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Longitudinally (2008–2012) assess whether community-level sociodemographic characteristics were associated with patient-centered medical home (PCMH) capacity among primary care and specialty physician practices, and the extent to which variation in PCMH capacity can be accounted for by sociodemographic characteristics of the community.

Linear growth curve models among 523 small and medium-sized physician practices that were members of a consortium of physician organizations pursuing the PCMH.

Our analysis indicated that the average level of sociodemographic characteristics was typically not associated with the level of PCMH capacity, but the heterogeneity of the surrounding community is generally associated with lower levels of capacity. Furthermore, these relationships differed for interpersonal and technical dimensions of the PCMH.

Our findings suggest that PCMH capabilities may not be evenly distributed across communities and raise questions about whether such distributional differences influence the PCMH’s ability to improve population health, especially the health of vulnerable populations. Such nuances highlight the challenges faced by practitioners and policy makers who advocate the continued expansion of the PCMH as a means of improving the health of local communities.

To date, most studies have focused cross-sectionally on practice characteristics and their association with PCMH adoption. Less understood is how physician practices’ PCMH adoption varies as a function of the sociodemographic characteristics of the community in which the practice is located, despite work that acknowledges the importance of social context in decisions about adoption and implementation that can affect the dissemination of innovations.

The relationships of physician practice characteristics, care management effectiveness, autonomy, and managed care involvement, and physicians’ practice and career satisfaction were investigated. A panel sample (N=660) of 6800 physicians was made up of eleven physicians randomly selected from each of the sixty communities. Three latent constructs include care management effectiveness, practice autonomy, and openness in private practice. Multilevel modeling was performed. A statistically insignificant association was found between the perceived effectiveness of care management and physician satisfaction, holding the practice characteristics and other perception factors constant. The study demonstrated direct effects of practice characteristics and care management effectiveness on the practice of gate-keeping functions and on earnings. Only two contextual variables, managed care penetration and median income in the study communities, were related to physicians’ practice.

This paper examines how medical practice, like all other productive activities, has been subject to the transformative elements of the forces and the relations of production involving class struggle and intra-class conflict. It will explore changes in the relations of production of medical practice which have been catalyzed by powerful productive forces. The current period of medical production involves the transformation of simple commodity production into a transitional stage of capitalist production with the seemingly unbounded growth of the medical productive forces. This development was precipitated by the intervention of capital as a whole, to restrict the drain on their variable capital through the placement of units of financial capital into the management of medical production, using the leverage of access to patients. In response, physicians have consolidated and centralized their practices to create enterprises with market power to limit the extraction of surplus by financial capital, and by their own employment of productive labor to extract surplus from hired physician labor and other clinical workers. Rationalization of the production of medical service commodities, and the sharing of surplus generated from exploitation of an expanded labor force by managed care financial capital and their capitalist partners owning medical enterprises, constitutes the contemporary relations of production. The contradictions of this mode of medical production and the potential for its reproduction will be analyzed.

Building on prior research linking stakeholder relationship quality with financial performance, we explore interorganizational engagement from a bilateral perspective, more fully representing the dynamics within an alliance. Interorganizational relationship quality and stakeholder management theory in healthcare and in accounting research provide the foundation for these insights.

While the study's findings demonstrate consistent views regarding the importance of relationship management and patient care, the two stakeholder groups hold divergent perspectives on how to accomplish these goals. Insurance executives take a population perspective, whereas physician practices focus their decision making at the patient level. The relative power and size between stakeholders was instrumental in how insurers chose to develop relationships with individual physician practices. These findings provide the nucleus for understanding reported frictions.

Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.

We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.

The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.

While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.

Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.

Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.

This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.

There is anecdotal evidence that ethnic minority physicians are underrepresented in managed care contracts. The purpose of this paper, therefore, is to determine ethnic Asian‐Indian physician‐managed care organization experience and job satisfaction in the USA by age, gender, region and percent of patients in managed care organizations.

A random (nation‐wide) mail survey was conducted of 254 physicians who were American Association of Physicians of Indian Origin (AAPI) members during the period 1998 to 2000. Managed care experience was categorized into physician satisfaction; service quality rating; service limitations; difficulties acquiring and maintaining managed care contracts; and financial impact.

Physicians in solo and group practice relied heavily on managed care enrolled patients. Limitations providing care to patients was a more serious problem than for those in staff‐model health maintenance organization and hospital/clinic‐based practices. Physician satisfaction was not significantly related to board certification, practice type, region and managed care participation. However, practice staff participating in managed care had the highest number of board‐certified physicians.

There was a low response rate (37 percent) to data collection using questionnaires.

The paper underlines ethnic minority physicians' capability to get managed care contracts.

This is the first national study of Asian‐Indian physicians and their managed care organization experience. Asian‐Indian physicians are over‐represented in the medical profession and hence the paper will interest those working and dealing with managed care organizations and their patients.

