The "clinics without walls" controversy

We began this article with the report from the Washington-based Health Care Advisory Board that "clinics without walls" are a "recipe for failure". But the analysis we've done indicates that the so-called "clinics without walls" may become the single most frequent format for new medical groups throughout the country. In some markets, hospitals and physicians simply don't have a viable alternative. The "clinic without walls" concept may just be a half-way house for fully integrated groups. If it is, then failures among "clinics without walls" should be viewed as simply failures of groups to gel. They shouldn't be viewed as the failure of a model for integration. In fact, any attempts by physicians to organize in our highly volatile industry should be viewed as a positive. The organizing physicians at least have a shot at survival and are not waiting to become casualties of managed care or healthcare reform. The variations in the three models we analyzed all seem to boil down to the extent the individual physician trades independent decision-making for the benefits of the larger group structure. In the adjacent table, we've attempted to highlight key issues and the decision-making authority in each of the three models. We've also suggested objectives that can be achieved when decision making authority is delegated by the physicians to a central board and management. Very clearly, it's important to address all of the issues in the table early in forming a "clinic without walls".(ABSTRACT TRUNCATED AT 250 WORDS)