Description

Journal of Ambulatory Care Management is a peer-reviewed journal that provides timely, applied information on the most important developments and issues in ambulatory care management. The Journal of Ambulatory Care Management (JACM) gives you all the facts and information you need to keep up with this rapidly growing area. Major developments that are reshaping ambulatory care today are examined, evaluated, and explained quarterly in JACM. Each issue examines one topic of interest in depth. Recent issues have focused on information systems, marketing in ambulatory care, legal issues, physician productivity, joint ventures, AIDS, and other important topics of concern. JACM provides a forum for new ideas and timely topics not available in any other publication.

Publications in this journal

• The development of a successful physician compensation plan.

  Authors: Steven M Berkowitz

  The Journal of ambulatory care management. 25(4):10-25.

  Physician compensation plans are critical to the success of a physician group or may lead to the demise of the group. Essential components of the development and implementation of a successfulPhysician compensation plans are critical to the success of a physician group or may lead to the demise of the group. Essential components of the development and implementation of a successful physician compensation plan include: strategic planning, physician understanding and buy-in, appropriate incentives, objective performance measurement, and a specific funding source or mechanism. There are two basic philosophies to consider for use: the market-based model and the net economic contribution model. Advantages and disadvantages of each are discussed. Methods of incorporating these multiple aspects into a single plan are described.

• Physician office productivity improvement through operations analysis and process redesign.

  Authors: Eugene L McCarthy

  The Journal of ambulatory care management. 25(4):37-52.

  The operation of any physician practice is a complicated process with many different functions and systems. Though frequently overlooked, operations improvements and efficiencies are possible if aThe operation of any physician practice is a complicated process with many different functions and systems. Though frequently overlooked, operations improvements and efficiencies are possible if a participative, process-oriented approach is used. An actual case study of a "hospital system-owned" primary care physician group practice is presented. The methods of analysis and specific actions for improvement in operational efficiency and quality are described in detail. Opportunities for cost reduction, increased revenues, and increased patient and physician satisfaction are identified.

• Back to the future for many hospital-physician relationships: where do we go from here?

  Authors: Ronald L Vance, Ronald B Goodspeed

  The Journal of ambulatory care management. 25(4):59-63.

  Many hospitals, health systems, and large physician group practices have experienced the rise and fall of "managed care," over the past decade or so. The impact has been large and has included theMany hospitals, health systems, and large physician group practices have experienced the rise and fall of "managed care," over the past decade or so. The impact has been large and has included the rapid growth and acquisition of physician practices, followed by huge financial losses, and subsequent re-organization, divestiture, and bankruptcies. Regardless, physicians, hospitals, and health systems still face the burden of a rising demand for patient care services. Hospital-physician relationships are still crucial to the health care system. Suggestions with regard to how to analyze your local market and move forward from here to rebuild hospital-physician relationships and care systems are presented and discussed.

• Physician leadership: an interview with David M. Barrett, MD. Interview by Ronald B. Goodspeed and Zach Gerbarg.

  Authors: David M Barrett

  The Journal of ambulatory care management. 25(4):7-9.

• Physician leaders of medical groups face increasing challenges.

  Authors: Zack Gerbarg

  The Journal of ambulatory care management. 25(4):1-6.

  Physician leadership has emerged as one of the biggest challenges and opportunities for medical group success. The environment for medical groups has become increasingly complex as the result of fivePhysician leadership has emerged as one of the biggest challenges and opportunities for medical group success. The environment for medical groups has become increasingly complex as the result of five major factors: 1) varying reimbursement methods, 2) growth in the size of groups, 3) technology investments, 4) sale and merger of groups, and 5) regulatory and legal issues. Striking the right balance between too little or too much physician involvement in leading medical groups is a key business decision. Most large, successful businesses view investment in their leaders as critical for success. Medical groups can learn from other businesses that investment in education, coaching, and succession planning for leaders is a key to long-term success.

• A comparison of the performance of hospital- and physician-owned medical group practices.

  Authors: Barry R Greene, John E Kralewski, David N Gans, Dawn I Klinkel

  The Journal of ambulatory care management. 25(4):26-36.

