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Building the Physician Organization (a large, established
medical group) After some years experience with an integrated health system, you apply for a
post as executive director of a new moderate-sized physician organization
attached to one of the system’s hospitals. You will be interviewed by a panel of
the governing board, including several physicians representing primary and
referral specialties. About a week before the interview, the spokesperson for the
search committee tells you: We want to build a group that attracts the best doctors and makes quality
a habit. We want a say in our destiny. And we want to make competitive
incomes, and take paying patients from all forms of insurance. We've
gotten everybody signed up, both legally and emotionally, on those ideas. We think we have good doctors, and we have good malpractice records,
thank heaven. But we haven't really gotten into some important questions
we know we'll have to address, such as how big we should be, how we
should control our referral specialist numbers, and what specialties we
ought to include. We copied the hospital's credentialing system verbatim, and we're not
sure that's all we need because it doesn’t do much for outpatient care.
Some doctors think we should have specialty departments like the
hospital, others want geographic directors or leaders, and frankly a lot
would like total autonomy. Now we are in the pay-for—performance era. The system is giving us HEDIS
reports, a bunch of patient satisfaction data, and some process measures
like scheduling delays. We're doing okay on these, but the system says
they want benchmark performance on a bunch of them within three years.
They also give us cost reports that show we are a little over the system
average for many common problems. They want overall costs down 15
percent in two years. Some of our doctors think these goals are
impossible, but the system shows us data from other cities and
competitive information where the goals have already been met. We think
we're going to have to meet those goals, but honestly I don't have a clue
how we’ll do it. Tell us how we should organize to get all this done. From your experience with the system, you know the search spokesperson
outlined the right agenda. The market is demanding cost and quality
improvement, and the system will not tolerate much failure on the goals. You
decide to outline your response in detail, making sure you hit all the points and
give answers that will get you the job as well as establish a basis for doing the

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