Soft landings: dissolving a physician network.

Many healthcare organizations established physician networks to strengthen their competitive position in the marketplace. Many of these networks, however, have been unprofitable. As a result, some healthcare organizations are dissolving their networks. Healthcare organizations should plan the dissolution carefully and help the physicians establish an infrastructure for their new practices. By easing the physicians' transition to independent practice, healthcare organizations ensure the likelihood of a continued business relationship with the physicians in the future.

New compensation model improves physician productivity.

In the mid-1990s, Meridia Health System, a hospital system in the Cleveland, Ohio, area began acquiring primary care physician practices to form the core of an integrated delivery system to compete with other providers in the area. Unfortunately, the structure of the physician compensation plan for Meridia's new physician employees caused productivity to decline and losses to mount. Meridia appointed a task force that included physicians to develop a new compensation plan that bases pay on the application of a collection rate percentage to each physician's gross fee-for-service billings. While not perfect, the new compensation plan is helping both Meridia and its physicians achieve their mutual goals of high-quality care, reasonable productivity, and operating efficiency.

Physician network audits can improve financial performance.

A physician network audit is one way to evaluate the strengths and weaknesses of a network's performance in five key areas: practice operations, financial management, strategy and vision, managed care readiness, and organizational governance. An objective, comprehensive audit can help identify real versus perceived problems that are troubling a network. Then steps can be taken to align incentives and improve operating results.

Impact of tax sanctions on physician practice acquisitions and employment.

The intermediate tax sanctions create significant concerns for tax-exempt healthcare organizations that seek to integrate practicing physicians through practice acquisition or employment. The sanctions will force not-for-profit healthcare organizations to examine both the strategic and business implications of the dollars they have committed to practice acquisition and physician employment. The sanctions also should motivate organizations to reexamine their existing physician compensation arrangements, which may be creating negative incentives for practice productivity.

Egg fluids and cells of the chorioallantoic membrane of embryonated chicken eggs can select different variants of influenza A (H3N2) viruses.

Growth of influenza viruses in embryonated eggs frequently results in the selection of virus variants with amino acid changes near the receptor-binding pocket of the hemagglutinin molecule, yet the mechanism by which this third form of influenza variation occurs (the other two being antigenic drift and shift) has not been clearly defined. Because egg-mediated variation might affect influenza vaccine and surveillance programs, we have initiated studies to determine the site(s) of variant virus selection within the embryonated egg. In this report we show that both the cells of the chorioallantoic membrane (CAM) and the fluids from embryonated chicken eggs are capable of selecting variant influenza viruses, but that these variants are distinct at the molecular level depending on the conditions of virus propagation. Serial passage of viruses in cells of the chorioallantoic membrane selects one set of variants which possess specific amino acid changes near the receptor binding pocket of the hemagglutinin molecule characteristic of viruses grown in embryonated eggs. However, passage of the same viruses in mammalian tissue culture cells supplemented with egg fluids selects a separate set of hemagglutinin variants also characteristic of viruses grown in eggs, yet at different residues from those observed following passage in CAM. These results suggest that two separate mechanisms may exist in the embryonated egg that lead to the selection of variant influenza viruses: one at the cellular level and another at the extracellular level.

Evaluation of viral-lysate enzyme-linked immunosorbent assay kits for detecting human immunodeficiency virus (type 1) infections using human sera standardized by quantitative western blotting.

The first generation of proprietary reagents for detecting antibodies to the Human Immunodeficiency Virus Type 1 (HIV-1) by enzyme-linked immunosorbent assay (ELISA) used as antigen partially purified virus from cell culture lysates. These tests, which are still in use, may vary in their antibody measurement capabilities if different proportions of the viral polypeptides are present in the viral lysate mixtures. We determined the quantities of antibodies in the serum of persons infected with HIV-1 by dilution analysis using 3 ELISA kits: Abbott [A], Du Pont [D], Genetic Systems [G]. The proportionate antibody titres of each serum to p24gag and gp160env/120env were established by quantitative Western blotting. Serum antibody titres were high, frequently over 1:10,000, a result observed both by ELISA and Western blot. For Kit D, sera with high proportions of antibody to p24gag produced antibody titration curves with steep slopes whereas shallower slopes were found in sera with high proportions of antibody to gp160env. In contrast, Kit A gave steeper slopes with sera enriched for gp160env antibodies. Kit G gave results with slopes intermediate between Kits A and D. Serum antibody titres differed between kits depending upon the proportion and concentration of antibodies in a given serum to gp160env and p24gag. The findings that both the concentration and proportion of antibodies to specific viral polypeptides in human sera markedly affect the signal intensity produced by proprietary ELISAs suggest the need for several control sera which reflect the diversity of human serum responses. Standardization of human reference sera by quantitative Western blotting will assist in evaluation and quality control of ELISA tests.