  This study compares the financial and productivity performance of hospital- versus physician-owned medical group practices. Nineteen hospital-owned and twenty-three physician-owned family practicesThis study compares the financial and productivity performance of hospital- versus physician-owned medical group practices. Nineteen hospital-owned and twenty-three physician-owned family practices were matched by location (state) and size (full-time equivalent providers). The data were obtained from the 1998 Medical Group Management Association (MGMA) Cost Survey database. The focus of this study is on the "bottom-line" performance of the organizations as well as the production costs of the different type of practices. Analyses of these data consider staffing differences, charge and revenue differentials, productivity factors, and differences in patient volume and procedure volume. When comparing the hospital-owned and physician-owned family practice groups, the statistical analysis of these data suggest that the underlying distinctions are driven by differences in the volume of patients and volume of procedures.

• A health care anomaly: a successful community hospital-affiliated group practice.

  Authors: Linda Shyavitz, Joseph Clark

  The Journal of ambulatory care management. 25(4):53-8.

  Many hospital-affiliated group practices have had significant problems. Failures are common. Sturdy Memorial Associates, a hospital affiliated group practice functioning out of twelve sites in theMany hospital-affiliated group practices have had significant problems. Failures are common. Sturdy Memorial Associates, a hospital affiliated group practice functioning out of twelve sites in the greater Attleboro area in Massachusetts, has been a success. Two senior managers discuss the history and the reasons why.

• Constructing powerful control charts.

  Authors: Raymond G Carey

  The Journal of ambulatory care management. 25(4):64-70.

  Control charts are intended to tell a story about whether or not a process is stable, improving, or deteriorating. Effective storytelling requires more than correctly following the rules for choosingControl charts are intended to tell a story about whether or not a process is stable, improving, or deteriorating. Effective storytelling requires more than correctly following the rules for choosing the best control chart and applying the tests for a special cause. The story will be told more effectively when control charts include all the information needed to convey the key messages and exclude information that distracts from the storyline. This article presents some graphical guidelines for making control charts tell their stories more forcefully.

• Medical neutrality: another casualty of the intifada.

  Authors: Nathaniel A Raymond

  The Journal of ambulatory care management. 25(4):71-3.

  The Physicians for Human Rights (PHR) reports findings of a March 2002 investigation in Israel and the Occupied Territories. Although there were many cases of medical professionals providing unbiasedThe Physicians for Human Rights (PHR) reports findings of a March 2002 investigation in Israel and the Occupied Territories. Although there were many cases of medical professionals providing unbiased care to patients and continual respect and collaboration with colleagues regardless of ethnicity, evidence shows that violations of medical neutrality are being committed by combatants on both sides.

• Outpatient encounter data for risk adjustment: strategic issues for Medicare and Medicaid.

  Authors: W Pete Welch

  The Journal of ambulatory care management. 25(3):1-15.

  Payers are increasingly using diagnostic data from outpatient encounter records to adjust the payment to health plans. Although much has been written about the ability of such data to predict healthPayers are increasingly using diagnostic data from outpatient encounter records to adjust the payment to health plans. Although much has been written about the ability of such data to predict health care costs, little has been written about the data itself--its quality and availability. Fee-for-service (FFS) data face several threats to their validity, including the possibility that they may seriously underreport diagnoses. Because the systems and incentives that yield FFS and managed care diagnosis data are quite different, they may not be comparable, depending on circumstances such as audit rules. The next generation of risk adjustment models should be designed around the capabilities and potentialities of plans' information systems.

• Outpatient encounter data for risk adjustment--a view from Europe: comments on Welch.

  Authors: Peter C Smith

  The Journal of ambulatory care management. 25(3):23-5.

  This article comments from a European perspective on W. Pete Welch's article, which examines the use of outpatient encounter data for risk adjustment. Although diverse, Western European health careThis article comments from a European perspective on W. Pete Welch's article, which examines the use of outpatient encounter data for risk adjustment. Although diverse, Western European health care systems all seek to provide a comprehensive package of care, financed by premiums unrelated to health status. Some form of risk adjustment is therefore required as a basis for funding insurers in all systems. Two objectives have dominated: to secure equity between patients covered by different insurers and to ensure that (where implemented) competitive insurer markets operate efficiently. The commentary concludes that, although risk adjustment research of this type is important, the most fundamental requirement is to develop a more active purchasing function on the part of insurers.

