Catch the Global Wave

What does the future hold?  I can’t be certainty. However, I do know leaders must be courageous, adaptable, and communicators for their followers. Many people fear the future and change. With globalization connected to America’s future, leaders need to also consider a worldview. Stewart Black, Allen Morrison, and Hal Gregersen, authors of Global Explorers, maintain that exemplar global leaders possess a keen interest in global business.

 Furthermore, business savvy becomes the word of the day because people must think globally and adjust activities on the local level as well as satisfying customers at all levels. Inquisitive person are also valuable on a global front because they are curious in the face of uncertainty.

Management strategists view these cultural shifts like movements of waves in an ocean.  Each successive wave of technology brings with it a corresponding value shift. Sadly, new technologies can bring giant leaps in productivity while expanding the moral decay of mankind.  For example, the Industrial Era ushered in a period of materialism, self-sufficiency, and the supremacy of man.

Currently, organizations are witnessing the explosion of information, advancement of communication technology, globalization, and the rising of knowledge workers. Globalization can even shift behavior. In the movie Slumdog Millionaire, 18-year old Jamal Malik is a slave to cultural trends. The movie demonstrated the impacts of globalization on diverse cultures in the world.

Herman Maynard and Susan Mehrtens, authors of The Fourth Wave: Business in the 21st century, suggest the following emerging trends: (a) shift in consciousness, (b) disenchantment with science, (c) inner sources of power, (d) spiritualization of humanity (e) anti-materialism (f) political and economic democratization, and (g) global unification

 Furthermore, today’s existent represents an integration of all dimensions of life and responsibility for all individuals in globalization; it also promotes the unification of the human race. If today’s organizations want to be competitive in the international market, they must learn to active survey the world that is around them. Therefore, modern leaders cannot afford to miss interpret the trends in this global market.

 What are some trends in your industry and how will it impact society?

 © 2010 by Daryl D. Green

 

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25 thoughts on “Catch the Global Wave

  1. In the industry of healthcare, one of the current trends is a group model for physicians. In the past 25 years the number of physicians in group practices has increased from 20% to a little more than 30%. Physicians have been notoriously known as independent and self-reliant. More and more physicians seem to be gravitating towards group practices. The reason physicians are “finding solace” in large medical groups is “a combination of economic, clinical and lifestyle issues (which) all have contributed to the growing importance and allure of large medical groups.” By joining group practices, physicians can have financial security and be able to take some vacation time since there are other physicians to cover their patients. These two things alone can lead to a decrease in stress for the physician.

    This trend does not indicate that solo practices will become obsolete though they may decline in number. “Most healthcare today is still rendered by solo practitioners or small groups.” For physicians and patients the positive of large medical groups is they “can deliver safety, quality and efficiency.” All three of which are vital to providing good healthcare.

    “30 Trends/Innovations to Watch.” Modern Healthcare. Vol. 36, p58-82.

    • Health care costs continue to rise rapidly in the U.S. and throughout the developed world. Total U.S. health care expenditures are estimated to have grown to $2.6 trillion in 2010 we are in a period of dramatic change. In analyzing the major trends affecting health care in this country — trends that impact the cost, access and quality of health care — it is important to understand that the forces which led to the recent national debate over health care reform have not gone away. While the threat of government intervention prompted private insurers and providers to take action, the situation is expected to get worse.
      global competition for paying patients, increased costs, expected growth/volume decline, shift from inpatient to outpatient, proposed legislation forcing hospitals to absorb costs for adverse events that occur during a patient’s hospitalization, a more informed consumer, increased transparency of quality outcomes for hospitals, evolution of “retail clinics,” workforce challenges, etc. No need to go through the whole list – you get the point! While many of these issues have challenged hospital leaders for several years, it’s probably safe to say that a “perfect storm” type scenario is on the horizon, whereby all of these are impacting hospitals simultaneously. Which issue do we spent the majority of our time focusing on first? How do we manage this change going forward? Regardless of our focus, I just wanted to share this “Leading through Disruptive Change” statement, as I think it’s a perfectly appropriate label for our efforts in healthcare at the moment.
      Reference: http://www.cdc.gov/nchs/data/misc/healthcare.pdf

