If you were a physician, which type of practice would you like to be part of to
ID: 241579 • Letter: I
Question
If you were a physician, which type of practice would you like to be part of to practice medicine (e.g., staff model, group model, IPA, PPO, …)?? What reasons would you have? Why do these features appeal to you? Please explain. Include reference If you were a physician, which type of practice would you like to be part of to practice medicine (e.g., staff model, group model, IPA, PPO, …)?? What reasons would you have? Why do these features appeal to you? Please explain. Include reference If you were a physician, which type of practice would you like to be part of to practice medicine (e.g., staff model, group model, IPA, PPO, …)?? What reasons would you have? Why do these features appeal to you? Please explain. Include referenceExplanation / Answer
The answer is Group Model
Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) administer the most common types of managed care health insurance plans. Managed care plans typically arrange to provide medical services for members in exchange for subscription fees paid to the plan sponsor—usually an HMO or PPO. Members receive services from a network of approved physicians or hospitals that also have a contract with the sponsor. Thus, managed care plan administrators act as middlemen by contracting with both health care providers and enrollees to deliver medical services. Subscribers benefit from reduced health care costs, and the health care providers profit from a guaranteed client base.
There are three main types of managed health care plans: health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans. All of these managed care plans attempt to reduce utilization and to control the amount of money being paid to providers of care.
Health Maintenance Organizations
A health maintenance organization is a managed care plan that provides or arranges for the provision of health care services to a group of defined participants on a prepaid basis for a fixed fee. HMOs require substantial capital investment as well as new management capacity and a new vision for physicians and patients. In order to remain solvent, an HMO needs to reduce subscribers' utilization of health care services such as hospital stays.
There are several types of HMOs: closed-panel, staff model, group model, and open-panel. The closed-panel HMO is a managed care plan that has an exclusive arrangement with physicians that blocks them from seeing patients from another managed care organization. The staff model HMO employs providers of health care and these providers practice in common facilities. The unique feature of this model is that the insurance plan and the doctors are working together for the same employer. Physicians employed in the staff model HMO model are salaried employees who are all required to follow the same practices and procedures. The group model HMO contracts with a multispecialty group of physicians who agree to provide, on an exclusive basis, all the covered services for the HMO's subscribers. This type of HMO may contract with a group practice or, in some cases, actually own the group practice. The subscribers to this form of HMO usually represent a significant proportion of the group practice's patients and revenues.
closed-panel HMO
An HMO that pays only for health services provided by physicians and hospitals in its network.
staff model HMO
An HMO that employs health care providers directly, so that both insurance and care are provided by the same organization.
group model HMO
An HMO that contracts for medical services with various multispeciality groups and also with one or more hospitals. HMO contracts with certain provider groups, with whom rates for medical care are negotiated. The HMO then pays the negotiated rate for care provided to the policyholders. Contracts are also made with hospitals for care provided to the policyholders.
Physician Practice Option: Group Practice
The majority of new physicians transitioning to post-residency employment traditionally opt to join group practices, which range widely from as few as three physicians to as many as several hundred.
There are two basic types of medical groups: single-specialty and multi-specialty groups. Multi-specialty groups tend to employ a mixture of primary care physicians and related specialists like surgical and internal medicine specialists. The PCPs often serve as a referral source for the specialists in multi-specialty groups, who in turn offer the PCPs a convenient resource for consults and help to maintain continuity of care by keeping treatment under the same roof.
While there are advantages to multi-specialty groups, incomes may be power than in single-specialty groups because the overhead is higher. Also, political rifts between specialists and primary care physicians in multi-specialty groups aren't uncommon, with specialists feeling that they're "footing the bill" while the primary care physicians feel relegated to "junior partner" status because of the differences in revenue generated by each party.
For some physicians, the appeal of group practice lies in an impression of "strength in numbers." Groups are seen as providing stability, call coverage, a collegial atmosphere and clinical backup helpful to those coming out of a residency. Group practices generally provide a salary as well as some sort of production-based bonus. They also frequently offer established patient base and referral patterns, letting new physicians avoid the need to build a practice from scratch.
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