• Saving American health care.

  Authors: Brian R Klepper, Patrick G Hayes, J Brooks Brown

  The Journal of ambulatory care management. 25(3):34-40.

  Over the last two years, a new nonpartisan, not-for-profit group, the Center for Practical Health Reform, has formed to actively work for balanced meaningful change in American health care. The goalOver the last two years, a new nonpartisan, not-for-profit group, the Center for Practical Health Reform, has formed to actively work for balanced meaningful change in American health care. The goal is simple: restabilizing the system in ways that will let us sustain the primarily market-based approach we've had for the last 60 years. This article describes this effort.

• Outpatient prospective payment: uses and progress to date.

  Authors: Carole Cusack, Mitch DeKoven, Randi Dessingue, James Shurtleff

  The Journal of ambulatory care management. 25(3):56-62.

  This article provides an overview of the outpatient prospective payment environment, a summary of early adopters, insights into its analytical and quality measurement capabilities, and financialThis article provides an overview of the outpatient prospective payment environment, a summary of early adopters, insights into its analytical and quality measurement capabilities, and financial impact data and coding statistics that will aid providers in the negotiation process.

• Multispecialty physician practices: fixed and variable costs, and economies of scale.

  Authors: Thomas P Weil

  The Journal of ambulatory care management. 25(3):70-7.

  Medical Group Management Association survey data from 1955 to 1999 was to assess fixed compared to variable cost and the existence of economies of scale among single- and multispecialty groups.Medical Group Management Association survey data from 1955 to 1999 was to assess fixed compared to variable cost and the existence of economies of scale among single- and multispecialty groups. During these intervening 44 years, physician operating costs were estimated to increase roughly three times the consumer price index. Among the multispecialty groups in 1999 at least 85% of total medical revenues were considered fixed costs when including a physician's compensation and fringe benefits. On the basis of relative value units (RVUs), 10 practitioners provided the maximum economies of scale. However, for multispecialty groups, based on a physician's total compensation, optimal efficiency occurred between 26 and 50 doctors. Those multispecialty practices with 51 or more MDs are thought to be "less efficient" for several reasons: they deliver care on multisites, experience a higher percentage of managed care patients, and are less effective in controlling their peers' use of time and resources.

• Health professionals' call to action on HIV/AIDS.

  Authors: Barbara Ayotte

  The Journal of ambulatory care management. 25(3):84-6.

  Physicians for Human Rights, in coordination with Partners In Health, has launched a new campaign for health professionals, Health Action AIDS. Ambulatory care professionals have a particularlyPhysicians for Human Rights, in coordination with Partners In Health, has launched a new campaign for health professionals, Health Action AIDS. Ambulatory care professionals have a particularly important role to play in the treatment and prevention of HIV/AIDS. Please read the below Call to Action and sign it today.

• It's management not payment that we should focus on: comments on Welch.

  Authors: Norbert Goldfield, Richard Averill

  The Journal of ambulatory care management. 25(3):16-22.

  This comment discussed the ideas put forward by Peter Welch in his article on federal policy pertaining to managed care. Specifically, we assert that it is important to have as wide a data set asThis comment discussed the ideas put forward by Peter Welch in his article on federal policy pertaining to managed care. Specifically, we assert that it is important to have as wide a data set as possible if one is to maximize the benefits of capitation. These benefits largely revolve around creating a tool that primarily represents a language that can facilitate communication between the financial and clinical sides of managed care.

• An innovative model of health care delivery: the care management program of the University of Iowa.

  Authors: Barbara A Muller, Cynthia L Doyle, Elizabeth Hasselman, Pamela S Moore, Joyce L Powell, Jay J Cayner

  The Journal of ambulatory care management. 25(3):26-33.