  2. The trends in healthcare make national headlines every single day in virtually every media outlet known to man. It is constantly discussed at schools, barbershops, dinner tables and the topic makes up part of the agenda of every political candidate. There is no doubt that change will come to health care. The debate, however, is just what form it will take. A nationalized approach to healthcare would significantly impact both physicians and third party payers alike. Many claim that nationalized health care will significantly curtail rising healthcare costs, put regulation on insurance companies, and provide care to thousands that cannot afford it. However, many experts including physicians and industry experts believe that such a movement will place many hurdles between the patient and physician and do little to nothing to control costs. With the government controlling the amount and type of coverage a patient receives, many feel that the level of care the average patient receives will decline. Furthermore, nationalized medicine does not address the issue of illegal immigrant being covered in such a plan. This will most definitely add incalculable costs.
    There is no doubt that the healthcare system is broken. Skyrocketing costs place the system as a whole is serious peril. But the consensus claims that a case for nationalized healthcare does not address the appropriate problem. Regardless only time will show the future face of healthcare.

    Reference:
    http://www2.timesdispatch.com/business/2010/jun/27/hlth27s5-ar-232455/

    • I agree with you that the premise of the health care debate has been about who will be paying the bill, while the real question is controlling the cost. Physicians and the Industry must essentially do the impossible: decrease costs while at the sometime increase satisfaction. Many industry analysts recognize that consumer expectations for health care are increasing in both developed and developing countries. This creates a scenario where Physicians will be forced to do more with less. In order to solve this problem, entrepreneurs must view this trend as an opportunity and collaborate to create value in the medical encounter. Perhaps through service and product bundling, patients could receive additional services from other industries while at the same time receiving health care.. What if for every dollar you spend at your doctor’s office located in Wal-Mart you received a 20% discount on all merchandise purchased there. This type of pricing structure could create value for the patient and thus increase satisfaction while decreasing cost by maximizing economies of scale.
      1. Woolhandler, S., M.D., M.P.H., Campbell, T., M.H.A., & Himmelstein, D. U., M.D. (2003). Costs of Health Care Administration in the United States and Canada. New England Journal of Medicine, 349(8), 768-775.

  3. Electronic Medical Records or EMRs is currently being pushed by the federal government in an effort to assist in the streamlining of medical care. It has been met with some resistance in medical practices with an established paper system already in place. There was also a concern that the computer would create a barrier between the patient and the physician with decreased eye contact, etc. In a 2006 survey of patients in a Headache clinic found that overall patients found the EMR system more efficient, contributing to better care, leading to less medical mistakes, and easier with printed prescriptions. There may be some need for specialized forms within the EMR to reduce keyboarding and screen staring time for physicians while in the interview with a patient.

    Freedman, Marshall C, MD, Taylor, Anne P, BA, Adelman, James U MD. Electronic Medical Record System in a Headache Specialty Practice: A Patient Satisfaction Survey. Headache 2009;49:212-215.

  4. Cisco HealthPresence revolutionizes healthcare access through global and local telemedicine. One-stop convenience for direct consultation to specialists will modernize access and continuity of care. Cisco also projects that their HealthPresence services will be accessible via future, but standard, home technologies such as HD monitors, web cams, and high speed access to the internet (therefore a patient won’t even need to leave their home to consult a physician). Furthermore, Cisco chairman and CEO, John Chambers, promises that HealthPresence will create jobs and buffer the 160,000 shortfall of doctors.

    The San Jose pilot results, conducted by United Health Group and Cisco in 2008, determined HealthPresence’s usefulness as an alternative to in-person doctor’s visits. WellPoint Systems, a possible competitor to Cisco’s HealthPresence, are delaying a launch date until they deem general public valuing telehealth as a sound technology rather than a work in progress. Although, the San Jose pilot study participants were overwhelmingly positive, revealing that 97% were able to communicate effectively with healthcare providers, 98% were comfortable with the technology, and 90% would recommend the service to others.

    Reference:
    Barker, Christopher. “Cisco Telemedicine Pilot Program Demonstrates a New Way to Deliver Health Services Across the Globe – Cisco News.” Cisco. 2009. Web. 14 July 2010. .

