Professional integration and the type selected for many healthcare organizations will determine their success when they begin implementation of the Patient Protection and Affordable Care Act (PPACA). Cuellara & Gertlerb (2006) list the five most common arrangements in use: Independent Physicians Associations (IPAs), Open Physician–Hospital Organizations (OPHOs), Closed Physician–Hospital Organizations (CPHOs), Management Service Organizations (MSOs), and Fully Integrated Organizations (FIOs). Each of these five types of professional integration has proven successful however there have been many failures, which ultimately led to a degraded access and quality of health care in those communities.
Major Points of Two Selected Types of Physician-Hospital Arrangements
The two types of physician-hospital partnerships that I have selected are the IPA and FIO. IPAs and FIOs are arrangements at the opposite end of the professional integration spectrum. The major points for each type are described below.
Independent Physicians Associations (IPAs)
IPAs are a group of physicians who own a practice and are not employed by another healthcare organization such as a hospital or health maintenance organization (HMO). IPA physicians form a legal corporation, partnership, or foundation and contract as a group to provide their services. Some IPAs contract with HMOs while also seeing non-HMO patients. The IPA shares economic risk but not overhead costs.
Fully Integrated Organizations (FIOs)
Under the FIOs structure the healthcare enterprise purchases a physicians practice to include the physician’s services. Physicians become salaried employees and in some organizations they share governance with healthcare management. However, FIOs run the high risk of physician attrition by placing them on salary. FIOs have the ability to increase efficiency by coordinating and cross-leveling care and if successful in this they lower patient cost while delivering high quality care. Finally FIOs normally “accept risk-based capitation contracts from HMOs” (Cuellara & Gertlerb, 2006).
Comparison of Two Selected Types of Physician-Hospital Relationships
In comparison IPAs and FIOs have physicians and providing healthcare in common. The difference between an IPA and a FIOs is like comparing a boutique store to that of a nationwide chain of department stores. The IPA like the boutique store, is owned and operated by the same group of people, they cater to the wants and needs of the customers/patients, and normally charge more for the very high quality of service provided. IPAs have open access if the customer/patient can afford the cost of their service. FIOs on the other hand provide the same high quality goods/services but at a much lower cost. The physicians in a FIO are employees where in an IPA they are the owners and the choice is directly related to the level of autonomy each individual desires.
The Most Effective Type of Physician-Hospital...