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The low-temperature heat capacity of semi-crystalline aliphatic oligo-urethane obtained from the reaction between butane-1,4-diol and hexamethylene 1,6-diisocyanate was measured using a Quantum Design PPMS (Physical Property Measurement System) in the temperature range of (2.04–292.38) K. The experimental heat capacity data below the glass transition temperature of 280.2 K (7.05 °C) were interpreted in terms of molecular motion and were linked to the vibrational spectrum of oligo-urethane structure. The presented approach applies the classical Einstein, Debye and Tarasov treatments using the ATHAS Scheme. The low-temperature solid heat capacity was estimated by separately approximating the group and skeletal heat capacities from their vibrational spectra. The group vibrational heat capacity was calculated based on the chemical structure and molecular vibrational motions ( N gr = 90) derived from infrared and Raman spectroscopy. The skeletal vibrational heat capacity contribution was estimated by a general Tarasov equation with thirty skeletal modes ( N sk = 30). The solution of this equation gave the values of characteristic Debye temperatures as: Θ 1 = 493.6 K, Θ 2 = 133.9 K, and Θ 3 = 51.6 K. The result indicates the existence of planer ( Θ 2 ) interactions in the oligo-urethane molecules, in addition to linear ( Θ 1 ) and special ( Θ 3 ) interactions, which are attributed to a possible branched structure mixed with the linear form of the oligomer. The total vibrational heat capacity, being the sum of the group and skeletal heat capacities, was extended to higher temperatures and analysed further. The liquid heat capacity of semi-crystalline aliphatic oligo-urethane was approximated from experimental data by a linear regression and was compared with the estimated linear contributions of polymers that have the same constituent groups and were expressed as C p (liquid) = 0.406 T + 428.5 in J·K −1 ·mol −1 . The solid and liquid heat capacities of oligo-urethane were applied as equilibrium baselines for advanced thermal analysis of the experimental, apparent heat capacity data. Using estimated parameters of transitions and solid and liquid heat capacities at equilibrium, the integral thermodynamic functions of enthalpy, entropy and free enthalpy as functions of temperature were calculated. [ABSTRACT FROM AUTHOR]

We had hoped that the Mais Médicos Program (More Doctors Program) would have generated several changes and reflections in each municipality in which it was deployed. In order to observe those changes, we sought to analyze the experience of Cuban physicians in the Mais Médicos program from an actor-centered perspective, based on the Paideia Method - an approach that seeks to enhance the ability of the subjects to analyze and intervene in their practice. We performed semi-structured interviews to analyze our research object that consisted in the experience of those actors included professionally in the Mais Médicos program in a metropolis with unique characteristics. In order to assess the interviews, we applied Content Analysis followed by Thematic Analysis. From the discourse of the actors, of which illustrative excerpts are transcribed in this article, we can affirm that the program's potential surpassed any initial barriers, presenting itself as fine-tuning instrument for replacing the biomedical model in line with the Paideia Method. [ABSTRACT FROM AUTHOR]