    • I see many problems with telemedicine. One aspect is liability. Glenn W. Wachter in his article Malpractice and Telemedicine Telemedicine Liability: The Uncharted Waters of Medical Risk, that medical negligence first requires that a patient-physician relationship be established that further sets the stage for the patient to take advice from the physician that results in a bad outcome. In telemedicine, a mere email or phone call establishes such a relationship holding the physician liable, even if the physician does not have all of the information regarding the patient. Increasing patients’ access to healthcare through telemedicine could then further increase such litigation. To complicate this even further, litigation could then be carried out both in the state of the patient and the state of the physician. This is just one negative aspect of telemedicine that I foresee.

      http://tie.telemed.org/articles/article.asp?path=legal&article=malpracticeLiability_gw_tie02.xml
      Malpractice and Telemedicine Telemedicine Liability: The Uncharted Waters of Medical Risk
      By Glenn W. Wachter, July, 2002

    • The current expansion of telemedicine will allow the delivery of high quality medicine to patients not just in America but globally. In addition it will bridge the gap between labs, hospital management, and physician practices. As Charles stated, the growing availability of HD camera’s, broadband internet, and webcams will level the playing field in providing global access to care. In addition, the availability of portable, low cost diagnostic equipment will provide accurate and real time monitoring capabilities to the remote client such as Bluetooth Pulse Oximeters and blood pressure cuffs. Medical procedures and medical vacations are on a significant rise relegating the U.S. health-care system to what the Japanese auto industry did to American carmakers,” says Princeton University healthcare economist Uwe Reinhardt. However, we now have an ability to reach across continents to provide the best medical care to the world. While there are some stepping stones as Taralyn stated, however we would be missing a great opportunity to provide care, decrease medical costs, enter emerging markets, and globalization if we didn’t embrace this technology.

      Sources:
      http://www.time.com/time/magazine/article/0,9171,1196429,00.html#ixzz0tj03EEzO

      Top ten health industry issues in 2010 (December 2009)
      c/o Price Waterhouse Coopers

      Sources:
      http://www.time.com/time/magazine/article/0,9171,1196429,00.html#ixzz0tj03EEzO

      Top ten health industry issues in 2010 (December 2009)
      c/o Price Waterhouse Coopers: http://www.pwc.com/us/en/healthcare/publications/top-ten-health-industry-issues-in-2010.jhtml

  5. Liebert states that telemedicine applications will play an increasingly important role in health care and provide tools that are indispensable for remote patient monitoring and disease management that encompasses not only rural health and battlefield care, but nursing home, and global/culturally relevant care. Essentially, patients will have more choices. Advances in technology including wireless connectivity and mobile devices will give practitioners tools for managing patient care, electronic records, and medical billing to ultimately enable patients to have more control of their own well being.
    According to Mucic, a telemedicine project was conducted to improve access to culturally appropriate care providers by the use of videoconferencing. A self-completed retrospective questionnaire survey was conducted with asylum seekers, refugees and migrants. The purpose of the referral was either for diagnostic assessment with a subsequent treatment recommendation, or for treatment via telemedicine. A total of 318 telemedicine sessions were conducted. Nine languages were spoken during the study. Patients reported a high level of satisfaction and willingness to use telemedicine again and recommend it to others. They preferred telemedicine via their mother tongue, rather than interpreter-assisted care. Like it or not, telemedicine is looming strong on the horizon in this global market.

    Mucic, David. “Transcultural Telepsychiatry and Its Impact on Patient Satisfaction — Mucic 16 (5): 237.” Journal of Telemedicine and Telecare. July 2010. Web. 14 July 2010. .

    Telemedicine and E-Health.” Mary Ann Liebert, Inc. The Leading Publisher in Biotechnology. Web. 15 July 2010. .

  6. Undoubtedly, good and thorough medicine takes time, which is unfortunately coupled with our societies increase in need and decrease in patience. With the nature of modern medicine in America, many patients are left feeling unsatisfied. It can be surprisingly difficult for a patient to really get a thorough and efficient visit with a doctor. Often, the visit requires long waits and a stressed-out office. I think people will begin to look at the advantages of concierge medicine with a serious regard for its implications. Unfortunately, this service comes with a price tag that many believe limits the accessibility to only the ‘rich’. However, the goal is not to make money, but to be able to provide better and more preventative healthcare while minimizing the frustrations among patients with the current system. Internist Richard Goldman said, “It would be nice to provide this level of care to everyone, but, until the system changes, I think this style of practice is a very viable option for both patients and doctors.” I think if organized appropriately, this could help shift our idea modern medicine to focus on more preventative principles, which could help reduce the cost of medicine.

