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Executives share management tips.

Members of the American College of Physician Executives were asked earlier this year to share the experiences in solving particularly nettlesome management problems. The goal was to construct a problem-solving tool for the widest possible array of problems in the full range of health care environments. This article is a distillation of the responses that were received, including contacts for further information on the problems and their solutions.

h year for the past four years, the American College of Physician Executives has queried its membership to obtain a catalog of responses to management problems. Our goal has been to provide an array of problem solving approaches that adds to the published experience of the medical management profession. In March 1990, we again asked members to provide brief accounts of major problems that they had faced in the preceding year, along with an assessment of the techniques that were used to resolve the problems. This article is a summary of some of the accounts that were received. In the following compendium, the problems and their solutions are listed first under the type of organization (group practice, hospital, managed care, and other) in which they were found. Under the organizational listing, the problems are listed by topic. For each entry, the name of the College member and his or her mailing address have been provided.

Every effort has been made to ensure that this listing is a significant problem-solving resource for physician executives. Some problems can be solved expeditiously if fresh insights are obtained from outside the immediate environment of the problem. The sharing represented by this listing should provide just such insights. Where a solution proves especially valuable to a reader, we hope that the adaptation will also be shared with the College so that it can be disseminated more widely.

Group Practices

Physician Compensation The group had no clearly defined, explicitly communicated, and rational basis for physician compensation. Physicians had no incentive to work harder, because linkage between productivity and compensation was weak and unclear. The group implemented a market-based, specialty-specific compensation scheme that includes an incentive bonus to reward "high producers" and "significant contributors.'Alfredo A. Czerwinski, MD, Medical Director, Kelsey-Seybold Clinic, P.A., 18th Floor, 1709 Dryden, Houston, Tex. 77030.

Overutilization Laboratory and radiology services were overused by some group physicians. The group wanted to identify and retrain these physicians. Group physicians are grouped by specialty and accounting data are used to calculate laboratory and radiology charges per visit per physician. Rankings within specialties are discussed with each physician at the time of quarterly reviews, and monthly trends are discussed.-Bradford B. Burnett, MD, 3625 Del Amo Blvd., La Jolla, Calif. 90503.

Facility Expansion

The group wished to acquire public land in a downtown area through a public process and in competition with multiple developers. Public and political support for the group's project was developed by the physician executive through extensive external networking, and the group's goal was accomplished.-Stuart Heydt, MD, FACPE, President and CEO, Geisinger Medical Center, North Academy Ave., Danville, Pa. 17822-0150.

Growth Policy

Rapid growth of multidisciplinary clinic created a need for reevaluation of goals. Related issues were quality of care, physician reimbursement, and the morale of the management team. A management consultant was hired, and several board retreats were conducted, along with physician group meetings, and general retreats focused on communications. About 25 percent of clinic physicians, administrators, and managers have been involved, and progress to date has been good.Allan E. McLaughlin, NO, Medical Director, Laurelwood Hospital, 35900 Euclid Ave., Willoughby, Ohio 44094. Clinical Research Policy

A group physician developed a commercial product in the course of a research project and attempted to market it without the group's knowledge. When the activity was discovered, the group developed an agreement with the physician to spell out what he could and could not do. From this experience, a clinical research policy was developed for all physicians-Edward R. Sweetser, MD, Vice President and Chief Medical Officer, Lovelace Medical Center, 5400 Gibson Blvd., S.E., Albuquerque, N.M. 87108.


An important figure in an entrepreneurial project was not pulling his weight. The group implemented a monthly, graphic, computerized productivity analysis system with individual feedback and intragroup comparisons.-Jeffrey Burke Satinover, MD, Executive Director and Chairman of the Board, Sterling Institute of Neuropsychology and Behavioral Medicine, 1250 Summer St., Stamford, Conn. 06905.