IMPORTANCE Hospitals are rapidly acquiring medical groups and physician practices. This consolidation may foster cooperation and thereby reduce expenditures, but also may lead to higher expenditures through greater use of hospital-based ambulatory services and through greater hospital pricing leverage against health insurers. OBJECTIVE To determine whether total expenditures per patient were higher in physician organizations (integrated medical groups and independent practice associations) owned by local hospitals or multihospital systems compared with groups owned by participating physicians. DESIGN AND SETTING Data were obtained on total expenditures for the care provided to 4.5 million patients treated by integrated medical groups and independent practice associations in California between 2009 and 2012. The patients were covered by commercial health maintenance organization (HMO) insurance and the data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid. MAIN OUTCOMES AND MEASURES Total expenditures per patient annually, measured in terms of what insurers paid to the physician organizations for professional services, to hospitals for inpatient and outpatient procedures, to clinical laboratories for diagnostic tests, and to pharmaceutical manufacturers for drugs and biologics. EXPOSURES Annual expenditures per patient were compared after adjusting for patient illness burden, geographic input costs, and organizational characteristics. RESULTS Of the 158 organizations, 118 physician organizations (75%) were physician-owned and provided care for 3 065 551 patients, 19 organizations (12%) were owned by local hospitals and provided care for 728 608 patients, and 21 organizations (13%) were owned by multihospital systems and provided care for 693 254 patients. In 2012, physician-owned physician organizations had mean expenditures of $3066 per patient (95% CI, $2892 to $3240), hospital-owned physician organizations had mean expenditures of $4312 per patient (95% CI, $3768 to $4857), and physician organizations owned by multihospital systems had mean expenditures of $4776 (95% CI, $4349 to $5202) per patient. After adjustingfor patient severity and other factors over the period, local hospital-owned physician organizations incurred expenditures per patient 10.3% (95% CI, 1.7% to 19.7%) higher than did physician-owned organizations (adjusted difference, $435 [95% CI, $105 to $766], P = .02). Organizations owned by multihospital systems incurred expenditures 19.8% (95% CI, 13.9% to 26.0%) higher (adjusted difference, $704 [95% CI,$512to $895], P < .001) than physician-owned organizations. The largest physician organizations incurred expenditures per patient 9.2% (95% CI, 3.8% to 15.0%, P = .001) higher than the smallest organizations (adjusted difference, $130 [95% CI, $-32 to $292]). CONCLUSIONS AND RELEVANCE From the perspective of the insurers and patients, between 2009 and 2012, hospital-owned physician organizations in California incurred higher expenditures for commercial HMO enrollees for professional, hospital, laboratory, pharmaceutical, and ancillary services than physician-owned organizations. Although organizational consolidation may increase some forms of care coordination, it may be associated with higher total expenditures. [ABSTRACT FROM AUTHOR]

The Meikirch Model of Bircher and Kuruvilla provides a new and very interesting definition of health and disease, based on a biopsychosocial framework and the idea of an interaction of an individual with social and environmental determinants of health. It is a modern systems approach, not only for acute, but particularly for chronic diseases. For this reason, I have adopted this analytic approach for conducting independent medical evaluations in the Swiss system of Social Security. [ABSTRACT FROM AUTHOR]

Data from a national study of medical groups and independent practice associations are used to examine the extent to which California physician organizations are different from physician organizations in the rest of the United States. California physician organizations are different in many ways: most notably, they are more likely to have external incentives to improve quality and more likely to use recommended care management processes for treating patients with chronic illnesses. The implications of these differences for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

Context: Organized care management processes (CMPs) can improve health care quality for patients with chronic diseases. The Institute of Medicine of the National Academy of Sciences has called for public and private purchasers of health care to create incentives for physician organizations (POs) to use CMPs and for the government to assist POs in implementing information technology (IT) to facilitate CMP use. Research is lacking about the extent to which POs use CMPs or about the degree to which incentives, IT, or other factors are associated with their use. Objectives: To determine the extent to which POs with 20 or more physicians use CMPs and to identify key factors associated with CMP use for 4 chronic diseases (asthma, congestive heart failure, depression, and diabetes). Design, Setting, and Participants: One thousand five hundred eighty-seven US POs (medical groups and independent practice associations) with 20 or more physicians were identified using 5 large databases. One thousand one hundred four of these POs (70%) agreed to participate in a telephone survey conducted between September 2000 and September 2001. Sixty-four responding POs were excluded because they did not treat any of the 4 diseases, leaving 1040 POs. Main Outcome Measures: Extent of use of CMPs as calculated on the basis of a summary measure, a PO care management index (POCMI; range, 0-6) and factors associated with CMP use. Results: Physician organizations' mean use of CMPs was 5.1 of a possible 16; 50% used 4 or fewer. External incentives and clinical IT were most strongly associated with CMP use. Controlling for other factors, use of the 2 most strongly associated incentives—public recognition and better contracts for health care quality—was associated with use of 1.3 and 0.7 additional CMPs, respectively (P<.001 and P = .007). Each additional IT capability was associated with 0.37 additional CMPs (P<.001). However, 33% of POs reported no external incentives and 50%... [ABSTRACT FROM AUTHOR]

Suggests recommendations on how to implement changes in physician practices. Articulating shared visions; Clarifying 'give and get' deals; Depreciating human capital; Ensuring visible sponsorship; Increasing the sense of urgency; Using feedback to keep the change on track.

Gives advice to physician supervisors on how to give feedback to the staff. Purpose of feedback; Use of the feedback sandwich technique; Importance of the quality of the criticism and praise.

