Individual Practice Association Research Articles

Mandatory HMO Enrollment in Medicaid: The Issue of Freedom of Choice

In areas where HMOs have enrolled a small proportion of the general population, physician participation is less in mandatory HMO programs for Medicaid beneficiaries than in fee-for-service Medicaid. But where HMOs have enrolled over one-quarter of the general population, participation rates are indistinguishable under the two systems. In those areas, mandatory enrollment restricts freedom of choice of provider. A plausible reason for this is that individual practice associations, which contract with large numbers of physicians with both fee-for-service and HMO patients, are becoming the lead form of HMO.

Innovative programs for the long-term survival of the American hospital industry

Health care organizations have been forced to make significant changes in their operating policies over the last several years in response to decreased revenues. The major reasons for the revenue decrease include a drop in census (number of patients at any one time in a hospital), the availability of alternative health care facilities, and a change in expense reimbursement procedures by insurance agencies. Hospitals, along with insurance agencies, have responded to these causes of decreased revenues in several ways. Hospitals have started increasing their number of out-patient programs and also have begun in-house cost cutting/containment programs. Hospitals and insurance agencies have joined together in developing programs such as Health Maintenance Organizations (HMO), Individual Practice Associations (IPA), and Preferred Provider Arrangements (PPA) to combat the decrease in census at hospitals. With these programs, hospitals are guaranteed a potential patient group and insurance agencies are able to provide lower premiums to covered companies. This paper will address the reasons forwarded for the changes occuring in American hospital policies and procedures. Following this, an explanation of the new programs being developed for both hospitals and insurance agencies will be discussed. Finally, suggested cost reduction programs for hospitals in the area of pharmaceuticals will be forwarded.

Providing Ophthalmic Services in a Contracting Environment

purpose of this symposium is to heighten your awareness about the most serious issue facing ophthalmology today-our access to patients. intent of this symposium is to provide a clearer understanding of the issues. Academy and ophthalmologists will then be in a better position to sharpen the focus of our efforts to ensure our access to patients. We plan to address some actions which you, as individual ophthalmologists, and the Academy should take to help ensure the public's continued direct access to ophthalmologic services. We also will present principles which should guide us as we approach the future. Each panelist will approach the issue of access from a different perspective, with the aim of painting a realistic and complete picture of the impact of alternative delivery systems (ADSs) on ophthalmology and the provision of ophthalmologic services. Today, we will use ADSs as a generic term to mean any system of payment that is other than the traditional fee for service. Many will find the following portrayal of reality grim and the suggestions anathema to our usual way of thinking and of approaching our practices. Times have changed, and the situation is such that things once unthinkable are not tomorrow's nightmares but today's realities. If your anger begins to surface when listening to this symposium, please do not reject the message or make efforts to sacrifice the messengers, for as Shakespeare so eloquently stated in Henry IV The first bringer of unwelcome news hath but a losing office. I urge you to think beyond what has been customary or familiar before rejecting anything out of hand. Above all, I exhort you to be realistic and to begin to deal with what we are facing. It is only by dealing with reality that we will be successful. For a long time, we have been talking about the effects of prepaid health plans (health maintenance organizations [HMOs], individual practice associations [IPAs], competitive medical plans [ECMPs], and preferred provider organizations [PPOs]) on the practice of ophthalmology, and the changes that might occur in the way we deliver ophthalmologic services. We have tried to envision what

The New Structure of Individual Practice Associations

There are two types of HMOs: prepaid group practices (PGPs) and individual practice associations (IPAs). Because of rapid change in the HMO industry, the academic literature, which is based primarily on data from the 1970s, is dated in several ways. The literature has focused on PGPs, but IPAs are growing three times faster than PGPs and are likely to dominate the HMO industry in the near future. The literature indicates that a small proportion of an IPA physician's practice is capitated, but such practices often are as much as one-third capitated. And while the literature indicates that IPA physicians are rarely given financial incentives to control cost, such incentives are now common. In this decade IPAs have cut their hospital days per thousand enrollees. Furthermore, IPAs in which individual physicians or medical groups bear some of the financial risk of hospital costs appear to have the same rate of hospital days as PGPs. Additional research is especially needed on cost and quality of care in modern IPAs.

Factors affecting physicians' choice to practice in a fee-for-service setting versus an individual practice association.

Individual Practice Associations (IPAs) must be able to recruit physicians from the community to compete in the future. This article reports the results of a study to assess the factors that influenced physicians in the Research Triangle area of North Carolina to join a primary care network type of IPA. Results indicate that physicians with lower incomes and fewer physician visits and those who were newly established in the community were more likely to join. Peers had a strong influence on their decisions, while Blue Cross/Blue Shield marketing representatives did not.

The Aftermath of Maricopa

An individual practice association (IPA) is a corporation or a partnership composed of physicians which contracts with health maintenance organizations (HMOs) to provide medical services to HMO subscribers. Since physicians typically practice independently, any agreement or arrangement among them may be perceived as an agreement of competitors. Hence, IPAs run the risk of challenge under the antitrust laws for activities such as price-fixing and the exclusion of physicians from membership.Prior to the recent Supreme Court decision in Arizona v. Maricopa County Medical Society, it appeared that courts were willing to consider a variety of factors that distinguished antitrust cases concerning health care providers from antitrust cases in the commercial marketplace, and to find that conduct by providers did not constitute antitrust offenses. Indeed, an earlier article appearing in Law, Medicine & Health Care analyzed the lower court's decision in Maricopa and discussed the development of this trend.

Organizational factors and performance of individual practice associations.

Organizational factors and performance of individual practice associations.

The Individual Practice Association: Its Implications for Dentistry? / Several Dental IPAs Examined

The Individual Practice Association: Its Implications for Dentistry? / Several Dental IPAs Examined

Utilization of Hospital Services in the Individual Practice Association on Guam

The HMO Act of 1973 gives impetus on a nationwide scale to the development of health care delivery systems capable of providing or arranging for comprehensive health services for our nation's consumers. However, while the organizational mode of the group-practice model HMO is well defined and tested, there has not been a similar "track record" established for the individual practice HMO. In this study, the author compares the utilization of hospital beds in two operating programs: an individual practice and a group-practice HMO, serving employees of the Government of Guam, U.S.A. Substantial differences in utilization between the two systems are observed over a 12-month period. With the focus on developing the IPA to meet the objectives for which it is intended, it is suggested that organizational structure, provider incentives, and how utilization controls were employed account for the discrepancy.