    Reference: Guglielmo, W. How to set up a concierge practice. Medical Economics. Aug. 22, 2003. http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=112475

  7. The progression of medicine requires that every that every practitioner be well attuned. From an ever increasing field of physician substitutes to integration of electronic medical records plus increased governmental regulations, there are major trends developing.
    PAs and NPs are pushing for greater autonomy. This is exacerbated by the fact that there is a shortage of physicians around the nation. A potential increase in the scope of practice of these professions can relegate physician and possibly put patient in a position of having to see one only when they need a specialist.
    The electronic age is upon us and health organizations are now moving to computer based medical records. This can be beneficial to patients since their medical history and current medication can be readily accessible to any practitioner. As mentioned by Dr. Bill Crounse, “A well planned, carefully executed strategy for electronic medical records can make healthcare service delivery more satisfying and efficient, improving our working relationships with one another and with our patients.”
    Another major trend in healthcare is a forceful push from third party payers to substantially reduce cost. But caution must be exercised not to reduce the quality of care at the expense of the patients.

    Cited Sources:
    Crounse, Bill. Electronic medical records: The right medicine for an ailing healthcare system. Microsoft Healthcare Providers. November 22nd 2005.
    http://www.microsoft.com/industry/healthcare/providers/businessvalue/housecalls/emr.mspx

  8. I believe that one trend in the medical industry is that many primary care physicians are moving towards concierge medicine. This gives the physician the opportunity to offer an enhanced level of care for an annual fee or retainer, which allows the patient to practice a higher degree of freedom and customization in their own healthcare. A wide range of services are offered, and spread from very affordable to highly expensive which depends on the level of care one demands. I believe it will greatly impact our industry in a positive manner in many ways. One way is that it will influence a greater number of primary care physicians into the market. Also, I feel that it will help the people who are denied service even though they have medical insurance since they will be able to afford and use this service. Since concierge service will only provide healthcare for those who can afford it, physicians will not be overwhelmed by patients lacking the ability to pay, and therefore be able to supply the care that each of their paying patient’s deserves.
    1.) That, Doing. “Forming a National Society of Concierge Physicians.” Physicians News. Web. 15 July 2010. .

  9. I think Yaya brings up an important and almost alarming trend in healthcare with increasing dependence on PA’s and Nurse Practitioners for primary care responsibilities. Not in any way to downplay their value or competence, but we should be concerned with the fact that many new doctors are avoiding primary care for various reasons. With some obvious bias, I feel that doctors should maintain a leading status in the practice of primary healthcare because of its need to draw on copious experience and clinical practice. By manipulating the system to increase attractiveness of primary care to physicians, we could see a better mesh of doctor, PA, and NP care that would help satisfy patient needs. In a recent study, it was concluded that, “Joint educational events and the development of General Practitioner preceptorship may help to develop a greater understanding of the potential value of advanced nursing roles in general practice.” I would suggest that the primary healthcare field not be turned over to NP’s and PA’s, but rather, more effort be focused on the integration of each. This would allow each to combine strengths and cut down on weaknesses.

    Reference: Wilson, A. Pearson, D. Hassey, A. Barriers to developing the nurse practitioner role in primary care- the GP perspective. Family Practice. Vol. 19, No. 6, 641-646. http://fampra.oxfordjournals.org/cgi/content/abstract/19/6/641.

  10. One of the biggest trends emerging in healthcare currently is the switch to electronic medical records. Even though EMR offer advantages in efficiency and communication to paper records, the switch has been slow for many medical offices and hospitals. According to the Wall Street Journal, there are currently only 10% of hospitals and 20% of doctors use a electronic medical record system. The reason why many medical services have not been able to make the switch to EMR has been because of the cost associated with not only the installation and set, but with the conversion of current paper documents to electronic records. However, this switch has been more cost friendly with the recent change in requirements for government funding. To receive federal funds for conversion to EMR systems, healthcare organizations had to meet certain requirements. These requirements have been reduced to allow more medical practices to take advantage of these federal funds. With the government providing more funds, the switch to EMR is not only more inevitable, but is likely to happen at much sooner time than expected.

    Adamy, Janet. “US Eases Funds to Adopt Electronic Medical Records.” Wall Street Journal. 13 July 2010. Web. 15 July 2010. .

