Physician productivity in ambulatory care: for-profit and military primary care health clinics.

In summary, by being aware of the characteristics of their physicians and patients, ambulatory care managers might be able to influence their physician productivity. Specifically, managers may wish to hire physicians who are board certified or foreign medical school graduates. Similarly, managers may seek to attract patients with acute, nonsevere, nonurgent conditions. Managers seeking to enhance physician productivity should consider these characteristics regardless of the reimbursement or proprietary nature of their ambulatory care organizations.

Competency in health care management: a training model in epidemiologic methods for assessing and improving the quality of clinical practice through evidence-based decision making.

This article describes a training model that focuses on health care management by applying epidemiologic methods to assess and improve the quality of clinical practice. The model's uniqueness is its focus on integrating clinical evidence-based decision making with fundamental principles of resource management to achieve attainable, cost-effective, high-quality health outcomes. The target students are current and prospective clinical and administrative executives who must optimize decision making at the clinical and managerial levels of health care organizations.

A comparison of patient populations between two types of military primary care health clinics.

A cross-sectional survey was conducted of 993 patients treated at either a Primary Care for the Uniformed Services health clinic or a nearby free-standing primary care health clinic operated directly by the Army Medical Department. The study found the clinics significantly different in terms of the patients' age, race and the sponsors' ranks. The clinics were not significantly different in terms of the patients' sex, medical diagnosis, and visit status. This study recommends that the location, capabilities, staffing, and operations of primary health care clinics be contingent on the characteristics of the patient population. Also, additional research should be conducted to identify other significant patient characteristics.

Reengineering medical treatment facilities for TRICARE: the Medical Group Practice Model.

The purpose of this article is to propose a model for reengineering military community hospitals, as well as medical centers, to adapt to the extraordinarily rapid and complex changes that are being made to the Military Health Services System. This article analyzes the changes taking place and discusses how a particular organizational model, the Medical Group Practice Model, can enhance quality and patient satisfaction in a capitated managed care environment. The phased implementation, structure, and performance management of the model are described, as is the model's advantages and disadvantages.

FORECAST 2000: a prediction of skills, knowledge, and abilities required by senior medical treatment facility leaders into the 21st century.

This paper reports results from a Delphi study conducted among the Commanders and Deputy Commanders for Administration of 37 Army medical treatment facilities (MTFs), who identified the most important issues challenging their institutions for the remainder of this decade, and the skills, knowledge, and abilities required by MTF leaders to deal successfully with those challenges. A Delphi mail-out was conducted in two iterations. Respondents identified 187 health care issues which were divided by content into nine domains by a panel of health care experts. The domains, ranked by importance, were cost-finance, health care delivery, access to care, quality and risk management, technology, professional staff relations, leadership, marketing, and ethics. In the second Delphi iteration, MTF leaders agreed upon the necessary skills, knowledge, and abilities of future leaders. Results indicated that future leadership will require enhanced financial, quantitative, and technical skills, as well as competence in a broad array of interpersonal and communication skills. Implications for military medical leader development initiatives are discussed.

A case study of a coordinated care program: development and implementation of Fort Sill's Catchment Area Management Project.

One of the Department of Defense's initiatives to contain costs of the Civilian Health and Medical Program of the Uniformed Services is the Catchment Area Management (CAM) Demonstration Project. CAM's fundamental coordinated care concept is to contain the military's health care costs by granting the military treatment facility (MTF) commander full clinical and fiscal responsibility for the health care of all beneficiaries within the MTF's catchment area. This article describes the CAM Demonstration Project at Fort Sill during its developmental and implementation phase from June 1989 to April 1991. The six operational goals of the CAM Project are identified and discussed. Additionally, nine essential lessons learned are briefly reviewed.

Variables affecting Army physical disability processing.

This research identifies variables affecting the length of time to process a soldier through the U.S. Army Physical Disability Evaluation System (PDES). The subjects are 8,301 soldiers whose disability records were processed in fiscal year 1996. The dependent variable examined was the average number of days a soldier remains in the disability processing system. Independent variables included age, component, compensation award, Congressional involvement, gender, grade, retirement eligibility, race, length of service, formal Physical Evaluation Board (PEB), and regional PEB. Statistical analysis using linear regression and SPSS yielded an average length of stay (ALOS) of 155 days and a range of 1 to 2,052 days. The research shows that the most significant variables affecting ALOS are Congressional involvement, component, compensation, formal PEB, and regional PEB. The authors recommend a program of disability case management and increasing emphasis on transition assistance programs to reduce ALOS in the PDES.

Trends in managed care organizations: implications for the physician executive.

The rapid change in the managed health care industry is placing substantial demands on the managerial and leadership skills of physician executives. These changes are forcing a reevaluation of the fundamental principles of managed care organizations, specifically in terms of patient satisfaction, cost containment, and quality health care. Additionally, the physician executive will be confronted with substantial issues concerning future staffing needs. This article assesses the health care industry's environment to suggest where managed care is going and how physician executives should position themselves to optimize their position in the marketplace.