Many employed physicians are being forced to consider entering the private practice arena as physician networks and groups are contemplating total or partial divestitures. Still other physicians are evaluating the possibility of leaving their current practice or hospital based network and opening their own practice. This article is designed to better prepare a physician for this situation ad proactively plan for their future. [ABSTRACT FROM AUTHOR]

Each physician group, network, or management services organization developed as part of an "integration" strategy over the past decade is unique. The current status of each of these entities is based on a variety of factors, including the local health care economy and environment, the sponsoring organization, and the entity's leadership. Much of the current news concerning integration initiatives is negative, and significant operating losses and the disillusionment of the participants have been reported. It is important to study the failures, however, for despite the unique factors impacting each one there are universal lessons to be learned in every case. This article chronicles the causes of one integrated group practice's breakup after five years of operation and the process undertaken to return the physicians to small independent practices. [ABSTRACT FROM AUTHOR]

Reports the libel suit filed by the Physician Management Companies in response to an anonymous messages on a Yahoo! Finance Website in the United States. Legal actions undertaken by PhyCor and ProMedco Management Inc.; Reactions of physicians and other alleged individuals to the case; Allegations of online defamation and insider trading in securities.

Examines the decision of United States hospitals and health care groups that built integrated organizations by purchasing physician practice management companies to break up. Reaction of physicians to the break up; Financial losses of the practices; Need for physicians and employers to consider their original objectives for integration.

Analyzes the for-profit transformation of health care with emphasis on Internet start-ups, physician practice management firms, insurance plans and hospitals at various stages in the industry life cycle. Forms of financial accountability that are distinct from those inherent in the capital sources available to nonprofit organizations; Variation in the pattern of for-profit conversions across health sectors.

Explores how acquisition-driven firms are valued in the financial markets and what structural factors may stand in the way of truly efficient valuation. Textbook models of securities valuation; Stock valuation in practice; Pyramidlike funny-money games as a factor driving the rise and fall of the physician practice management industry; Role of securities analysts.

Physicians increasingly organize strategically to mitigate the potentially adverse impacts of managed care on practice incomes. There are alternative routes to physician organizing. This article used a 1996-1997 survey of orthopedics and obstetrics-gynecology (OB-GYN) practices in Memphis, Tennessee, to investigate the determinants of specialty physician integration through physician practice management (PPM) firms. The percentage of managed care contracts indicates a weak but positive correlation with PPM integration. Different factors appear to influence the likelihood of integration in different specialties. [ABSTRACT FROM AUTHOR]

As physician organizations adapt their incentives, processes, and structures to accommodate the demands of an increasingly competitive and performance-sensitive external environment, the development of more effective administrative and managerial mechanisms becomes critical to success. The emergence of physician practice management companies (PPMCs) represents a potentially positive step for physician practices seeking increased economies of scale through consolidation, as well as enhanced access to financial capital. However, economic and finance theory, coupled with some empirical "arithmetic" regarding the financial and operational performance of leading publicly traded PPMCs, suggest caution in one's forecasts of the future prospects for these evolving corporate forms. [ABSTRACT FROM AUTHOR]

Discusses the future of physician practice management (PPM) companies. Disenchantment of investors; Loss of confidence among physicians affiliated in their groups; Need for correction of several fundamental flaws common to most PPM companies; Opportunity provided by the emergence of single specialty PPM in the 1990s.

Reports that family physicians in the United States are finding ways to bail out as physician management companies disintegrate. Includes taking back or buying back the practice; Entry into a joint venture; Importance to both independent and employed physicians of paying attention to profits. INSET: What's underlying the trend.

Discusses how physician practice management (PPM) can help clinics and hospital finances. Focus of the PPM; Estimated physicians that are partnering with PPM; How the growth of the PPM affect the financial well-being of not-for-profit hospitals. INSET: The power curve.