  The Indigent Patient Care Program (legislatively enacted in 1915) provides comprehensive health care to indigent Iowans without health insurance. The University of Iowa Hospitals and Clinics, aThe Indigent Patient Care Program (legislatively enacted in 1915) provides comprehensive health care to indigent Iowans without health insurance. The University of Iowa Hospitals and Clinics, a leading academic medical center, was designated as the health care provider for these medically and socially complex patients. The Care Management Program of the University of Iowa (CMPUI) is an innovative care delivery model responsible for total health management of patients enrolled in the indigent program. The CMPUI is a solution to preserve the tripartite missions of an academic medical center while ensuring the preservation of the historic Indigent Patient Care Program in Iowa.

• Diagnostic colonoscopy: performance measurement study.

  Authors: Naomi Kuznets

  The Journal of ambulatory care management. 25(3):41-55.

  This is the fifth of a series of best practices studies undertaken by the Performance Measurement Initiative (PMI), the centerpiece of the Institute for Quality Improvement (IQI), a not-for-profitThis is the fifth of a series of best practices studies undertaken by the Performance Measurement Initiative (PMI), the centerpiece of the Institute for Quality Improvement (IQI), a not-for-profit quality improvement subsidiary of the Accreditation Association for Ambulatory Health Care (AAAHC) (Performance Measurement Initiative, 1999a, 1999b, 2000a, 2000b). The IQI was created to offer clinical performance measurement and improvement opportunities to ambulatory health care organizations and others interested in quality patient care. The purpose of the study was to provide opportunities to initiate clinical performance measurement on key processes and outcomes for this procedure and use this information for clinical quality improvement. This article provides performance measurement information on how organizations that have demonstrated and validated differences in clinical practice can have similar outcomes, but at a dramatically lower cost. The intent of the article is to provide organizations with alternatives in practice to provide a better value to their patients.

• Making better use of scarce resources: the Palestinian experience, 1995-1999.

  Authors: Maged Awni Abu-Ramadan

  The Journal of ambulatory care management. 25(3):63-9.

  Until August 2, 1997, The Eye Hospital-Gaza (EH) provided both primary and secondary eye services to almost 1 million inhabitants in Gaza. This exerted a tremendous load on the hospital's facilitiesUntil August 2, 1997, The Eye Hospital-Gaza (EH) provided both primary and secondary eye services to almost 1 million inhabitants in Gaza. This exerted a tremendous load on the hospital's facilities and prevented the hospital from performing its main role as a secondary eye care provider. The training and guidance of primary health care (PHC) providers are essential in order that they can do their share in eye care. A prevention of blindness awareness campaign, training, workshops, and practical instruction took place in Gaza over a three-year span. A new purpose designed referral system was started on August 2, 1997, that resulted in a great change and improvement of the services in the hospital. Primary eye care is an integral part of ophthalmic services. Proper continuous training of PHC providers is essential, not only for providing service to patients near their residence in the shortest time possible, but also to facilitate the smooth, effective, and efficient functioning of the hospital as a secondary and tertiary eye care provider. We believe the system and methodology used is efficient and reproducible in many developing countries.

• Improving patient satisfaction: a control chart case study.

  Authors: Raymond G Carey

  The Journal of ambulatory care management. 25(3):78-83.

  Health care providers both in inpatient and outpatient settings commonly use patient satisfaction surveys. However, when the surveys are administered and the results are interpreted without attentionHealth care providers both in inpatient and outpatient settings commonly use patient satisfaction surveys. However, when the surveys are administered and the results are interpreted without attention to sound scientific methodology, the findings may be useless and even misleading. As a result, money and resources are wasted. To use surveys to improve patient care, providers must first obtain high-quality data. This requires choosing an instrument that is valid and reliable, employing an appropriate and credible sampling method, and obtaining a representative response rate. Providers are then faced with the difficult challenge of interpreting and responding to the survey findings. This article addresses this latter task by presenting a case study that demonstrates how control charts can be used to interpret survey findings, develop improvement plans, and assess the effectiveness of these plans.

• The CAM movement and the integration of quality health care: the case of chiropractic.

  Authors: Monica Smith, Barry R Greene, William Meeker

  The Journal of ambulatory care management. 25(2):1-16.

