American health care and the law--we need to talk!

The first section of this paper highlights five critical legal developments over the past half-century that, while not reflecting considered policy judgments about how the health care industry should operate, put American health care on some surprising paths. The second part then observes five fundamental policy contradictions discernible in health care law today, each of which reflects severe ambivalence in public attitudes toward health care. Although such confusion in the law is interesting in itself, the main purpose of the paper is to propose, in section three, the creation of a permanent high-level forum, perhaps in the Institute of Medicine, where leaders from the health and legal worlds could meet regularly with a view to helping the legal system resolve some of the policy confusion that exists.

An academic practice's transition to the business of medicine in the community. A case study

This case study highlights the problems confronting a clinical practice corporation affiliated with a major medical school, and the business realizations it made in the acquisition of a community-based clinic. Launching a financially viable enterprise requires careful planning, determination of formal goals and expectations, an appropriate mix of physicians and services, a specific marketing campaign and community support.

From service to commodity: corporization, competition, commodification, and customer culture transforms health care

Corporate medical practice, a market economy, and a consumer culture are transforming health care. The service relationships of doctors with patients are now commodities. The doctor, directed by disease management protocols (to improve outcomes, reduce costs, and standardize care), is, in effect, providing programmed service commodities. In addition, medical-surgical specialties, now "packaged" for the care of body parts and conditions (as Breast, Stroke, Obesity, Aneurysm Centers), are also made service commodities, marketed by newspaper advertisements, TV, radio, and Internet to patient-customers in search of a healthy body. In sum, the promise of corporate practice in a competitive market economy is greater efficiency and productivity to reduce the costs of care that are a burden on industries and the state. Viewed from office encounters with patients, such transformation of services to commodities changes the doctor-patient relationship and the moral mission of care.

Surgery center joint ventures

Surgery centers have been accepted as a cost effective, patient friendly vehicle for delivery of quality ambulatory care. Hospitals and physician groups also have made them the vehicles for coming together. Surgery centers allow hospitals and physicians to align incentives and share benefits. It is one of the few types of health care businesses physicians can own without anti-fraud and abuse violation. As a result, many surgery center ventures are now jointly owned by hospitals and physician groups. This article outlines common structures that have been used successfully to allow both to own and govern surgery centers.

The anatomy of an annual report to stockholders

This article gives practical advice about how to develop an annual report to a governing body. The author urges involvement of staff to prepare the data, exhibits and financial information; external advisors such as CPAs should review the data to add creditably. The narrative section should be easy-to-understand by physicians; use of short explanations of accomplishments is suggested. The article gives examples of information that could be used. The author suggests that developing a formal report can be rewarding; and encourages every chief executive to prepare one for their practice.

Maintaining the new practice networks

Unless acquired physicians are managed carefully, many will flee the acquiring networks in anger and frustration. Because older networks relied on a self-selected population of physicians, the newer networks will have to develop alternative strategies to motivate those physicians who did not self-select for employment. This article makes recommendations about how to build a corporate practice culture under these new conditions.