Context: Medical groups are growing and merging to improve efficiency and bargaining leverage in the competitive managed care environment. An increasing number are affiliating with physician practice management (PPM) firms that offer capital financing, expertise in utilization management, and global capitation contracts with health insurance entities. These physician organizations provide an alternative to affiliation with a hospital system and to individual physician contracting with health plans.Objective: To describe the growth, structure, and strategy of PPM organizations that coordinate medical groups in multiple markets and contract with health maintenance organizations (HMOs).Design: Case studies, including interviews with administrative and clinical leaders, review of company documents, and analysis of documents from investment bankers, the Securities and Exchange Commission, and industry observers.Setting: Medical groups and independent practice associations (IPAs) in California and New Jersey affiliated with MedPartners, FPA Medical Management, and UniMed.Outcome Measures: Growth in number of primary care and specialty care physicians employed by and contracting with affiliated medical groups; growth in patient enrollment from commercial, Medicare, and Medicaid HMOs; growth in capitation and noncapitation revenues; structure and governance of affiliated management service organizations and professional corporations; and contracting strategies with HMOs.Results: Between 1994 and 1996, medical groups and IPAs affiliated with 3 PPMs grew from 3787 to 25763 physicians; 65% of employed physicians provide primary care, while the majority of contracting physicians provide specialty care. Patient enrollment in HMOs grew from 285503 to 3028881. Annual capitation revenues grew from $190 million to $2.1 billion. Medical groups affiliated with PPMs are capitated for most professional, hospital, and ancillary clinical services and are increasingly delegated responsibility by HMOs for utilization management and quality assurance.Comment: Physician practice management organizations and their affiliated medical groups face the challenge of continuing rapid growth, sustaining stock values, and improving practice efficiencies while maintaining the loyalty of physicians and patients. [ABSTRACT FROM AUTHOR]

Analyzes the role of economic entity in the rapidly evolving health care sector, while highlighting physician practice management (PPM) companies. Role of medical groups and physician networks in the managed care system; Ways in which physicians can respond to changes being made in the health care sector; Details on the role of PPMs.

Opinion. Comments on issues pertaining to physician practice management (PPM) companies, with emphasis on changes made in the health care sector. Methods which can be used to improve the health sector; Attempts made by physician organizations to improve the sector; Reference to the role of PPMs.

Advises physicians in the United States on the steps which should be taken when a physician practice management company (PPMC) approaches them. Benefits of affiliation with a PPMC; Considerations to be made for a PPMC; Information on the importance of professional advice when dealing with a PPMC; Details on other precautions which should be taken. INSET: Wall Street, PPMCs and your practice.

Highlights the benefits of physician management companies in the United States. Generation of revenues from acquired practices and management service contracts; Availability of capital, expertise, information systems and access to managed care contracts; Offer of economies of scale in terms of employment benefits, malpractice insurance and purchasing. INSET: What PPMCs will pay..

During the 1964 Hearings on Physician-Ownership held by the Senate Subcommittee on Antitrust and Monopoly witnesses charged that certain medical doctors were establishing firms that purchased prepared drugs in bulk, packaged them, and then marketed the drugs in smaller quantities under brand names. Physicians with interests in drug repackagers would write prescriptions specifying brands marketed by their firms, and antisubstitution laws would prevent the pharmacist from using other brands. Critics of the practice argue that physicians purchase drug repackagers and tie drugs to extend their monopoly power into the ethical drugs market with the resulting foreclosure of independent firms. This paper argues that physicians purchase drug interests not to create a new monopoly, but rather to extract more monopoly profits from their original markets. But evidence exists that in doing so physician-owners impose a welfare loss on their patients. The paper concludes with an analysis of efforts made thus far to end the practice and suggests that amendment of state antisubstitution laws would make it more difficult for physician-repackager owners to tie drugs. [ABSTRACT FROM AUTHOR]

The article focuses on the use of physician management companies in the United States as doctors respond to the changing health care environment. Discussed are reasons why doctors are joining physician management companies, the services offered by PhyCor Inc. and other management companies, and the involvement of dentists in the management business. Dental businesses such as Professional Dental Associates in Natick, Massachusetts are utilizing management firms so they won't have to waste time on business management.

The article deals with the obligation of hospitals to determine fees imposed on patients in acquired physician practices and other hospital-based facilities in the U.S. and in Connecticut. Topics discussed include the legal basis for patient notification of hospital facility fee charges, the definition of a facility fee and the requirements of written notice to patients regarding these fees. The role of staff of physician practices in explaining the process involved in fees is also discussed.

Answers questions about medical practice. Includes a pediatrician joining a family group; Use of reciprocal billing arrangements; Impact of contracting a management service organization on the physician.

Focuses on physician practice management (PPM) companies in the United States. Requirements for success; Involvement of urologists in PPMs; Factors affecting the success or failure of PPMs; Benefits offered by PPMs to participating urologists.

The author reflects on the need for the physicians and the British National Health Service (NHS) to have a covenant for the benefit of the former. The author mentions the propensity of physicians to have mental illnesses because of their jobs. He cites the need of general practitioners (GP) for occupational health provisions.