Hospital/Medical Staff Competition Primary care physicians were threatened by executive physical examination program, viewing it as competition. Multiple meetings were held with all concerned groups and compromise was reached.John Babka, MD, FACPE, Director, Medical Affairs, Morton Plant Hospital, P.O. Box 210, Clearwater, Fla. 34617-0210.


A general surgeon who had been a member of the hospital medical staff prior to the arrival of orthopedic surgeons retained some orthopedic privileges. He used outdated equipment for certain procedures and obtained less than desirable results. A decision was made to discard the older equipment and not replace it. Surgeons using the newer equipment were required to attend a training course before being credentialed.-Bernard Sisman, MD, Director of Medical Affairs, Mercy Memorial Hospital, 740 N. Macomb St., Monroe, Mich.48161.


The privileges of a senior member of the medical staff were a concern. The physician's department was involved in discussions, and the medical staff executive committee appointed an ad hoc investigating committee. The executive committee of the hospital board was also involved, and the vice president of medical affairs orchestrated the effort while providing support to the practitioner. The physician's privileges were suspended, remedial education was recommended, and an evaluation of physical, mental, neurological, and psychological status was conducted.-Frederic G. Jones, MD, FACPE, Executive Vice President, Medical Affairs, Memorial Hospital, 800 N. Fant St., Anderson, S.C. 29621.

Emergency Department

Average waiting time for admission to the hospital from the emergency department sometimes was 48-72 hours, causing severe overcrowding. Ambulances were diverted to other institutions, hospital discharges were expedited, a more effective means for transferring patients to longterm care facilities was developed, and patients were admitted to all available beds in the hospital.-Jasmin Moshirpur, MD, Medical Director, City Hospital Center at Elmhurst, 79-01 Broadway, Elmhurst, N.Y. 11373.

Support Staff

Secretarial staff was demonstrating slipshod work and poor attendance. A breakdown in satsifactory communication was also observed. Meetings with the secretaries were held immediately, and complaints of overwork and poor working conditions were heard. Management acknowledged their complaints and pledged to improve equipment and space.-Robert L. Meckelnburg, MD, Director, Department of Nuclear Medicine, Medical Center of Delaware, Ogletown and Stanton Roads, Newark, Del. 19718.


The hospital had received reports of slow turnarounds for radiology reports and of physician reluctance to read films promptly. A system of standardized merit pay was developed, based on a formula whose largest element acknowledged productivityRobert Hughes Posteraro, MD, Professor and Chairman, Department of Radiology, Texas Tech University School of Medicine, 3601 4th St., Lubbock, Tex. 79430.

Peer Review

Medical staff of voluntary hospital refused to make necessary effort for peer review documentation to meet Joint Commission on Accreditation of Healthcare Organizations standards and local needs. An initial educational approach failed to develop compliance. Now, ancillary personnel do the work, and physicians sign the forms and follow outlines. There was resistance at first, but physicians are now accepting help.-Robert E. Reed, NO, FACPE, Senior Vice President, Medical Affairs, Butterworth Hospital, 100 Michigan S t., N.E., Grand Rapids, Mich. 49503.


A decrease in the number of internal medicine residents, coupled with a desire to improve housestaff working conditions through a reduction in hours, resulted in insufficient housestaff coverage. A series of meetings were held within the department of medicine and changes were implemented that reduced housestaff call but maintained the number of patient beds and provided a full range of services. The changes included use of a physician's assistant for calls and activation of a subspecialty unit where fellows provided patient care for elective subspecialty admissions.Robert H. Roswell, MD, Chief of Staff, Veterans Administration Medical Center, 921 N.E. 13th St., Oklahoma City, Okla. 73104. Managed Care Medical Records A provider would not dictate his office notes until a week or so after appointments. Charts collected in his office,
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Title Annotation:American College of Physician Executives share advice
Author:Zins, Gwen
Publication:Physician Executive
Date:Nov 1, 1990
Previous Article:A strategy to enhance accountability in health care delivery.
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