Expenditures on physician services amounted to $171 billion in 1993, compared with $13.6 billion in 1970. During this period, the environment in which physicians practice was transformed as a part of the changing health care financing and delivery system. This Issue Brief provides an overview of changes in the health care system that affect the environment in which physicians practice, focusing on what is known and issues needing further analysis.Public and private payers have held down the rate of growth in payments to physicians by restructuring reimbursement. Physician behavior, payment, and practice patterns will be major factors in determining future health care costs and the type and quality of health care individuals receive.In both the private and public sectors, one of the significant changes affecting physician practice patterns has been the movement of insured individuals away from traditional retrospective fee-for-service reimbursement to a prepaid prospective managed care setting. As a result, physicians are more likely to contract with a managed care organization.The way in which physicians are reimbursed for outpatient Medicare services has changed significantly as a result of OBRA '89, which adopted a fee schedule based on a resource based relative value scale coupled with volume performance standards. These changes were designed to eliminate the incentive for physicians to increase service volume.The distribution of physicians across specializations changed significantly between 1970 and 1992. In 1970, 17.3 percent of physicians were practicing family and general medicine, compared with 11 percent in 1992.Recently, a larger proportion of physicians has joined group practices, and the average size of a group practice has increased. In 1975, 23.5 percent of physicians worked in a group practice, compared with 32.6 percent in 1991. Between 1975 and 1991, the average size of a group practice increased from 7.9 physicians to 11.5 physicians.The U.S. physician-to-population ratio has been growing since at least 1970. In 1992, there were 255 physicians per 100,000 Americans, up from 161 in 1970. Among physicians with office-based practices, there were 209 physicians per 100,000 Americans in 1992, compared with 134 in 1970.

This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.

Drawing on the work of the Roundtable on Evidence-Based Medicine, the 2007 IOM Annual Meeting assessed some of the rapidly occurring changes in health care related to new diagnostic and treatment tools, emerging genetic insights, the developments in information technology, and healthcare costs, and discussed the need for a stronger focus on evidence to ensure that the promise of scientific discovery and technological innovation is efficiently captured to provide the right care for the right patient at the right time. As new discoveries continue to expand the universe of medical interventions, treatments, and methods of care, the need for a more systematic approach to evidence development and application becomes increasingly critical. Without better information about the effectiveness of different treatment options, the resulting uncertainty can lead to the delivery of services that may be unnecessary, unproven, or even harmful. Improving the evidence-base for medicine holds great potential to increase the quality and efficiency of medical care. The Annual Meeting, held on October 8, 2007, brought together many of the nation's leading authorities on various aspects of the issues - both challenges and opportunities - to present their perspectives and engage in discussion with the IOM membership.

Ten years after the adoption of the HITECH Act of 2009, eMessaging and the Physician/Patient Dynamic: Practices in Transition examines the complex, interlocking forces at play when mandates for electronic health records (EHRs) and electronic messaging within secured health portals forced an unprecedented transformation of the healthcare environment. Technological, sociological, medical, economic, political, governmental, legal, and communication issues converged, forever altering the “medicological environment,” a space within which health professionals and patients alike strive towards efficacious, satisfying transactions that lead to improved health. Susan M. Wieczorek’s analysis discusses the layers of policies and regulations that thrust healthcare users—often unwillingly—into the newly required practice of online communication between physicians and patients. Wieczorek also compares and contrasts rural and urban early adoption practices through the use of surveys, critical incident reports, and oral histories and anticipates future trends in data mining of electronic messaging by demonstrating a content analysis of over 60,000 electronic medical transactions within secured health portals. This book identifies the key converging influences that affected the real-life, early adopters amid this transformation process and provides a practical foundation for current, on-going practice applications while anticipating the inevitable challenges of future health communication technologies. Scholars of communication, health, and media studies will find this book particularly useful.

Options for physicians working within the prepaid medicine system make sense when you understand the pros and cons, strategies, and structures analyzed in this guide to the new managed care environment. -- Evolution of the managed care movement -- Myths about organizational requirements for managed care success -- Pros and cons of solo practice versus IPA, PHO, or group practice -- Working for a hospital or HMO -- Entrepreneurial, legal, and regulatory characteristics of each model -- Best opportunities for primary care and specialist physicians -- The ideal physician organization for managed care -- Future winners and losers, quality of care, reform, and Wall Street Analyze the cost and benefits of practice and managed care proposals, because an informed choice makes good medicine work.

Published in association with the MGMA and written for physician leaders and senior healthcare managers as well as those involved in smaller practices, Physician Practice Management: Essential Operational and Financial Knowledge provides a comprehensive overview of the breadth of knowledge required to effectively manage a medical group practice today. Distinguished experts cover a range of topics while taking into special consideration the need for a broader and more detailed knowledge base amongst physicians, practice managers and healthcare managers. Important Notice: The digital edition of this book is missing some of the images or content found in the physical edition.