THE SHIFT TOWARD A MANAGED CARE ENVIRONMENT IN A MULTISPECIALTY GROUP-PRACTICE MODEL - LOOKING FOR RECIPROCAL BENEFITS

Managed care is notably affecting the practice of surgery in the Unite d States. Four principal elements are subject to change: (1) patient c are patterns, (2) ethics, (3) education and research, and (4) surgeon compensation. The Virginia Mason Clinic, a multispecialty group practi ce, is adapting to the demands of managed and capitated care. With the patient as the primary focus of effort, the goal is to create optimum value in health care. The principles of Continuous Quality Improvemen t are used to increase value in health care by ensuring appropriate tr eatment with optimum outcome at reasonable cost. Practice patterns are shifting to provide value to patients and payers. Ethical conflicts t hreaten but have been avoided. Surgical education remains unaffected, but future funding is problematic. The emphasis in surgical research h as shifted reward outcome-based studies. The conflict between work eff ort and resource conservation as determinants of physician compensatio n is less for surgical than for medical practitioners. Although the pr incipal benefactors of the shift toward managed care have been the pay ers, patients have gained modestly through efficiencies in the health care process and more stable insurance premiums. The satisfaction leve l of the surgeons in our multispecialty group practice remains high. S urgical research is thriving, volumes and case mix remain excellent, a nd changes in practice pattern have enabled us to increase efficiency without compromising patient care.