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The human serum antibody response to polypeptides of human immunodeficiency virus type 1 (HIV-1) was quantitated by reflectance densitometry of Western immunoblots by using two commercially available blotting systems. In one system, human antibodies were detected by an avidin-biotin method using peroxidase as the label, and in the other, human antibodies were detected by peroxidase-labeled conjugate against human immunoglobulins. When staining intensity was plotted against the log of the serum dilution, a shallow slope was evident, with a 50% change in staining intensity requiring as much as a 100-fold change in antibody content. The linear range of the staining intensity curves was frequently found in serum dilutions of 1:2,500 to 1:1,000,000, and a plateau was often observed at high antibody concentrations (1:80 to 1:640). When replicate strips were tested, staining intensities varied by +/- 7 to 37%. Antibodies to p24gag and gp160env were readily detectable in several sera diluted 1:1,000,000, a result seen with both blotting systems. If Western blotting were to be used to observe increase or decreases in levels of antibodies to various polypeptides, several widely spaced serum dilutions would need to be tested.

Many healthcare organizations established physician networks to strengthen their competitive position in the marketplace. Many of these networks, however, have been unprofitable. As a result, some healthcare organizations are dissolving their networks. Healthcare organizations should plan the dissolution carefully and help the physicians establish an infrastructure for their new practices. By easing the physicians' transition to independent practice, healthcare organizations ensure the likelihood of a continued business relationship with the physicians in the future.

In the mid-1990s, Meridia Health System, a hospital system in the Cleveland, Ohio, area began acquiring primary care physician practices to form the core of an integrated delivery system to compete with other providers in the area. Unfortunately, the structure of the physician compensation plan for Meridia's new physician employees caused productivity to decline and losses to mount. Meridia appointed a task force that included physicians to develop a new compensation plan that bases pay on the application of a collection rate percentage to each physician's gross fee-for-service billings. While not perfect, the new compensation plan is helping both Meridia and its physicians achieve their mutual goals of high-quality care, reasonable productivity, and operating efficiency.

A physician network audit is one way to evaluate the strengths and weaknesses of a network's performance in five key areas: practice operations, financial management, strategy and vision, managed care readiness, and organizational governance. An objective, comprehensive audit can help identify real versus perceived problems that are troubling a network. Then steps can be taken to align incentives and improve operating results.

The intermediate tax sanctions create significant concerns for tax-exempt healthcare organizations that seek to integrate practicing physicians through practice acquisition or employment. The sanctions will force not-for-profit healthcare organizations to examine both the strategic and business implications of the dollars they have committed to practice acquisition and physician employment. The sanctions also should motivate organizations to reexamine their existing physician compensation arrangements, which may be creating negative incentives for practice productivity.

Clyde Hardy's contributions to the field of medical group management have been many. He earnestly served the Bowman Gray School of Medicine for 43 years until his retirement in 1984. Mr. Hardy also made many contributions to the Medical Group Management Association--as president of both MGMA and ACMGA. Members will remember his excellent, down-to-earth presentations. During the MGMA annual conference in Hawaii in 1984, attendees were honored, entertained, and inspired by the wit and wisdom of this friend as he looked back on his experiences as a medical group manager. The words he spoke will long ring in the memory of those fortunate enough to be witness. The first in a trilogy of MGM articles focusing on the manager's look back, this article is taken from the text of Mr. Hardy's October 1984 presentation.

By broadening your knowledge of healthcare delivery systems, you can grow as a healthcare administrator and play a larger leadership role in healthcare planning for the future at the local, state, and even national levels. Overseas conferences sponsored by the American College of Medical Group Administrators (ACMGA) provide a unique opportunity for detailed exposure to the healthcare delivery systems of other countries. An abstract of papers presented at the ACMGA 1981 conference in Munich has been prepared by the author, sketching an outline of the history, organization, problems, and future trends of medical care in the Federal Republic of Germany.

A university-affiliated hospital faced increasing patient demand to minimize or eliminate traditional medical and institutional involvement in labor and delivery. To develop appropriate responses to this demand, the hospital established a committee that included professional practitioners and consumers. Responses developed by the committee included a "home-style" labor and delivery room, more liberal visitation policies, and revised medical procedures. Through a series of compromises, the committee was able to meet patient demands while maintaining the benefits of medical and institutional care.

While physicians leave a medical group for a variety of reasons, a key to preventing physician dissatisfaction is honest communication during the interview process. Physicians who enter groups with a full awareness of compensation, benefits, and the physician situation are less likely to have regrets, challenge administration, or leave the group. Administrators play an important role in the recruitment process as they are most able to present a realistic picture of the practice, and its strengths and weaknesses.

Thirty-five years ago bonding between physicians in a group practice was strong. Spouses played an important role. New members were enthusiastically welcomed. But group practice medicine is no longer one-for-all and all-for-one.