Quantitation of antibody reactivity to human immunodeficiency virus (type 1) proteins and glycoproteins on Western immunoblots by reflectance densitometry.

The human serum antibody response to polypeptides of human immunodeficiency virus type 1 (HIV-1) was quantitated by reflectance densitometry of Western immunoblots by using two commercially available blotting systems. In one system, human antibodies were detected by an avidin-biotin method using peroxidase as the label, and in the other, human antibodies were detected by peroxidase-labeled conjugate against human immunoglobulins. When staining intensity was plotted against the log of the serum dilution, a shallow slope was evident, with a 50% change in staining intensity requiring as much as a 100-fold change in antibody content. The linear range of the staining intensity curves was frequently found in serum dilutions of 1:2,500 to 1:1,000,000, and a plateau was often observed at high antibody concentrations (1:80 to 1:640). When replicate strips were tested, staining intensities varied by +/- 7 to 37%. Antibodies to p24gag and gp160env were readily detectable in several sera diluted 1:1,000,000, a result seen with both blotting systems. If Western blotting were to be used to observe increase or decreases in levels of antibodies to various polypeptides, several widely spaced serum dilutions would need to be tested.

Who took the group out of group practice?

Thirty-five years ago bonding between physicians in a group practice was strong. Spouses played an important role. New members were enthusiastically welcomed. But group practice medicine is no longer one-for-all and all-for-one.

Paint an honest picture during recruitment.

While physicians leave a medical group for a variety of reasons, a key to preventing physician dissatisfaction is honest communication during the interview process. Physicians who enter groups with a full awareness of compensation, benefits, and the physician situation are less likely to have regrets, challenge administration, or leave the group. Administrators play an important role in the recruitment process as they are most able to present a realistic picture of the practice, and its strengths and weaknesses.

Survival through dependency: a confession.

Clyde Hardy's contributions to the field of medical group management have been many. He earnestly served the Bowman Gray School of Medicine for 43 years until his retirement in 1984. Mr. Hardy also made many contributions to the Medical Group Management Association--as president of both MGMA and ACMGA. Members will remember his excellent, down-to-earth presentations. During the MGMA annual conference in Hawaii in 1984, attendees were honored, entertained, and inspired by the wit and wisdom of this friend as he looked back on his experiences as a medical group manager. The words he spoke will long ring in the memory of those fortunate enough to be witness. The first in a trilogy of MGM articles focusing on the manager's look back, this article is taken from the text of Mr. Hardy's October 1984 presentation.

Healthcare delivery in the Federal Republic of Germany.

By broadening your knowledge of healthcare delivery systems, you can grow as a healthcare administrator and play a larger leadership role in healthcare planning for the future at the local, state, and even national levels. Overseas conferences sponsored by the American College of Medical Group Administrators (ACMGA) provide a unique opportunity for detailed exposure to the healthcare delivery systems of other countries. An abstract of papers presented at the ACMGA 1981 conference in Munich has been prepared by the author, sketching an outline of the history, organization, problems, and future trends of medical care in the Federal Republic of Germany.

Hospital meets patient demand for 'home-style' childbirth.

A university-affiliated hospital faced increasing patient demand to minimize or eliminate traditional medical and institutional involvement in labor and delivery. To develop appropriate responses to this demand, the hospital established a committee that included professional practitioners and consumers. Responses developed by the committee included a "home-style" labor and delivery room, more liberal visitation policies, and revised medical procedures. Through a series of compromises, the committee was able to meet patient demands while maintaining the benefits of medical and institutional care.