MSOs: key to PHOs and community-based health care systems.

: In the '50s and '60s, as you drove through the United States, you could not help but notice the large number of mom and pop businesses--gas stations, groceries, restaurants. The same ride in the '70s and '80s is remembered because of the large number of these businesses that had closed their doors. In the '90s, this could very well begin to happen to doctor's offices and small clinics as medicine comes to look more and more like a business. This decade has already seen a shift in medicine from fee-for-service to more managed types of insurance and payment programs and the beginning of larger physician groups. Proposed health reform initiatives can only serve to accelerate these trends. Those in medicine prepared for changes will survive and perhaps even thrive. The others will wither on the vine. One of the key strategies that will enhance survival is cooperation and organization among the different players--hospitals, insurance companies, and providers. An extremely valuable tool for survival, along with the independent practice arrangement, the integrated delivery system, etc., will be the management service organization.