  High and increasing consumer demand for complementary and alternative medicine (CAM) services necessitates a concerted focus to determine the effectiveness of such practices and to ensure that futureHigh and increasing consumer demand for complementary and alternative medicine (CAM) services necessitates a concerted focus to determine the effectiveness of such practices and to ensure that future possible integration of CAM with conventional medicine is founded on sound evidence-based principles of quality health care delivery. The example of chiropractic provides useful insights to guide further research and integration of evidence-based CAM into mainstream health care in the United States. A critical point of departure for this area of inquiry is identifying and addressing barriers to conducting scientifically sound and meaningful cross-disciplinary, practice-based research.

• CAHPS in practice: the Iowa demonstration.

  Authors: Peter C Damiano, Jean C. Willard, Margaret C Tyler, Elizabeth T Momany, Ron D Hays, David E Kanouse, Donna O Farley

  The Journal of ambulatory care management. 25(2):32-42.

  This article evaluates the usefulness of the Consumer Assessment of Health Plan Study (CAHPS) surveys and reports in a demonstration and evaluation with three health care purchasers in Iowa. TheThis article evaluates the usefulness of the Consumer Assessment of Health Plan Study (CAHPS) surveys and reports in a demonstration and evaluation with three health care purchasers in Iowa. The CAHPS survey detected significant differences between health plans in several domains of health care. Both paper- and Web-based consumer reports were developed and distributed to consumers and stakeholders. There was some agreement on the value of these reports, but areas for improvement were noted.

• Providers of primary care to homeless women in Los Angeles County.

  Authors: Jeff Luck, Ron Andersen, Suzanne Wenzel, Lisa Arangua, Dalia Wood, Lillian Gelberg

  The Journal of ambulatory care management. 25(2):53-67.

  Little is known about the access barriers homeless women face at the sites where they are most likely to receive primary health care. To investigate this issue, we administered a mail survey toLittle is known about the access barriers homeless women face at the sites where they are most likely to receive primary health care. To investigate this issue, we administered a mail survey to administrators and clinicians at clinic sites that were actual or potential providers of primary health care to homeless women in Los Angeles County in 1997. The response rate was 65%. Ninety percent of the homeless women seen by responding sites were seen at only 34% of those sites (designated as "major providers"). Deficiencies were identified in several structural and process characteristics that enhance access to and quality of care for homeless women, including clinician training in care for homeless persons; formal screening for homeless status and associated risk factors; and on-site provision of comprehensive health services, including mental health, substance abuse, reproductive health, and ancillary services. Some, but not all, deficiencies were less severe at major providers. Our results suggest that, although providers of care to homeless women share challenges faced by many safety net providers, there are several policy interventions that could improve access to and quality of care for homeless women.

• Women's health and human rights in Afghanistan: continuing challenges.

  Authors: Barbara Ayotte

  The Journal of ambulatory care management. 25(2):75-7.

  Physicians for Human Rights has released a ground-breaking survey of more than 1,000 Afghan women and men on their attitudes and experiences regarding health and human rights for Afghan women. HealthPhysicians for Human Rights has released a ground-breaking survey of more than 1,000 Afghan women and men on their attitudes and experiences regarding health and human rights for Afghan women. Health care for women in Afghanistan still poses daunting challenges.

• Organizational and provider characteristics fostering smoking cessation practice guideline adherence: an empirical look.

  Authors: Thomas E Vaughn, Marcia M Ward, Bradley N Doebbeling, Tanya Uden-Holman, William T Clarke, Robert F Woolson

  The Journal of ambulatory care management. 25(2):17-31.

  We examined the relationship between physician adherence with a smoking cessation guideline and organizational structures, policies, leadership support, and physician knowledge and attitudes. AWe examined the relationship between physician adherence with a smoking cessation guideline and organizational structures, policies, leadership support, and physician knowledge and attitudes. A random sample of 844 physicians practicing in 127 VHA hospitals was surveyed. Survey results were aggregated to the hospital level and linked with data on organizational characteristics from the 1998 annual survey of hospitals by the American Hospital Association. Significant predictors of adherence included organizational policies related to nicotine replacement prescriptions, the timing and effectiveness of guideline implementation, physicians' knowledge of VHA clinical guidelines generally, and physicians' beliefs about the receptiveness of patients to smoking cessation.

Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.