Regarding Michael Romano's Reporter's Notebook A Gadfly in the Ointment at AMGA:In my experience, medical groups offer more opportunity for peer review and discussion on patients' clinical needs. Often, in groups that I have managed I have seen immediate consultation between primary care and specialists or specialist to specialist. The commonality of the patient record aids in this discussion, review or communication. Also, the patient care and operation tends to rise to a higher level, as the partners and employees of the medical group want to be known for high quality medicine and customer service. Physicians and medical group administrators know that word of mouth, giving outstanding patient care and service is the best way to let the community know of your services.
Solo physicians have less opportunity for peer review, and they maintain their own standards, which you would hope would be high, but there is less of peer interaction and they have less access to medical management input.
In California, many medical groups, in particular those involved with capitated medicine, either in formal groups or in an IPA structure have adopted pay for performance goals, focused on patient care and structural aspects of care delivery that influences quality. Those in fee for service medicine only are not involved in these quality patient focused programs. Although Medicare is proposing quality measures tied to added reimbursement, starting July 1, 2007.
And groups and physicians who belong to AMGA and MGMA are focused on patient care legislation. I think we should remember the quality care mantra of: structure-process-outcome, and that just because we may focus on certain structure and process aspects of medical group administration in legislation that these areas are pertinent to patient safety, efficiency, creating a welcoming environment, improving the credentialing and billing process and being fiscally responsive, which allows medical groups to deliver high level care and continue to do so.
Avram KaplanFullerton, Calif. Executive director Saddleback Physician Services
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