CONSIDERATIONS – Class 6

1. Role play. Depending on the number of participants create at least three groups with four to five participants per group. Assign each group a role. Have only one group as Physician Group One as the Patient’s Doctor and only one group assigned as the Physician Executive. Have one or more groups, depending on the number of participants, with at most four to five persons per group, assigned to a Physician Group “Number” to share in the bonus, withholding pools of money. For example, if there are sixteen participants, create four groups and assign each group one of the following roles: Physician Group One – Patient’s Doctor, Physician Group Two, and Physician Group Three- Part of shared pool with each other andPhysician Group One, and assign the fourth role of Physician Executive. Each group will have the same scenario as specified below. Each group will appoint a recorder to take notes of the discussion of this scenario from their assigned perspective and will discuss amongst themselves prior to rejoining as a complete full group of sixteen. Then join back together as one group and there will only be one person from each of individual group presenting their role.

Each group (4 – 5 adults) appoints a recorder to take notes of the discussion so that at the end of class there is only one speaker for each group.

Role play a meeting of four parties:

(1) physician group one

(2) physician group two

(3) physician group three

(4) medical director
From your assigned perspective discuss the following scenario:

A patient wants some very costly medical treatment for cancer that had metastasized. The treatment would cost $140,000.00 for surgery involving bone marrow transplant that generally offers no more than a one -in -four chance of survival. This treatment is considered experimental by this patient’s HMO and the HMO initially denies paying for the cost of medical treatment, even though the HMO had granted the same costly procedure for two other patient’s who can testify as living proof that the treatment might work.

Physician Group One seeks an exception from the HMO medical guideline rules. Physician Group Two and Physician Group Three would be effected by the HMO granting an exception because the money for the services would come out of a shared pool between these three physician groups. Such an exception would reduce all of the physician group’s bonus at the end of the year.

Role play joint meeting:

(1) Physician Group One – as patient’s doctor, present request for exception to medical guidelines.

(2) Physician Group Two as part of a shared pool with physician group one, present response to physician group one’s request.

(3) Physician Group Three as part of a shared pool with physician group one, present response to physician group one’s request.

(4) Physician Executive – create criteria for basis to make decision.
2. If you were the medical director of a HMO how would you handle the following situation: Your HMO uses medical practice guidelines that are required by the contract with providers and you have a provider who consistently deviates from the guidelines.

3. What are the advantages and disadvantages working as an employee of a managed care organization.

4. What skills must physicians acquire to become effective leaders and managers.

5. Do you think medical groups with physician owners should apply the concepts of a medical director position for their own practice? Explain your answer, listing the advantages and disadvantages of this approach.

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