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Mt. Auburn/Cambridge Group Practice Initiative
Young, David W.
Leddy, Sheila
Functional Area(s):
   General Management
   Organizational Behavior
   Healthcare Management
Difficulty Level: Intermediate
Pages: 10
Teaching Note: Not Available. 
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First Page and the Assignment Questions:
Our goal is to bring interested specialists and primary care physicians, as well as some key players from Mount Auburn Hospital together to discuss our future relationship. We’ve got to sit down and decide how to organize ourselves so that we can compete more effectively in this environment.

    Horst Filtzer, M.D., a vascular and general surgeon, and Chief of Surgery at Cambridge Hospital, was describing the goal he and his colleagues had for an upcoming retreat. The retreat had been organized to discuss the possibility of forming a group practice that would be opened to the approximately 40 specialists who practiced in Mount Auburn Hospital and Cambridge Hospital, both located in the City of Cambridge. He continued:

We’ve had many discussions about our situation and we’re convinced that some kind of initiative is necessary to better align the goals of the specialists, the PCPs [primary care physicians] and the hospitals, particularly The Mount [Mount Auburn] which is under increasing financial pressure and is undergoing changes in leadership. There are many issues we need to address if an initiative is to be successful, but our immediate concern is to build a consensus around some basic principles and goals. In addition, we need to reach some decisions as to how we should organize ourselves.

    Based on a series of discussions that had taken place over the past several months, Dr. Filtzer and several of his colleagues had developed a list of what they believed were seven common goals of the specialists: (1) self-governance and self-determination, (2) shared resources, (3) development of practice patterns, (4) improved bargaining positions through strength in numbers, (5) patient advocacy in the context of shrinking resources, (6) alignment of services with the needs of the community, and (7) strong hospital/physician relationships based on mutual respect.

    It was not completely clear that these goals were shared by all of the specialists, but they appeared to represent a consensus. More specifically, though, there were seven questions that the organizers of the retreat knew needed to be addressed in some detail if the retreat was to be successful:

1.    Given these goals, is a multispecialty practice the only option or are there other organizational forms that might be more appropriate?

2.    Who should be included in the group practice initiative?

3.     What kind of relationship should the specialists have with the primary care physicians?

4.    Should the group practice initiative be focused around Mount Auburn Hospital, where the majority of physicians practiced, and, if so, how should the Cambridge Hospital physicians be incorporated into the group?

5.    How will the group practice be governed?

6.    How will the financial flows work?

7.    What process needs to be put in place that will allow the group to move forward in a constructive and effective manner?


1.    Consider the seven common goals at the beginning of the case. Do you agree with these? Are there others that you would add? Are there some that are more importance than others? What criteria did you use to assess importance?
2.     Seven questions were raised early in the case. Think about how you would answer these questions. What other questions, if any, should be considered?
3.     What are the next steps that the specialists should take? Please be as concrete as you can in describing the steps, your rationale for them, and the sequence in which they should be taken.