Projects and Experience	In our twenty years as a firm working with many types of health care organizations, we have been honored to be involved in a variety of assignments. The following is a partial list from which we are able to draw references.   Reorganized a number of hospital based physician groups, both from the perspective of the health system and the doctors. In one case, we replaced an entire department. In other cases, we acted on behalf of hospitals to qualify the existing groups through the development of RFP's and through the upgrading the physician contract process.   Replaced a radiology group in a Midwestern hospital. Reorganized multiple providers within an anaesthesia group into one P.C. in order to allow cohesive professional contracting, working on behalf of the doctors under the direction of the hospital. Changed the contract form at a large metropolitan hospital for the anaesthesia group to accommodate a new director, a new income determination methodology and new staffing patterns. Merged hospital based groups in a variety of merging institutions. Reorganized billing systems on behalf of hospital and physician clients to assure optimum performance.   Developed a number of health system projects which required the equity reorganization of primary care and specialty practices and very high level medical staff development tools.   Reorganized primary care practices in one large urban setting to incorporate owned and sponsored practices in a new hospital sponsored P.C. The eventual organization included over 60 primary care physicians. Purchased primary care practices on behalf of a parochial sponsored system in order to allow a more classic form of integration. Over half of the practices in the immediate region were purchased and eventually the hospital client was approached by one of its competitor hospitals with a request for merger (takeover). Developed a medical staff plan on behalf of a hospital system in order to salvage a satellite hospital in a competitive environment. This plan resulted in a variety of options for doctors including reorganization of their equity structures, mergers and consolidations, new medical office buildings, practice relocations and other recruitment/retention efforts. After the planning was accepted by the board, the La Penna Group was asked to assist in the implementation.   MSO development on behalf of a variety of clients including, but not limited to:   The development of an MSO on behalf of a parochial system to rescue the key internal medicine group associated with their premier urban based hospital. The MSO eventually was the basis for a system which eventually supported over 125 primary care and specialty practitioners. The development of a primary care oriented MSO on behalf of an Osteopathic hospital which supported (initially) 30 private and independent primary care practitioners initially and, eventually, the activities at four ambulatory care sites and all of the owned and sponsored practices throughout the system. The development of numerous specialty MSO's (in the form of physician owned co-ops) to support practices which were moving toward consolidation and which were utilizing the MSO structure as a first step. Many of these practices still use this form of collaboration and some have moved on to a more formal merger and have incorporated the MSO services within their management operational structure.   Surgery center implementation.   The La Penna Group has initiated twelve ASC CON's in a number of states and has never had a CON application it has produced denied by the reviewing agency. La Penna Group staff have certified four ASC's in a variety of states under Medicare and Blue Cross standards and guidelines. La Penna Group staff have organized three surgery centers "from the ground up" and have developed protocols and processes used by a number of other centers.   Practice and hospital mergers and consolidation:   The La Penna Group's largest merger was one in which two groups of over forty physicians merged with the involvement of a sponsoring health care system. The result covered almost 100% of the providers in the region and included over 100 physicians.   We have merged virtually all of the primary care in a local region with the resulting entity comprising five sites and twenty five practitioners. The group has since developed a very powerful joint venture relationship with the local hospital and has exclusive arrangements with managed care providers and is the controlling interest in the local IPA (which we also developed on their behalf).   Planning assignments have included:   Medical staff planning for a variety of hospitals, health systems and group practices. Specialty services planning for hospitals and group practices. Strategic planning for HMO providers with special emphasis on physician network development. Acquisition planning for companies which are publicly held (PPMC's). Strategic and operational planning for group practices and for sponsored practices. There are several large practices which have the La Penna Group manage their planning and implementation functions with annual retreats, the establishment of timelines, coordination of finances and follow-up on implementation.   IPA and PHO Development. Development of Employer Managed Health Programs  Physician practice management Managed care contracting and the development of integrated systems Acquisitions and equity reorganization Direct contracting and market survey activities