Landon Bruce E, Normand Sharon-Lise T, Frank Richard, McNeil Barbara J
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.
Health Serv Res. 2005 Jun;40(3):675-95. doi: 10.1111/j.1475-6773.2005.00380.x.
To describe physician practices, ranging from solo and two-physician practices to large medical groups, in three geographically diverse parts of the country with strong managed care presences.
DATA SOURCES/STUDY DESIGN: Surveys of medical practices in three managed care markets conducted in 2000-2001.
We administered questionnaires to all medical practices affiliated with two large health plans in Boston, MA, and Portland, OR, and to all practices providing primary care for cardiovascular disease patients admitted to five large hospitals in Minneapolis, MN. We offer data on how physician practices are structured under managed care in these geographically diverse regions of the country with a focus on the structural characteristics, financial arrangements, and care management strategies adopted by practices.
A two-staged survey consisting of an initial telephone survey that was undertaken using CATI (computerized assisted telephone interviewing) techniques followed by written modules triggered by specific responses to the telephone survey.
We interviewed 468 practices encompassing 668 distinct sites of care (overall response rate 72 percent). Practices had an average of 13.9 member physicians (range: 1-125). Most (80.1 percent) medium- (four to nine physicians) and large-size (10 or more physicians) groups regularly scheduled meetings to discuss resource utilization and referrals. Almost 90 percent of the practices reported that these meetings occurred at least once per month. The predominant method for paying practices was via fee-for-service payments. Most other payments were in the form of capitation. Overall, 75 percent of physician practices compensated physicians based on productivity, but there was substantial variation related to practice size. Nonetheless, of the practices that did not use straight productivity methods (45 percent of medium-sized practices and 54 percent of large practices), most used arrangements consisting of combinations of salary and productivity formulas.
We found diversity in the characteristics and capabilities of medical practices in these three markets with high managed care involvement. Financial practices of most practices are geared towards rewarding productivity, and care management practices and capabilities such as electronic medical records remain underdeveloped.
描述美国三个地理区域医疗集团的医生执业情况，涵盖从单人及双人执业到大型医疗集团等多种形式，这些地区管理式医疗较为普及。
数据来源/研究设计：2000 - 2001年对三个管理式医疗市场的医疗执业机构进行的调查。
我们向马萨诸塞州波士顿市和俄勒冈州波特兰市两家大型健康计划所属的所有医疗执业机构，以及明尼苏达州明尼阿波利斯市五家大型医院收治的心血管疾病患者提供初级护理的所有执业机构发放问卷。我们提供的数据涉及在该国这些地理区域不同的地区，管理式医疗模式下医生执业机构的结构情况，重点关注执业机构采用的结构特征、财务安排和护理管理策略。
采用两阶段调查，首先通过计算机辅助电话访谈（CATI）技术进行初始电话调查，然后根据对电话调查的特定回答触发书面模块。
我们访谈了468个执业机构，涵盖668个不同的护理地点（总体回复率72%）。执业机构平均有13.9名成员医生（范围：1 - 125名）。大多数（80.1%）中型（4至9名医生）和大型（10名或更多医生）集团定期安排会议讨论资源利用和转诊情况。近90%的执业机构报告称这些会议每月至少召开一次。支付执业机构费用的主要方式是按服务收费。大多数其他支付方式是按人头付费。总体而言，75%的医生执业机构根据生产率向医生支付报酬，但因执业机构规模不同存在很大差异。尽管如此，在不采用直接生产率方法的执业机构中（45%的中型执业机构和54%的大型执业机构），大多数采用由薪水和生产率公式组合而成的安排。
我们发现，在这三个管理式医疗参与度高的市场中，医疗执业机构的特征和能力存在差异。大多数执业机构的财务做法旨在奖励生产率，而诸如电子病历等护理管理做法和能力仍不发达。