  11. A current healthcare trend is physician super-specialization. With private practice NPs and PAs posing a threat as they veer toward autonomy, they are also slowly diminishing the incentive that physicians have to stick to the basics. This also explains the shortage of PCPs in healthcare. As leaders in healthcare, physicians must be courageous and reclaim an area of medicine that is vital yet recent trends are reporting dismal numbers. As leaders, physicians need to adapt to the swaying away from primary care and other changes currently being experienced in the field. And finally physicians need to communicate amongst each other that there is an imbalance in the field. There is hope as the Bureau of Labor Statistics predicts there will be 212,000 physician openings by 2014 due to growth and net replacement of retiring physicians.

    Literature Cited
    Moore, Pamela. Physician Shortage: Disappearing Docs.
    http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/888.htm

    • With the Baby Boomers nearing the age of retirement , there will be increased demand for PCPs, which will not be met as the upward trend of medical school admissions does not yet parallel the rising US population. In essence, long office waiting times and long drives to be seen by a PCP aren’t going anywhere.

  12. The electronic medical record is one of the hottest topics in health care today. Many hospitals and private practices have had to go through a rather painful transitional period converting from paper charting and medical record keeping to complete electronic based systems. In his blog Michael Lake reports of hospitals and private practices integrating their electronic medical records. In fact, big companies like Dell and GE health care are investing large sums of money into developing systems such as these. This creates a possibly new trend in the operation of physicians. Are physicians going to be forced to integrate their services with that of hospitals in order to say within the loop of information? Another interesting trend is the move towards more hospital based physicians known as “hospitalists.” These are employed by the hospital and thus do not have to deal with the stress of owing a private practice. According to the Forth Worth Business press of January 14 2008, patient stays are reduced when hospitalists are involved in their care. This is essentially a win win situation as both the physicians and society stands to gain.

    http://www.fwbusinesspress.com/display.php?id=6904

  13. The primary trends that physicians will be facing in the near future are decreased reimbursement rates for Medicare and Medicaid, the movement to electronic health records (EHRs), and an increasing age of the general population. While all of these will tremendously impact the healthcare industry, the movement to electronic health records will have one of the biggest impacts on osteopathic medicine. Rural hospitals, where many osteopathic physicians will be working, are going to get hit the hardest since they are already limited on the amount technology and funding available. Once these changes have been implemented, the physician/patient relationship might suffer due to the decreased interaction with the patient due to more time required to enter data into the computer. Stuart Quan M.D. states that EHRs “promote less personal interaction with patients and families because of the time required to input all of the requested information as well as the time needed to login to the system throughout the day.” This could very easily result in decreased patient satisfaction and a perceived reduction in the total quality of healthcare. EHRs are a great example of how disruptive change can result in many obstacles to be overcome in the future.

    Reference:
    Quan, Stuart. “The Electronic Health Record: The Train is Coming.” Journal of Clinical Sleep Medicine. 2009 April 15. 5(2): 101.

  14. In the field of healthcare, the aging population has always been and continues to be cause for concern and reevaluation of forecasting strategies. Since the 1990’s it has been known that we cannot sustain our current system growing at this rate. In the article, “The Aging of America,” Schneider and Guralnik make a case for the enormous escalation in the cost of Medicare, nursing homes, dementia, and hip fractures. They go on to state that Medicare costs for those 85 years and older may increase six fold by the year 2040 (in constant 1987 dollars). The current administration is attempting to deal with this issue, but only time will tell the negative economic impact of problem and possibly even the solution.

    Schneider, Edward L. and Jack M. Guralnik, “The Aging of America: Impact on Health Care Costs.” JAMA. 1990;263(17):2335-2340.

  15. There are many trends in the healthcare industry. Many of these trends are hurting the physicians and healthcare workers. The profession as a whole is being compromised by many of these trends. Such trends include the ever increasing number of uninsured and underinsured. This area is dynamic: changing every few years. Another trend is the shortage in healthcare workers. While this could be viewed as an opportunity for others, it causes much unneeded stress to current workers of healthcare. Other trends included unions, downsizing, insurance consolidations, telemedicine, and the list goes on. There are other trends such as electronic medical records, and pay for performance trends that also seem to be making ground. Nevertheless, these are trends and may develop into full blown models for the future of healthcare.

