How 10 leading health systems pay their doctors.

We conducted interviews with senior executives at 10 leading health systems to better understand how organizations use performance-based compensation. Of the organizations interviewed, five pay physicians using productivity-independent salaries, and five use productivity-adjusted salaries. Performance-based pay is more prevalent in primary care than in subspecialties, and the most consistently identified performance domains are quality, service, productivity, and citizenship.

Growth dynamics in the context of pediatric sports injuries and overuse.

The onset and timing of the growth of children and adolescents occurs with considerable variability in cohorts of the same chronological age. The musculoskeletal system changes in proportion over time, and lever-arm changes, altered individual flexibility, and strength lead to age-specific injury patterns in youth sports. In sports, juniors are commonly grouped according to their chronological age.

Association between availability of health service prices and payments for these services.

Importance: Recent governmental and private initiatives have sought to reduce health care costs by making health care prices more transparent.

Objective: To determine whether the use of an employer-sponsored private price transparency platform was associated with lower claims payments for 3 common medical services.

Design: Payments for clinical services provided were compared between patients who searched a pricing website before using the service with patients who had not researched prior to receiving this service.

Management strategies to effect change in intensive care units: lessons from the world of business. Part II. Quality-improvement strategies.

The success of quality-improvement projects relies heavily on both project design and the metrics chosen to assess change. In Part II of this three-part American Thoracic Society Seminars series, we begin by describing methods for determining which data to collect, tools for data presentation, and strategies for data dissemination. As Avedis Donabedian detailed a half century ago, defining metrics in healthcare can be challenging; algorithmic determination of the best type of metric (outcome, process, or structure) can help intensive care unit (ICU) managers begin this process.

Management strategies to effect change in intensive care units: lessons from the world of business. Part III. Effectively effecting and sustaining change.

Reaping the optimal rewards from any quality improvement project mandates sustainability after the initial implementation. In Part III of this three-part ATS Seminars series, we discuss strategies to create a culture for change, improve cooperation and interaction between multidisciplinary teams of clinicians, and position the intensive care unit (ICU) optimally within the hospital environment. Coaches are used throughout other industries to help professionals assess and continually improve upon their practice; use of this strategy is as of yet infrequent in health care, but would be easily transferable and potentially beneficial to ICU managers and clinicians alike.

Management strategies to effect change in intensive care units: lessons from the world of business. Part I. Targeting quality improvement initiatives.

The business community has developed strategies to ensure the quality of the goods or services they produce and to improve the management of multidisciplinary work teams. With modification, many of these techniques can be imported into intensive care units (ICUs) to improve clinical operations and patient safety. In Part I of a three-part ATS Seminar series, we argue for adopting business management strategies in ICUs and set forth strategies for targeting selected quality improvement initiatives.

Incidence and risk factors for early adjacent vertebral fractures after balloon kyphoplasty for osteoporotic fractures: analysis of the SWISSspine registry.

Purpose: The SWISSspine registry (SSR) was launched in 2005 to assess the safety and effectiveness of balloon kyphoplasty (BKP). In the meantime, repeated reports on high rates of adjacent vertebral fractures (ASF) after BKP of vertebral insufficiency fractures were published. The causes for ASF and their risk factors are still under debate.

The Affordable Care Act and the future of clinical medicine: the opportunities and challenges.

The Affordable Care Act is a once-in-a-generation change to the U.S. health system.