Does primary care diabetes management provided to Medicare patients differ between primary care physicians and nurse practitioners?

Aims: The aim of this study was to answer the overall question: Does primary care diabetes management for Medicare patients differ in scope and outcomes by provider type (physician or nurse practitioner)?

Background: In the USA as well as globally, there is a pressing need to address high healthcare costs while improving healthcare outcomes. Primary health care is one area where healthcare reform has received considerable attention, in part because of continued projections of primary care physician shortages. Many argue that nurse practitioners are one solution to ease the consequences of the projected shortage of primary care physicians in the USA as well as other developed countries.

Setting the right path and pace for integration.

Far from being a monolithic trend, integration in health care today is progressing in various forms, and at different rates in different markets within and across the range of healthcare organizations. Each organization should develop a tailored strategy that delineates the level and type of integration it will pursue and at what pace to pursue it. This effort will require evaluation of external market conditions with respect to integration and competition and a candid assessment of intraorganizational integration.

Managing the physics of the economics of integrated health care.

The physics metaphor, as applied to the economics (and financial performance) of the integrated health system, seems appropriate when considered together with the nine principles of management framework provided. The nature of the integrated design enhances leaders' management potential as they consider organizational operations and strategy in the markets ahead. One question begged by this argument for the integrated design is the durability, efficiency and ultimate long-term survivability of the more "traditional" community health care delivery models, which, by design, are fragmented, internally competitive and less capital efficient.

Financing strategic healthcare facilities: the growing attraction of alternative capital.

Community health system leaders often dismiss use of alternative capital to finance strategic facilities as being too expensive and less strategically useful, preferring to follow historical precedent and use tax-exempt bonding to finance such facilities. Proposed changes in accounting rules should cause third-party-financed facility lease arrangements to be treated similarly to tax-exempt debt financings with respect to the income statement and balance sheet, increasing their appeal to community health systems. An in-depth comparison of the total costs associated with each financing approach can help inform the choice of financing approaches by illuminating their respective advantages and disadvantages.

Capital efficiency and integrated health system designs.

Community health system design plays a role in capital efficiency, including returns on invested capital. This role becomes important in a future healthcare world of pressured payments, increased consolidation, constrained resources, and stretched community service missions and budgets.

The psychology of organizational structure in integrated health systems.

Examine a social learning theory model as a framework to guide health system leaders as they consider the psychology of organizational design as it pertains to the successful integration.

Examining the "dyad" as a management model in integrated health systems.

Examine a two-pronged approach to the management of physician/hospital integration, including the responsibilities of physician leaders and nonphysician leaders.

Understanding the quality of earnings for integrated health systems.

Integrated delivery systems could benefit from analyzing quality of earnings to better understand their management plans and methods. Quality-of-earnings analyses can provide understanding of current and future financial performance beyond the bottom line. Following a framework for analysis can help leaders gain a better overall picture of the system's finances.

The future of management education and training for physician leaders.

Learn how the job descriptions of physician executives are likely to expand as integrated health systems become more complex.

Integrative specialty care: pursuing a convergent path with medical staff.

Physician integration--This phrase raises myriad issues in the minds of health system executives: Can true win-win relationships be developed and sustained? Will moving toward physician integration be disruptive to the hospital environment? How will long-term profitability be affected?

Head games. The psychology of medical group financial management and the role of physician leaders.

Good practice leaders must understand the psychology of presenting and managing the financial performance of the medical group. Leaders--especially physicians--must strive to understand this psychology to shepherd the group through the various financial challenges it will face.

Physician-led: good idea or not?

Whether physicians or not, leaders must possess certain skills and qualities to achieve success. Take a look at what's required to be an effective leader.