Purpose – To develop a framework for studying financial incentive program implementation mechanisms, the means by which physician practices and physicians translate incentive program goals into their specific office setting. Understanding how new financial incentives fit with the structure of physician practices and individual providers’ work may shed some insight on the variable effects of physician incentives documented in numerous reviews and meta-analyses.

Design/Methodology/Approach – Reviewing select articles on pay-for-performance evaluations to identify and characterize the presence of implementation mechanisms for designing, communicating, implementing, and maintaining financial incentive programs as well as recognizing participants’ success and effects on patient care.

Findings – Although uncommonly included in evaluations, evidence from 26 articles reveals financial incentive program sponsors and participants utilized a variety of strategies to facilitate communication about program goals and intentions, to provide feedback about participants’ progress, and to assist practices in providing recommended services. Despite diversity in programs’ geographic locations, clinical targets, scope, and market context, sponsors and participants deployed common strategies. While these methods largely pertained to communication between program sponsors and participants and the provision of information about performance through reports and registries, they also included other activities such as efforts to engage patients and ways to change staff roles.

Limitations – This review covers a limited body of research to develop a conceptual framework for future research; it did not exhaustively search for new articles and cannot definitively link particular implementation mechanisms to outcomes.

Practical Implications – Our results underscore the effects implementation mechanisms may have on how practices incorporate new programs into existing systems of care which implicates both the potential rewards from small changes as well as the resources which may be required to obtain buy-in and support.

Originality/Value – We identify gaps in previous research regarding actual changes occurring in physician practices in response to physician incentive programs. We offer suggestions for future evaluation by proposing a framework for understanding implementation. Our model will assist future scholars in translating site-specific experiences with incentive programs into more broadly relevant guidance for practices by facilitating comparisons across seemingly disparate programs.

As a key component of the American health care system, the physician office could be the front line in a bioterrorist attack. Nationally and locally, the primary focus on this subject appears to be from a hospital preparedness and public health agency perspective, with little attention devoted to primary physician providers in their own offices, and those specialists to whom patients may be referred. While unrelated to bioterrorism, the recent SARS outbreak also brings to the forefront the need for physicians offices to be able to clinically, operationally, and managerially respond to illnesses that mirror the symptoms of known illnesses, but may be more virulent new organisms or hybrids of existing organisms. If the face of bioterrorism is subtle and slow in its presentation, physicians, in their own offices, could be the first providers of care. Will they be prepared, or will they be among the first fatalities in a bioterrorist attack?

There are longstanding concerns about the sustainability of the US health care system. Payment reform has been seen over the last decade as a key strategy to reorienting the US health care system around value. Alternative payment models (APMs) that seek to accomplish this goal have become increasingly prevalent in the US, yet there is a perception that physicians are resistant to their use and that organizations have been slow to adopt such models. The reasons for the limited effectiveness of APM programs are multifactorial and include aspects related to the design and implementation of these programs and lack of alignment and coordination across different payers and health care sectors. Most importantly, however, is that the current organizational structures in US health care serve to dampen the direct impact of these incentives, often because health care delivery organizations face conflicting incentives themselves. Organizations filter and refine the incentives from multiple external payment contracts and develop internal incentive systems that best reflect the amalgamation of the incentives embedded across their contracts, and thus the fragmented nature of the US health care system serves to undermine efforts to transform care under value-based contracts. In addition to organizations having conflicting incentives, there also are fundamental problems with the design and implementation of APMs that hinder their acceptance among physicians and the organizations in which they work. Moreover, much remains to be learned about how organizations can best adapt to succeed under these models, and how organizational culture can be leveraged to transform care.

The dynamics of the physician knowledge system in the Southern California Region of Kaiser Permanente are explored. The framing and analysis use concepts from the knowledge management literature and network theory. The criticality of this issue to the establishment of sustainable healthcare relates to the lynchpin nature of embedding evidence-based knowledge in healthcare practice and the simultaneous challenge of combining this with clinical knowledge that derives from practice.

The case study is compiled from longitudinal interviews with over 40 physicians and other stakeholders and an examination of archival information including published articles generated by the learning system.

The socio-technical approach to building this learning system was critical given the expectations of physicians for autonomy in making clinical decisions with respect to their patients. This robust learning system builds on rich professional and organizational networks, is led by physicians, and builds on and extends the foundation of evidence relating to quality and value. The goals of the physician practice and a robust measurement and feedback system provide focus for the learning system.

Accelerating the incorporation of evidence-based practice and increasing the scope and reach of the learning system entails building physician networks, having a robust system for critically examining and extending evidence, and a clear linkage to valued outcomes.

This detailed examination of the dynamics of knowledge absorption extends understanding of the capacity of medical care systems to absorb evidence-based knowledge.