of the problems the patient is facing rather than focussing separately on just one health problem (World Health Organization,
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. An HMO is a integrated delivery system that combines both the delivery and financial aspects of health care for consumers. Under the HMO, each patient is appointed to a primary care physician (PCP), who is essentially accountable for the long-term care of the members that she/he has been assigned and any specialists that a patient needs to see should be referred by their PCP. Some examples of HMOs are Kaiser Permanente and Humana. HMOs are licensed at the state level, under a license that is known as a certificate of authority. A pro of an HMO is that treatment for a patient can begin prior to their insurance being authorized; A member may benefit from this because there would be little to no treatment delays. A con of an HMO is that in order to save cost, most HMOs provide narrow provider networks; A member may not benefit if in an emergency because their “in-network” emergency room might be far or there are “quick-care” in their
In 2010, the passage of the Patient Protection and Affordable Care Act (PPACA) initiated reforms between healthcare and healthcare providers. For example, Huntsville Hospital Health System developed as smaller healthcare providers sought refuge under Huntsville Hospital’s larger umbrella. Nine separate campuses, among the North Alabama area, constitute the Huntsville Hospital Health System
Shay, P. D., & Mick, S. S. (2013). Post-Acute Care and Vertical Integration After the Patient Protection and Affordable Care Act. Journal Of Healthcare Management, 58(1), 15-27.
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.
Competitive advantage matters greatly to those responsible for the management of healthcare institutions. Together with rapidly escalating healthcare costs, increasingly complex medical technologies, and growing regulatory and legal pressures, healthcare organizations face a critical need to improve the quality of care at reduced costs (Cu...
One professional organization is the “Professional Association of Healthcare Coding Specialists” (PAHCS). This organization is a communication network and member support system that enhances compliance, documentations, and reimbursements of healthcare coders. PAHCS confidently code for the maximum and honest reniburstments. Another organization is the “Healthcare Billing & management Association” (HBMA). This association is one of the most valuable resources; from answering general questions regarding coding, to more specific relating to billing fields. The members who work for this association uses their expertise to assist with invaluable experiences and can help others keep in touch with professionals as well. They keep connections who know
members’ ability to share the burden of being “on call” to cover patients during non business
Accountable Care Organizations (ACOs) are one example of how providers can participate in the APM track and are becoming more common. In fact, here is Lucas County there are two prevalent ACOs; ProMedica Health Network, Inc., of which the University of Toledo Physicians, LLC is a participant, and the Northwest Ohio Accountable Care Organization. An ACO can be described as a group of healthcare professionals
Professional collaboration is an important aspect regarding patient safety in the medical field. This is a time when different kinds off professionals collaborate with one another about a patient’s health status and condition. “Specifically, Interprofessionality is a process by which professionals reflect on and develop ways of practicing that provides an integrated and cohesive answer to the needs of the client/family/population…(involving) continuous interaction and knowledge sharing between professionals” (Black, 2014). The collaboration of different professionals allow for a better decision to be made towards the patient’s health outcomes.
In order to be a successful business of any kind, those that run it must know where it is going, in order to get there; strategic planning is the way to make that happen. Opening doors in 1970, without a plan for the future only makes a plan more necessary today. Health care is an ever changing, ever growing “business” that if one does not have a plan; one will drown in the future. To be successful one needs to know the purpose and rules of the “game”, the strengths and weaknesses of the “crew”, and be well-conditioned and prepared for what is to come (Bryson, 1988). If the hospital is able to plan, unite, and conquer; the future will be successful. Strategic thought and action are important to the viability and the effectiveness of any agency. Without starting a strategic ...
The Integrated health care is an approach of interdisciplinary of collaboration and communication among health professionals. The characteristic is unique because of the sharing information which in the team members and related to patient care to establishment of treatment whether biological, psychological, and social needs. The interdisciplinary health care team includes a diverse and variety group of members (e.g., specialist, nurses, psychologists, social workers, and physical therapists), depending on the needs of the patient for the best treatment to the patient care.
This paper’s brief intent is to identify the policies and procedures currently being developed at Midwest Hospital. It identifies how the company’s Management Committee was formed and how they problem solved and delegated responsibilities. This paper recognizes the hospital’s greatest attributes and their weakest link. Midwest Hospital hired Dr. Herb Davis to help facilitate the development and implementation of resolutions for each issue.
Physicians, administrators, staff, and patients who are affiliated within the healthcare organization should understand the importance of interoperability by coming together to ease situations, in efforts to create a better community. Most communities have more than one healthcare organization available for service.... ... middle of paper ... ...