    Source:
    mastersinhealthcare.org/2010/17-healthcare-trends-that-are-actually-bad-for-us/

  16. Obesity Epidemic
    Michelle Schmitz
    A trend that is emerging in the United States healthcare system is that more and more people are suffering from obesity related illness. If two out of every three adults is obese or overweight the healthcare consequences are reaching farther than one would think. The most obvious of these healthcare problems is type two diabetes and heart disease but there are also people with disabilities because of knee, back and hip injuries from carrying around extra weight. Some experts are calling for a shift in research funding from cancer to heart disease and diabetes because of the effectiveness of the research. Obese people on average die earlier than non-obese people and when the shorter life span is accounted for obese people they spend more on healthcare than non-obese people. The obesity epidemic is a trend that must be dealt with in America because it affects more than just the healthcare system it effects occupational health, life expectancy and disability payments.
    Bibliography
    Ruhm, C. J. (2007). Current and Future Prevalence of Obesity and Severe Obesity in the United States . Forum for Health Economics and Policy , 1-26.

  17. The U.S. is currently experiencing a great healthcare shortage that is estimated to worsen enormously as the majority of physicians will be retiring soon in addition to the expected increase in need of healthcare. A current trend is to turn to Nurse Practitioners and Physician Assistants to lighten the patient load of primary care physicians. The Medical Journal of Australia comments on our new trend in the following, “With the shortage of physicians interested in general medicine, medical systems are increasingly turning to PAs and NPs to shoulder the burden of primary care. While this may not have been the intent of early policymakers, the reality is that PAs and NPs may be the only resource available in the near future”. PAs and NPs were not trained to take on the role assigned to them by mini clinics that are attempting to quickly fix our healthcare crisis. Providing adequate and superior healthcare is a team effort, and the roles of NPs and Pas are essential, but they should not be thrown into the same position as a physician who was trained much differently. This is a band-aid approach that I feel may leave patients hesitant to pursue future medical care.

    Hooker, Roderick S. “Physician Assistants and Nurse Practitioners: the United States Experience.” Medical Journal of Australia, Vol. 185, No. 1, July 2006. https://www.mja.com.au/public/issues/185_01_030706/hoo10101_fm.pdf.

  18. There are many trends in medicine that are developing. Some patients are going towards point of service, so they pay cash for medical consults at a discounted price. These patients still keep catastrophic coverage, but they rather manager their primary care issues without an intermediary in between: Insurance companies.

    On the same note, concierge medicine seems to be on the rise. Wealthy patients do not want to deal with a physician who rarely has time for them. Another reason why patients may choose this method for their medical care may be the need for privacy since they are mostly high-profile patients in the Hollywood or Business arena.

    The biggest trend that will occur is the new healthcare bill. We would have to incorporate the new healthcare law into our consideration. There is already a very low supply of physicians. There was an already estimated shortage of physicians because the baby boomers will be retiring soon. Now, with the new healthcare law, there will be an additional 30 million newly insured people looking for medical care they could not access before. With all of these factors, Physician Assistants and/or Nurse Practitioners will play be playing an increased role in our medical clinic and we would be only allowing more complicated cases being assigned to the actual physicians (Health care reform a golden opportunity for nurse practitioners, 2010).

    Works Cited

    Health care reform a golden opportunity for nurse practitioners. (2010, June 25). Retrieved July 16, 2010, from Capstrat: http://www.capstrat.com/insights/blog/reform-golden-opp-for-NPs/

  19. Some of the current trends that are seen in the healthcare industry are: increase in cost, increase in elderly population/chronic conditions, increase demand for PCPs, and increase technology.

    All the trends seen are intertwined with each other; one trend affects the next-society sets the trend which then affect society itself. For example, the increase in the elderly population would mean that there is an increase in chronic conditions since most of the chronic conditions are brought on by age. Increase in chronic conditions means patients will require long term care which in turn means increase in cost of healthcare. As most of the elderly population relies on the government to pay their healthcare expenditures, the government with intention cut cost and to provide care to may will regulate many aspects of the healthcare industry which will affect mostly small practice providers. One interesting trend is the shift from private to hospital base practice which Anne Sharamitaro mentions in Trends in Physician Practice Settings: Shift from Independent Private Practice to Hospital-centric.

    Sharamitaro, Anne. “Trends in Physician Practice Settings: Shift from Independent Private Practice to Hospital-centric” Health Capital. February 2010.

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