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Citing data collected between 1987 and 1994 at the St. Paul-Ramsey Medical Center, Ramsey Clinic and Ramsey Foundation, Paul A. Sommers, Ph.D., executive vice president and chief administrative officer of Ramsey, Michael G. Luxenberg, president of Professional Data Analysts, and Eric. P. Sommers of the River Falls Clinic, write how CQI has been introduced. The key is the application of inferential evaluation.

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This article describes the results made by Ramsey Clinic during the second year following consolidation of the Clinic with a Hospital (St. Paul-Ramsey Medical Center); a medical education/research Foundation (Ramsey Foundation) into a public benefit corporation (Ramsey HealthCare, Inc.). Many issues inspired Ramsey Clinic to examine ways and means to stabilize its growth and development as a multi-specialty physician and dentist group practice in the highly competitive health care environment of Minneapolis-St. Paul, MN. Influencing the need to change were such elements as shrinking reimbursement for physicians from government and other third party payers; increasing malpractice and general liability premiums; as well as, escalating competition among area health care providers reflected by significant variations in charges for similar services and exclusivity agreements with HMO's and PPO's for select services. In the fall of 1987, Ramsey Clinic consummated its consolidation as a subsidiary member of Ramsey HealthCare, Inc., a public benefit corporation established by an Act of the Legislature of the State of Minnesota, 1986 Laws of Minnesota, Chapter 462. As a public benefit corporation, Ramsey HealthCare, Inc. was chartered to "engage in the provision and delivery of health care and related services." Ramsey Clinic serves as the physician organization for the corporation. An article appeared in the March/April 1989 issue of the Group Practice Journal titled "A Natural Partnership" which described the Ramsey approach and illustrated 1988 results following consolidation. Continued change has resulted in further integration of services among the subsidiaries with a focus on expense reduction, revenue enhancement and increased operating efficiencies. This article provides a longitudinal follow-up on operational amalgamations and 1989 results.

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This article describes the progress made by Ramsey Clinic during the first year following consolidation of this unique health care service in the highly competitive health care environment of Minneapolis-St. Paul, MN.

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Physicians must recognize the contemporary role consumers play in the delivery process. Although it is common knowledge that without consumers there would be little need for the elaborate health systems in existence today, few physicians actively plan for, implement and systematically evaluate services delivered. The rising cost of malpractice insurance in this age of spiraling materials and equipment expense, is forcing more physicians to consider better ways of serving and keeping their patients. This article describes one approach, consumer satisfaction.

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A comprehensive perspective is essential to properly manage medical services for patients with multiple needs. For optimum care, all service aspects must be coordinated and a program format developed to meet individually identified needs. The Gundersen Clinic in LaCrosse, Wisconsin, has designed and implemented comprehensive care programs for two very different patient populations: children with special health and education problems, and the elderly. Many important aspects of a comprehensive care program are examined here, including ease of accessibility and follow-through, cost consciousness, staffing and space considerations, the administrative structure, marketing techniques, and evaluation procedures.

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The organized management of medical services provided to special children can influence: The development of a coordinated follow-up plan for each child; reduced costs for parents by avoiding the duplication of tests and unnecessary trips to the doctor; and, increased referrals once it becomes known that services are being provided with the consumer in mind.

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Comprehensive health care planning can augment the educational programming for children with exceptional health and/or learning needs. The coordination of medical service and education is critically needed to reduce the traditional gulf between these two essential disciplines. Bridging this gulf will enable patients and their families, referral sources, and providers to collectively profit from the effort.

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