The cost of health care in the United States continues to grow despite numerous strategies to limit increases in expenditures. The total annual cost to society now approaches $500 billion. At times, it appears that the complexity of practicing medicine has increased even faster than either our knowledge of disease or our ability to treat. Patients and professionals are confronted with a bewildering array of financial arrangements, payer mechanisms, and business concerns.1-3 Increasingly, physicians are becoming directly involved in the management of the health care system.
Group practices have increased from 6371 in 1969 to more than 16 000 in 1986.4-6 Physicians who lead groups must assemble a team of experts to manage and evaluate not only the medical performance of their colleagues, but also their economic performance. Managing a group practice requires knowledge of marketing, finance, personnel management, billing and reimbursement, contracts with payer organizations, benefit and