Temporary firms in community hospitals: elements of a managerial theory of clinical efficiency.

implementation of Medicare’s prospective payment system (Rice 1992). Managed care organizations are also pressuring physicians to discharge sooner and find the &dquo;quick route to health&dquo; for their patients (Chilingerian 1992). In 1992, Medicare instituted the resource-based relative value system (RBRVS), which put direct financial pressure on physicians to avoid using expensive hospital care and procedures, and also to penalize physicians as a group for exceeding service-volume and intensity standards (Fahey 1992). For the first time, the attending physician is being asked to manage hospital resources rather than merely to use them.