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This exploratory study examines the acquisition and formation of physician group practices by for-profit and not-for-profit organizations from a strategic management perspective. Data sources include the 1991 and 1995 AMA Census of Medical Groups, the 1991 and 1995 InterStudy Census of HMOs, and the 1991 and 1995 AHA Annual Surveys. Longitudinal and cross-sectional logistic regressions are used to conduct the hypothesis tests. The data suggest that economies of scope in physician practice is a leading attribute in the selection of acquisition targets. Whereas transitions to not-for-profit ownership were associated with both target attributes and local market characteristics influencing physicians to sell, for-profit acquisition of group practices was predicted solely by target attributes. The paper concludes by suggesting several potentially fruitful directions for future studies.
This article compares the ability of hospital and physician characteristics to explain variations in length of stay and mortality, controlling for factors associated with severity of illness. The analysis is based on 54,571 discharges, covering 11 medical and five surgical conditions, from nonfederal general hospitals in one state during 1988. Results suggest that both hospital and physician characteristics are important predictors of both outcome measures. Contrary to previous research, the volume of patients with the same condition treated by the hospital increases both length of stay and mortality. The volume of patients with the same condition treated by the physician increases length of stay among patients with medical conditions, decreases length of stay among those with surgical conditions, and decreases mortality. One interesting finding is that the medical school attended by the physician influences the patient's length of stay. Findings are interpreted in light of research evidence on factors affecting medical outcomes and recent federal efforts to improve quality of care.
All of the sectors analyzed in this volume face the same dual challenge: the invention of new technology and assuring its long-term clinical adoption by customers. These challenges are neither easy nor inexpensive.
The quality improvement strategy (QIS) helps managers decide where changes in an organization′s services will improve its competitiveness. The QIS measures customer perceptions of the organization′s services relative to its competitors′ offerings (competitiveness) and relative to what its offerings ought to be (satisfaction). The QIS logic uses the intersection of competitiveness and satisfaction data for each service to identify and prioritize improvements that will result in a competitive advantage.
During the 1990s US healthcare markets underwent a significant transformation. Managed care rose to become the dominant form of insurance in the private sector. Also, a wave of hospital consolidation occurred. In 1990, the mean population-weighted hospital Herfindahl-Hirschman Index (HHI) in a Health Services Area (HSA) was .19. By 2000, the HHI had risen to .26. This paper explores whether the rise in managed care caused the increase in hospital concentration. We use an instrumental variables approach with 10-year differences to identify the relationship between managed care penetration and hospital consolidation. Our results strongly imply that the rise of managed care did not cause the hospital consolidation wave. This finding is robust to a number of different specifications.
Abstract: The pressures for closer alignment between physicians and hospitals in both rural and urban areas are increasing. This study empirically specifies independent dimensions of physician and clinical integration and compares the extent to which such activities are practiced between rural and urban hospitals and among rural hospitals in different organizational and market contexts. Results suggest that both rural and urban hospitals practice physician integration, although each emphasizes different types of strategies. Second, urban hospitals engage in clinical integration with greater frequency than their rural counterparts. Finally, physician integration approaches in rural hospitals are more common among larger rural hospitals, those proximate to urban facilities, those with system affiliations, and those not under public control.
Research Objective. To assess the extent to which the organizational culture of physician group practices is associated with individual physician satisfaction with the managerial and organizational capabilities of the groups. Study Design and Methods. Physician surveys from 1997 to 1998 assessing the culture of their medical groups and their satisfaction with six aspects of group practice. Organizational culture was conceptualized using the Competing Values framework, yielding four distinct cultural types. Physician‐level data were aggregated to the group level to attain measures of organizational culture. Using hierarchical linear modeling, individual physician satisfaction with six dimensions of group practice was predicted using physician‐level variables and group‐level variables. Separate models for each of the four cultural types were estimated for each of the six satisfaction measures, yielding a total of 24 models. Sample Studied. Fifty‐two medical groups affiliated with 12 integrated health systems from across the U.S., involving 1,593 physician respondents (38.3 percent response rate). Larger medical groups and multispecialty groups were over‐represented compared with the U.S. as a whole. Principal Findings. Our models explain up to 31 percent of the variance in individual physician satisfaction with group practice, with individual organizational culture scales explaining up to 5 percent of the variance. Group‐level predictors: group (i.e., participatory) culture was positively associated with satisfaction with staff and human resources, technological sophistication, and price competition. Hierarchical (i.e., bureaucratic) culture was negatively associated with satisfaction with managerial decision making, practice level competitiveness, price competition, and financial capabilities. Rational (i.e., task‐oriented) culture was negatively associated with satisfaction with staff and human resources, and price competition. Developmental (i.e., risk‐taking) culture was not significantly associated with any of the satisfaction measures. In some of the models, being a single‐specialty group (compared with a primary care group) and a group having a higher percent of male physicians were positively associated with satisfaction with financial capabilities. Physician‐level predictors: individual physicians' ratings of organizational culture were significantly related to many of the satisfaction measures. In general, older physicians were more satisfied than younger physicians with many of the satisfaction measures. Male physicians were less satisfied with data capabilities. Primary care physicians (versus specialists) were less satisfied with price competition. Conclusion. Some dimensions of physician organizational culture are significantly associated with various aspects of individual physician satisfaction with group practice.