Management competencies required in ambulatory care settings.

A study was conducted to identify the most important competencies physician executives in medical groups and other ambulatory settings will need to have in the next five years. The specific job skills, knowledge, and abilities (SKA) that physician executives will need to acquire these competencies were also explored. The Delphi techniques were used to analyze responses from two surveys from members of the American College of Medical Practice Executives. The most important competencies were grouped into 13 management domains, each with specific SKAs. "Managing health care resources to create quality and value" and "fundamentals of business and finance" were rated as the most important competencies. The most frequently rated SKA was the "ability to build and maintain credibility and trust."

Identifying management competencies for health care executives: review of a series of Delphi studies.

This analysis reviews a selected body of research that identifies the essential areas of management expertise required of future health care executives. To ensure consistency, six studies are analyzed, utilizing the Delphi technique, to query a broad spectrum of experts in different fields and sites of health care management. The analysis identifies a number of management competencies, i.e., managerial capabilities, which current and aspiring health care executives, in various settings and with differing educational backgrounds, should possess to enhance the probability of their success in current and future positions of responsibility. In addition, this review identifies the skills (technical expertise), knowledge (facts and principles) and abilities (physical, mental or legal power) required to support achievement of these competencies. Leadership and resource management, including cost and finance dimensions, are the highest-rated requisite management competencies. The dominant skills, knowledge and abilities (SKAs) are related to interpersonal skills. The lowest-rated SKAs are related to job-specific, technical skills. Recommendations include the review of this research by formal and continuing education programs to determine the content of their courses and areas for future research. Similarly, current health care executives should assess this research to assist in identifying competency gaps. Lastly, this analysis recommends that the Delphi technique, as a valid and replicable methodology, be applied toward the study of non-executive health care managers, e.g., students, clinicians, mid-level managers and integrated systems administrators, to determine their requisite management competencies and SKAs.

Management competencies for medical practice executives: skills, knowledge and abilities required for the future.

The purpose of this study was to obtain a consensus of opinion from a large and diverse population of experienced ambulatory health care administrators regarding the essential ambulatory health care management competencies, and their related skills, knowledge and abilities (SKA) requirements, that will be required for successful management performance in ambulatory health care delivery settings in the next five years. A literature review suggests limited research in this essential and rapidly developing area for the health care community. The research design and methods employed the Delphi technique. Three hundred and twenty (320) Fellows of the American College of Medical Practice Executives (ACMPE) were asked to respond to two rounds of a Delphi mail survey. The results indicate that the essential ambulatory management competencies could be discretely grouped into six Management Domains, each with related SKAs. The respondents rated leadership and strategic management as the most important Management Domains. The highest rated SKA emphasized interpersonal skills with the next highest SKA relating to ethical and moral dimensions. Patient care management, as well as two SKAs relating to computer skills, were rated lowest.

Product-line evaluation of graduate medical education program costs.

This article reports the results of an innovative application of traditional multivariate approaches to estimating hospital costs in order to support product-line evaluation of graduate medical education (GME) program costs among the clinical departments and teaching facilities of a nationwide, federal multi-institutional system. Department-level data for 1988, 1989, and 1990 were used to estimate a multiple regression model of total costs per disposition for the specialties of medicine, surgery, obstetrics/gynecology, orthopedics, psychiatry, and pediatrics. Systemwide and facility-specific GME program costs per disposition were estimated for each specialty on the basis of dependent variable scores predicted by the regression model. Measures of case-mix intensity, facility bed size, department staff size, clinical specialty, GME status, teaching intensity, operating efficiency, and regional variation each made statistically significant contributions to the explained variance in total costs per disposition, and yielded an adjusted R2 of .701. Estimates of total costs and GME costs per disposition revealed substantial variation among clinical specialties, both systemwide and within specific facilities. The results of these techniques, their usefulness for enhancing executive ability to evaluate costs of GME programs as product lines, and their implications for public policy regarding hospital payments are discussed.

Health care administration in the year 2000: practitioners' views of future issues and job requirements.

This research identifies the most important domains in health care administration (HCA) from now to the year 2000 and differentiates job skill, knowledge, and ability requirements necessary for successful management. Fellows of the American College of Healthcare Executives from about half of the United States responded to two iterations of a Delphi mail inquiry. Fellows identified 102 issues that were content-analyzed into nine domains by an HCA expert panel. Domains, in order of ranked importance, were cost/finance, leadership, professional staff interactions, health care delivery concepts, accessibility, ethics, quality/risk management, technology, and marketing. In the second Delphi iteration, Fellows reviewed domain results and rated job requirements on required job importance. Results indicated that while a business orientation is needed for organizational survival, an equal emphasis on person-oriented skills, knowledge, and abilities is required.